高眼压青光眼滤过手术中恶性青光眼的处理体会

Reflection on malignant glaucoma treatment in high intraocular pressure glaucoma filtering operation

摘要:

目的：探讨高眼压青光眼滤过手术中恶性青光眼的手术处理，应用前房注气技术联合可调整缝线，可解除睫状环阻滞，减少恶性青光眼的发生。

方法：高眼压闭角型青光眼患者30例，初诊眼压大于60mmHg，经详细检查，符合复合式小梁切除手术适应证，药物降眼压，手术前眼压大于45mmHg。采用复合式小梁切除术，手术中完成巩膜瓣缝线后，出现无前房高眼压(睫状环阻滞)状态，采取加缝巩膜瓣可调整缝线并行前房注射消毒空气形成前房。

结果：术后随访6mo，30例均未出现恶性青光眼，前房深度稳定，25例眼压小于18mmHg，5例滤泡局限后眼压22～28mmHg。

结论：高眼压状态下行青光眼滤过手术，手术中出现高眼压无前房(睫状环阻滞)状态的机会很高，本文通过集中归纳30例此类手术情况，认为手术中加缝巩膜瓣可调整缝线并采用前房注射消毒空气形成前房的方法可以缓解术中睫状环阻滞，避免此类青光眼术后发生恶性青光眼情况。

Abstract:

AIM:To investigate the surgical treatment in filtering operation for malignant glaucoma with high intraocular pressure. Application of anterior chamber gas injection technology combined with adjustable suture can relieve ciliary blockand reduce the occurrence of malignant glaucoma.

METHODS:A total of 30 cases of closed-angle glaucoma patients with high intraocular pressure were selected as research objectives. Their intraocular pressure were >60mmHg at the first time. After detailed inspection those patients met the indications of compound trabeculectomy and were given drugs to reduce intraocular pressure with the preoperative intraocular pressure >45mmHg. The compound trabeculectomy were performed in those patients. After completion of the operation of scleral flap suture, it formed a state of intraocular hypertension with no anterior chamber(ciliary block). By suturing scleral flap with adjustable suture line and injecting sterile air into anterior chamber, anterior chamber was formed.

RESULTS: During the follow-up of 30 cases in six months, there were no malignant glaucoma; anterior chamber depth was stable; 25 cases of intraocular pressure were less than 18mmHg; 5 cases of IOP after follicular limitation were between 21-28mmHg.

CONCLUSION:If filtering surgery for closed-angle glaucoma is performed at a state of high intraocular pressure, the incidence of state of high intraocular pressure with no anterior chamber(ciliary block)state will be very high. By summarizing the 30 cases of this kind of surgery, this paper held that this method(suture of the scleral flap with adjustable suture combined with injection of sterile air in anterior chamber)can relieve ciliary block in the operation and avoid the occurrence of malignant glaucoma after this kind of operation.