[1]吴敏,胡竹林,陈燕华,等. 两步法治疗持续高眼压状态的急性原发性闭角型青光眼临[J].眼科新进展,2015,35(2):154-157.[doi:10.13389/j.cnki.rao.2015.0041]
　WU Min,HU Zhu-Lin,CHEN Yan-Hua,et al. Outcome analysis of two-step surgery for acute primary angle-closure glaucoma with persistent high intraocular pressure[J].Recent Advances in Ophthalmology,2015,35(2):154-157.[doi:10.13389/j.cnki.rao.2015.0041]
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 两步法治疗持续高眼压状态的急性原发性闭角型青光眼临
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《眼科新进展》[ISSN:1003-5141/CN:41-1105/R]

卷:
35卷
期数:
2015年2期
页码:
154-157
栏目:
应用研究
出版日期:
2015-02-05

文章信息/Info

Title:
 Outcome analysis of two-step surgery for acute primary angle-closure glaucoma with persistent high intraocular pressure
作者:
 吴敏; 胡竹林; 陈燕华; 郑志坤; 沈蔚
 650021　云南省昆明市，昆明医科大学第四附属医院眼科，云南省第二人民医院眼科
Author(s):
 WU Min;  HU Zhu-Lin ; CHEN Yan-Hua ;  ZHENG Zhi-Kun;  SHEN Wei
 Department of Ophthalmology, the Fourth Affiliated Hospital of Kunming Medical University,the Second People’s Hospital of Yunnan Province,Kunming 650021, Yunnan Province．China
关键词:
 ; 急性原发性闭角型青光眼; 持续高眼压状态; 两步法
Keywords:
 ; acute primary angle closure glaucoma;  persistent high intraocular pressure ;  two-step surgery
DOI:
10.13389/j.cnki.rao.2015.0041
文献标志码:
A
摘要:
 目的　探讨两步法治疗持续高眼压状态的急性原发性闭角型青光眼患者的临床疗效及其安全性。方法　回顾性分析２０１０年１月至２０１２年１２月在我院眼科就诊的持续高眼压状态的急性原发性闭角型青光眼患者５４例（５４眼），患者年龄为５５～７１（６２．１±３．６）岁，所有患者术前进行视力、最佳矫正视力、裂隙灯、眼压、ＡＳ-ＯＣＴ和Ａ／Ｂ超检查。在局麻下对所有患者实施两步手术法。第一步：前房注气＋睫状体扁平部放液术（部分病例联合虹膜根切）；术后予口服泼尼松片、局部用妥布霉素地塞米松滴眼液和眼膏，常规联合降眼压滴眼液进一步控制眼压。３ｄ后进行第二步手术；第二步：超声乳化白内障吸出术联合人工晶状体植入术＋房角分离＋小梁切除＋前段玻璃体切割术。术后随访观察视力、最佳矫正视力、眼压，并行ＡＳ-ＯＣＴ、裂隙灯、眼底、Ａ／Ｂ超检查和记录并发症发生情况。结果　患者眼压在第一步术后１ｄ、２ｄ和３ｄ分别为（１５．３±２．２）ｍｍＨｇ（１ｋＰａ＝７．５ｍｍＨｇ）、（１６.０±２．７）ｍｍＨｇ和（１７．６±２．１）ｍｍＨｇ，与术前眼压相比显著降低（ｔ＝１８.９０２、１６．２３７、１５．８１２，均为Ｐ＜０．００１）；第二步手术后１周、１个月、３个月和末次随访时眼压分别为（１５．３±２．２）ｍｍＨｇ、（１５.５±１．９）ｍｍＨｇ、（１５．６±２．１）ｍｍＨｇ和（１５．５±２.１）ｍｍＨｇ，与术前眼压分别比较，差异均有统计学意义（ｔ＝４５．４５７、４５．０７０、４０．８２７、３９．２５０，均为Ｐ＜０．００１）；第二步手术后１周眼压与术后１个月、３个月和末次随访的眼压两两比较，差异均无统计学意义（ｔ＝０．７２８、－０．８１０、－０．３８９，Ｐ＝０．４７０、０．４２１、０．６９９）。末次随访时１００％形成功能性滤过泡，手术完全成功率为９２．６％，部分成功率为７．４％，最佳矫正视力较术前显著提高（Ｐ＜０．０５），大部分患者恢复了有用的视力。除第二步手术后３眼发生浅前房、９眼前房及瞳孔区纤维蛋白膜渗出、１眼脉络膜脱离外，未观察到恶性青光眼、脉络膜上腔出血、眼球萎缩等严重并发症发生。结论　对持续高眼压的急性原发性闭角型青光眼患者实施分两步手术法是一种安全有效的手术方法，减少了术中、术后严重并发症，并且获得良好的眼压控制，改善大部分患者的视力。
Abstract:
 Objective To explore the effectiveness and safety of two-step surgery for acute primary angle-closure glaucoma ( APACG) with persistent high intraocular pressure. Methods Fifty-four cases of APACG with persistent high intraocular pressure in ophthalmology department of our hospital during January 2010 to December 2012 were retrospectively analyzed. The age of patients was ( 62. I + 3. 6) years old, ranged from 55 years t0 71 years. A1l the patients underwent the exanunations of visual acuity, best corrected visual acuity ( BCVA) , slit lamp , intraocular pressure ( IOP ) . AS-OCT and ultrasound AB scan. The two-step surgery was performed under local anaesthesia. The first step ( S1) :Intracameral air injection + pars plana vitreous cavity tapping ( combined with iridectomy in some cases ) . Prednisone tabletes , anti-glaucoma eyedrops , tobramycin dexemethasone eyedrops and ointment were applied after Sl. Three days later , the second step surgery , Phaco + IOL + goniosynechialysis + trabeculectomy + anterior segment vitrectomy , was performed. The postoperative follow up included visual acuity , BCVA , IOP. AS-OCT , slit lamp , opthalmoscopy and the complications. Results The average IOP at I day ,2 days and 3 days after Sl were ( 15. 3 +2. 2) mmHg ( I kPa = 7. 5 mmHg) , ( 16. 0 +2. 7) mmHg and ( 17. 6 + 2. I ) mmHg , which was significantly lower than that before surgery ( t = 18. 902 , 16. 237 , 15. 812 . all P < 0. 001 ) . The average IOP after S2 was ( 15. 3 +2. 2) mmHg at I week, ( 15. 5 + 1. 9) mmHg at I month. ( 15. 6 + 2. 1) mmHg at 3 months and ( 15. 5 + 2. I ) mmHg at last visit.which was significantly lower than those before surgery ( t = 45. 457 ,45. 070 , 40. 827 , 39. 250 . all P < 0. 001 ) . After S2 . comparison between IOP at I week.l month .3 months and last visit was performed, no statistically significant difference was found ( t = 0. 728. - 0. 810 , - 0. 389 ; P = 0. 470 . 0. 421 .0. 699 ) . At the last visit, the functional filtering bleb formed in all cases. The fully success rate was 92. 6% , the partially success rate was 7. 4% . BCVA was significantly improved (P < 0. 05 ) , and most of cases regain useful visual acuity. There were shallow anterior chamber in 3 eyes , fibrous exudates in anterior chamber and pupillary area in 9 eyes and choriodal detachment in I eye , which were treated medically. Malignant glaucoma, retinal hemorrhage, suprachoriodal hemorrhage and other severe complications did not occur. Conclusion Two-step surgery is an effective and safe procedure for APACG with persistent high intraocular pressure. It can reduce the incidence of severe intraoperative , postoperative complications such as suprachoriodal hemorrhage , achieve good control of IOP and improve visual acuity in most of cases.

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备注/Memo

备注/Memo:
 云南省应用基础研究项目（昆医联合专项）（编号：２０１３ＦＢ１０９）；云南省教育厅科学研究基金项目（编号：２０１１Ｃ０７９）；云南省卫生科技计划项目（编号：２０１２ＷＳ０１０９）；云南省高层次卫生技术人才培养专项经费资助
更新日期/Last Update: 2015-02-03