内路巩膜瓣复通术治疗青光眼联合白内障术后失败患者的疗效

摘要

目的：探讨内路巩膜瓣复通术治疗青光眼联合白内障术后早期失败患者的效果。　　方法：选取青光眼联合白内障术后早期(3 mo内)失败的患者共27例27眼,采用超声乳化辅助钩进入前房至原巩膜瓣下,从内部顶开已粘连的原巩膜瓣使之复通治疗。术后随访12mo,观察患者的眼压及最佳矫正视力。　　结果：术后12mo,14眼(52%)形成功能性滤过泡；17眼(63%)不用任何药物眼压<21mmHg,7眼(26%)加用1~2种降眼压药物眼压<21mmHg,3眼(11%)失败,成功率为89%。术前平均眼压30.2±6.8mmHg。术后1wk,1、3、6、12mo平均眼压分别为7.1±4.3、10.5±5.1、15.1±4.8、16.8±5.2、17.3±5.1mmHg,手术前后眼压比较有统计学意义(P<0.01)。术前最佳矫正视力平均0.46±0.44,术后1wk,1、3、6、12mo 平均最佳矫正视力分别为0.32±0.52、0.52±0.42、0.55±0.39、0.53±0.47、0.54±0.42。除术后1 wk较术前下降,其余皆较术前好转,差异有统计学意义(P<0.05)。术后前房出血5眼(19%),均在3~5d内自行吸收；脉络膜脱离7眼(26%),除1眼需要脉络膜上腔放液和前房成形外余皆保守治疗痊愈；术后持续低眼压并发黄斑水肿1眼(4%),持续4mo经积极治疗而愈。结论：内路巩膜瓣复通术治疗青光眼联合白内障术后早期失败患者是一种安全有效的方法。%AIM: To explorethe therapeutic efficacy of treating cataract phacoemulsification remove combined with trabeculectomy early postoperative failure with open sclera flap recanalization by phacoemulsification auxiliary hook interred the anterior chamber. METHODS:Twenty-seven cases ( 27 eyes ) of glaucoma combined cataract surgery(3mo) in the early failure were treated with that the phacoemulsification auxiliary hook into anterior chamber under the original sclera flap, open from the inside have adhesion of the sclera flap. Postoperative follow-up 12mo, the intraocular pressure and best corrected visual acuity were observed. RESULTS: The postoperative follow- up was 12mo. There were functional filtering bleb in 14(52%) eyes; and the IOP was below 21mmHg in 17 eyes(63%) without any anti- glaucoma drug, and in 7 eyes ( 26%) with 1 - 2 categories of lower intraocular pressure( IOP) drugs, and 3 eyes(11%), failure and the success rate was 89% after 12mo. Average intraocular pressure after 1wk, 1mo, 3mo, 6mo and 12mo were(7. 1±4. 3) mmHg,(10. 5±5. 1) mmHg,(15. 1±4. 8 ) mmHg, ( 16. 8±5. 2 ) mmHg, ( 17. 3±5.1 ) mmHg, significantly lower than the IOP preoperatively(30. 2±6. 8) mmHg (P<0. 01). Average visual acuity ( all of the following were best corrected vision) after 1wk, 1mo, 3mo, 6mo and 12mo was(0. 32±0. 52),(0. 52±0. 42),(0. 55±0. 39),(0. 53±0. 47),(0. 54±0. 42 ). Postoperative 1wk visual acuity deeper than preoperative( 0. 46 ± 0. 44 ) ( P < 0. 05 ), more than all improved compared with preoperative ( P < 0. 05 ). Postoperative anterior chamber bleeding in 5(19%) eyes, all absorbed itself in 3 to 5 days; ciliochoroidal detachment in 7 ( 26%) eyes, except one case need operate, others were conservative treatment to heal. Postoperative continuous low intraocular pressure concurrent macular edema was 1 eyes(4%), 4mo healed after treatment. CONCLUSION: It is a safe and effective method thattreating phacoemulsification cataract remove combined with trabeculectomy early postoperative failure with open sclera flap recanalization by phacoemulsification auxiliary hook interred the anterior chamber.