前部玻璃体切割联合房角分离术对白内障术后恶性青光眼的疗效观察

摘要

目的 观察前部玻璃体切割联合房角分离术对白内障术后恶性青光眼的治疗效果.方法 对2011年7月至2015年6月间因白内障摘除联合人工晶体植入术后继发恶性青光眼行药物和YAG激光治疗无效的20例(20只眼)患者,在安阳市眼科医院接受前部玻璃体切割联合房角分离手术治疗,随访3个月~1 a,观察记录20例患者手术后的最佳矫正视力、眼压、前房深度及视网膜、脉络膜状态等情况,并对数据进行统计学分析.结果 术后3个月,20例(20只眼)患者最佳矫正视力、眼压、前房深度分别为(0.58±0.25)、(15.26±2.97)mmHg、(3.28±0.42)mm,与术前比较差异均有统计学意义(P<0.05).术后第1天6只眼出现睫状体脱离,3只眼出现睫状体脱离合并脉络膜渗出性脱离.给予地塞米松针5 mg球旁注射,20%甘露醇注射液250 mL静滴,术后2周内9例患者睫状体及脉络膜脱离消失.结论 前部玻璃体切割+后囊切开+房角分离术可有效解除白内障术后恶性青光眼患者的睫状环阻滞、房水流出道阻塞,促进患者前房形成和房水流出,明显改善患者症状和提高视功能.%Objective To observe the effect of anterior vitrectomy combined with atrial angle separation on postoperative malignant glaucoma after cataract surgery.Methods Retrospective case analysis, 20 cases (20 eyes) of patients who had the treatment which were failed with YAG laser and medication received anterior vitrectomy combined with atrial angle separation to treat the secondary malignant glaucoma after cataract extraction and intraocular lens implantation from July of 2010 to June of 2014, follow up for 3 months to 1 year.The best corrected visual acuity, intraocular pressure, anterior chamber depth and the state of retina and choroid were observed and recorded in 20 cases, and the data were statistically analyzed.Results The best corrected visual acuity, intraocular pressure and anterior chamber depth of 20 patients (20 eyes) were 0.58±0.25、(15.26±2.97)mmHg、(3.28±0.42)mm and the difference was statistically significant (t=8.83, 18.93, 14.38 all of P=0.00) at the 3d months after operation.6 eyes had ciliary body detachment, 3 eyes had both ciliary body and choroid detachment at 1st day after operation, we treated the 9 eyes with dexamethasone and 20% mannitol , the ciliary body and choroid detachment of the 9 cases disappeared in 2 weeks after operation.Conclusion Anterior vitrectomy combined with posterior capsule incision and chamber angle separation could remove the ciliary block and Outflow tract obstruction of humor aquosus of the patients with malignant glaucoma after cataract surgery, and could significantly decrease the symptoms and improve the visual function.