白内障超声乳化术后恶性青光眼临床分析

发布时间：2018-10-30 10:26

【摘要】：目的探讨白内障超声乳化术后恶性青光眼的治疗方法及效果。方法回顾性研究2007年1月~2013年1月我科收治的恶性青光眼患者15例16眼,均于5 d~3个月(平均10 d)前行患眼的白内障超声乳化联合人工晶状体植入术,手术顺利完成,人工晶状体植入囊袋内。11例12眼经Nd:YAG激光治疗,6例6眼经透明角膜周边虹膜切开联合周边囊膜悬韧带切除联合前部玻璃体切除术治疗(其中包括Nd:YAG激光治疗后复发的2眼)。术后平均随访13个月,观察术后视力、前房深度、眼压等,评估治疗效果。结果 11例12眼经Nd:YAG激光治疗,其中治疗有效10眼(83.3%)。治疗后7 d患眼视力为0.34±0.08,较治疗前的0.08±0.03显著提高(P=0.00)。激光治疗后7 d患眼前房深度和眼压分别为(2.30±0.21)mm和(15.50±1.96)mmHg(1 kPa=7.5 mmHg),与治疗前的(0.83±0.18)mm和(35.10±5.78)mmHg相比,差异均有统计学意义(均为P=0.00)。手术治疗后7 d患眼前房深度和眼压分别为(2.15±0.22)mm和(14.50±2.17)mmHg,与治疗前的(0.47±0.08)mm和(39.83±4.40)mmHg相比,差异均有统计学意义(均为P=0.00)。末次随访时,激光治疗和手术治疗的患眼前房深度与眼压与治疗后7 d相比,差异均无统计学意义(均为P0.05)。所有患眼均无严重并发症发生。结论 Nd:YAG激光治疗白内障超声乳化术后人工晶状体眼的恶性青光眼,创伤小,操作简便,有效率高。经透明角膜周边虹膜切开联合周边囊膜悬韧带切除联合前部玻璃体切除术可有效解除房水逆流,手术效果肯定,可作为白内障超声乳化术后复杂恶性青光眼包括无Nd:YAG激光治疗条件或治疗失败患者的有效的治疗方法。
[Abstract]:Objective to investigate the treatment and effect of malignant glaucoma after phacoemulsification. Methods from January 2007 to January 2013, 15 patients (16 eyes) with malignant glaucoma underwent phacoemulsification combined with intraocular lens implantation (IOL) from 5 days to 3 months (mean 10 days). The intraocular lens was implanted into the capsule bag. 11 cases (12 eyes) were treated with Nd:YAG laser. 6 cases (6 eyes) were treated by transparent peripheral iris incision with peripheral capsular suspension ligament resection and anterior vitrectomy (including 2 eyes with recurrence after Nd:YAG laser therapy). The postoperative visual acuity, anterior chamber depth, intraocular pressure were observed and the therapeutic effect was evaluated. Results 11 cases (12 eyes) were treated by Nd:YAG laser, of which 10 eyes (83.3%) were effective. The visual acuity of the affected eyes was 0.34 卤0.08 on the 7th day after treatment, which was significantly higher than that of 0.08 卤0.03 before treatment (P0. 00). The anterior chamber depth and intraocular pressure were (2.30 卤0.21) mm and (15.50 卤1.96) mmHg () 1 kPa=7.5 mmHg), on the 7th day after laser treatment, compared with (0.83 卤0.18) mm and (35.10 卤5.78) mmHg before laser treatment. The difference was statistically significant (P < 0.001). The anterior chamber depth and intraocular pressure were (2.15 卤0.22) mm and (14.50 卤2.17) mmHg, on the 7th day after operation, compared with (0.47 卤0.08) mm and (39.83 卤4.40) mmHg before operation. The difference was statistically significant (P < 0.001). At the last follow-up, there was no significant difference in the depth of anterior chamber and IOP between laser and surgical treatment and 7 days after treatment (P0.05). No serious complications occurred in all eyes. Conclusion Nd:YAG laser therapy for malignant glaucoma of intraocular lens after phacoemulsification has the advantages of less trauma, simple operation and high effective rate. Transparent peripheral iris incision with peripheral capsular suspension ligament resection combined with anterior vitrectomy can effectively relieve aqueous humor reflux, and the effect of the operation is positive. It can be used as an effective treatment for complicated malignant glaucoma after phacoemulsification, including no Nd:YAG laser treatment or failure.
【作者单位】：河北省眼科医院白内障科;河北省眼科研究所河北省眼科学重点实验室;
【基金】：邢台市科技研究与发展计划项目(编号:2013ZC064)~~
【分类号】：R779.6

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