青光眼滤过术后浅前房的临床分析

Clinical analysis of shallow anterior chamber after glaucoma filtering surgery

摘要:

目的:讨论青光眼术后浅前房形成的常见原因及处理方法。方法:回顾性总结甘肃省庆阳市人民医院1990-01/2009-06期间连续收治住院的358例501眼青光眼住院患者行青光眼滤过性手术后发生前房的原因、类型及处理方法。结果:共行青光眼滤过性手术501眼,其中118眼发生浅前房,发生率为23.6%。小梁切除术21.2%,小梁切除+MMC35.2%、青光眼联合白内障的三联手术10.9%。浅前房发生时间在术后1～7d,其中房水滤过过强47眼(39.8%),睫状体脉络膜脱离33眼(28.0%),结膜瓣渗漏27眼(22.9%),恶性青光眼8眼(6.8%),恶性青光眼合并睫状体脉络膜脱离1眼(0.8%),脉络膜上腔出血2眼(1.7%),除恶性青光眼外其余均伴有术后低眼压。需要手术治疗才能恢复前房37眼,其余81眼仅通过保守治疗均恢复前房。结论:青光眼术后浅前房发生率高,其常见的原因是房水滤过过强、睫状体脉络膜脱离及结膜瓣渗漏。通常发生在术后1～2d。以小梁切除+MMC术后浅前房发生率高,MMC不但阻止滤过泡的纤维化,而且能使房水分泌减少。大多数浅前房可通过保守治疗治愈,必要时须采取手术干预。

Abstract:

AIM:To study the causes and managements of shallow anterior chamber after glaucoma filtering surgery.METHODS;A total of 358 consecutive patients(501 eyes)with glaucoma in the department of Ophthalmology,Qingyang People’s Hosptial from Jan.1990 to Jul.2009 were retrospectively reviewed on the survey,cause and management of postoperative shallow anterior chamber were discussed.RESULTS:The incidence of postoperative shallow anterior chamber in all the subjects and in the patients who underwent filtering operation of trabeculectomy,trabeculectomy with mitomycin C,antiglaucoma combined with cataract surgery was respectively 23.6%(118/501 eyes),21.2%(68/321 eyes),35.2%(44/125 eyes)and 10.9%(6/55 eyes).Shallow anterior chamber occurred in 1-7 days after operation and causes were excessive aqueous over-filtration(39.8%,47 eyes),choroidal detachment(28.0%,33 eyes),filter bleb leaks(22.9%,27 eyes),malignant glaucoma(6.8%,8 eyes),choroidal detachment and malignant glaucoma(0.8%,1 eye),and choroidal hemorrhage(1.7%,2 eyes).81 eyes needed surgical procedure for the reformation of shallow anterior chamber.Anterior chamber reformed in other 37 eyes without any surgical procedure.CONCLUSION:The incidence(23.6%)of shallow anterior chamber is high after filtering surgery,especially in trabeculectomy with mitomycin C(35.2%),it often appears at 1-2 days postoperatively.Most of the shallow anterior chamber can be reformed through conservative management.