张影影，张立贵，綦跃勤



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前路前段玻璃体切除术治疗青光眼白内障联合术后的恶性青光眼

张影影，张立贵，綦跃勤

•METHODS: Retrospective analysis. A total of 16 eyes of 14 patients with malignant glaucoma who had a history of cataract phacoemulsification removement +IOL combined with trabeculectomy (Phaco+IOL+Trab) were selected from Jun.2010 to Jun.2015 in our hospital. Due to ineffective conservative treatment, they were performed anterior segment vitrectomy. Through a clear corneal incision, iris retractor exposed 6 o’clock position of artificial crystal complex edge. Anterior and posterior capsular part resection combined with the corresponding parts of the anterior vitreous resection were performed.

•RESULTS: All patients were followed up for 12mo, all cases were successful in anterior chamber reconstruction. The mean best corrected visual acuity (BCVA, logMAR) was from 0.2±0.17 in the pre-operative to 0.5±0.29 in the last follow-up (P<0.05). The mean intraocular pressure (IOP) was 42.6±4.23mmHg in the pre-operative to 15.89±4.72mmHg in the last follow-up (P<0.05). Among them, 2 eyes needed a kind of anti-glaucoma drugs, 2 eyes with two kinds of anti-glaucoma drugs, the total success rate was 75%, partial success rate was 25%, the success rate was 100%. The mean anterior chamber depth was 0.62±0.23mm in the pre-operative to 3.49±0.57mm in the last follow-up (P<0.05). After the treatment, ciliary and choroidal detachment occurred in 2 cases were treated with conservative treatment, there were no serious complications such as corneal endothelial dysfunction, intraocular lens deviation, choroidal hemorrhage and retinal detachment in all patients during follow-up.

•CONCLUSION: Anterior segment vitrectomy is effective, simple, safe, easy to grasp and has less complications in treated the malignant glaucoma after surgery glaucoma combined with cataract compared with the posterior segment vitrectomy.

目的：探讨前路前段玻璃体切除术治疗青白联合术后恶性青光眼的疗效。

方法：回顾性分析2010-06/2015-06 间我院行超声乳化白内障摘除+人工晶状体植入联合小梁切除术后发生恶性青光眼的患者14例16眼，经保守治疗无效，采用前路前段玻璃体切除治疗：经透明角膜切口，虹膜拉钩暴露6∶00位人工晶状体复合体边缘，行前后囊膜部分切除联合相应部位前段玻璃体切除术治疗。

结果：所有患者经过12mo的随访观察，治疗后前房均重建成功，平均最佳矫正视力(best corrected visual acuity，BCVA，LogMAR)由术前的0.2±0.17，提高到末次随访的0.5±0.29,差异具有统计学意义(P<0.05),平均眼压由术前的42.6±4.23mmHg至末次随访的15.89±4.72mmHg,差异具有统计学意义(P<0.05), 其中2眼需用一种抗青光眼药物，2眼需用两种抗青光眼药物，其完全成功率为75%，部分成功率25%，成功率100%,平均前房深度由术前的0.62±0.23mm至末次随访的3.49±0.57mm, 2眼治疗后出现睫状体脉络膜脱离，经保守治疗恢复。所有患者在随访期间均未出现角膜内皮功能失代偿、人工晶状体偏位、脉络膜上腔出血、视网膜脱离等严重并发症。

结论：前路前段玻璃体切除可以有效治疗青白联合术后恶性青光眼，较后路法更简单安全、易掌握、并发症少。

青光眼；白内障；前部玻璃体切除术；恶性青光眼

引用：张影影，张立贵，綦跃勤.前路前段玻璃体切除术治疗青光眼白内障联合术后的恶性青光眼.国际眼科杂志2016;16(12):2317-2319

0引言

恶性青光眼又称为睫状环阻滞性青光眼，属继发性闭角型青光眼。如不及时处理或者处理不当，可导致严重后果。部分患者保守治疗如局部滴睫状肌麻痹剂、全身应用高渗剂及碳酸酐酶抑制、局部及全身使用皮质类固醇可缓解，但药物起效时间相对较长,易引起角膜及视神经等组织不可逆性损伤,为避免复发，需要长期滴用阿托品，可引起患者畏光、裸眼视力下降等不适，部分患者仍需手术治疗,包括睫状体扁平部抽吸玻璃体积液并前房成形、晶状体摘除、YAG 激光晶状体后囊膜及玻璃体前界膜切开、前部玻璃体切除等[1]。……