青光眼滤过术后白内障超声乳化术中突发高眼压的临床观察

摘要

Objective To summarize the clinical experience of suddenly increased intraocular pressure during cataract phacoemulsification in angle-closure glaucoma patients received filtering surgery previously.Methods Seventy-two patients (113 eyes) underwent cataract phacoemulsification and intraocular lens implantation after glaucoma filtering surgery.Suddenly increased intraocular pressure and shallow anterior chamber were observed during operations in 9 eyes.All patients had no significant pain,irritability or other uncomfortable symptoms.Two cases happened during the removement of cortex and the patient received pars plana anterior vitreous aspiration after the failure of treatment with 20％ mannitol and other conservative methods.The other seven cases happened during water separation and the viscoelastics agent in anterior chamber and the fluid in the capsule was discharged by lightly oppressing and rotating the lens.Results All 9 patients had successful operations after efficient treatment of suddenly increased intraocular pressure.The postoperative visual acuity improved in different degrees and the intraocular pressure was controlled within the normal range.Conclusions Suddenly increased intraocular pressure is an occasionally tough issue during cataract phacoemulsification in patients with glaucoma filtering surgery history.If it is treated timely and properly,the physical signs originated from high intraocular pressure can be relieved,and cataract phacoemulsification can be finished successfully mostly.%目的 总结闭角型青光眼小梁切除术后行白内障超声乳化术中突发高眼压的临床处理经验.方法 选取2012年6月～ 2017年4月在我院行白内障超声乳化联合人工晶状体植入术的闭角型青光眼滤过术后患者72例(113眼),其中9眼术中突发高眼压、浅前房,患者无明显疼痛、烦躁症状.2例为吸除皮质时出现,经20％甘露醇等保守治疗无效后予以经睫状体平坦部穿刺抽吸玻璃体液.7例为水分离时出现,予以排出前房黏弹剂、轻压或旋转晶状体挤出囊袋内液体等处理.结果 9例术中发生高眼压患者均在相应处理后顺利完成超声乳化并人工晶状体植入术,所有患者视力较术前有不同程度提高,术后眼压控制在正常范围内.结论 突发高眼压是青光眼滤过术后白内障超声乳化术中较少见的棘手问题,在术中针对病因进行及时处理,绝大部分患者可解除高眼压状态,顺利完成手术.