急性闭角型青光眼高眼压下小梁切除术的超声生物显微镜观察

Trabeculectomy for acute angle-closure glaucoma with persistent high intraocular pressure by ultra-sound biomicroscopy

关键词:  急性闭角型青光眼  高眼压  小梁切除术  超声生物显微镜

Key words:  acute angle-closure glaucoma  high intraocular pressure  trabeculectomy  UBM

摘要:

［目的］ 探讨急性闭角型青光眼高眼压下小梁切除术是否存在睫状体脱离的危险，以明确小梁切除术的安全性及效果。［方法］将56例（60只眼）急性闭角型青光眼病例，按手术前眼压水平分为治疗组（30例30只眼，眼压≥40 mmHg）和对照组（26例30只眼，眼压＜40 mmHg）。对两组病例术前术后眼压、视力以及超声生物显微镜(ultra-sound biomicroscopy，UBM)情况等进行统计比较。［结果］两组病例均未见有暴发性脉络膜出血及恶性青光眼等并发症发生。术后眼压均控制在7～16 mmHg。治疗组术后大多数保留了较好的视力。UBM检测结果，治疗组术后仅发生1例睫状体脱离，对照组术前术后2例睫状体脱离，两组比较差异无显著性意义(P>0.05)。［结论］急性闭角型青光眼高眼压下小梁切除术是安全、有效的，在充分应用降眼压药物后，应及时采取手术治疗。UBM有利于发现小梁切除术前后睫状体脱离及靠前的脉络膜脱离，对于青光眼的治疗具有一定的指导作用。

Abstract:

［Objective］To analyze the dangerous of complications and to evaluate the efficacy and safety of the surgery of AACG with IOP after trabeculectomy.［Methods］Fifty-six cases (60 eyes) of primary acute angle-closure glaucoma, which received trabeculectomy，were divided into 2 groups by the preoperational IOP value, the high IOP group：30 cases (30 eyes), IOP≥40 mmHg(1 mmHg=0.133 kPa), the control group: 26 cases (30 eyes ), IOP＜40 mmHg. And routine examinations such as IOP, BSCVA and UBM were observed and analyzed by SPSS 11.5 statistically.［Results］No severe complications such as choroidal hemorrhage and malignant glaucoma were observed in all cases. The IOP of both groups were controlled between 7 to 16 mmHg after surgery. Most patients of high IOP gained a better vision. Cyclodialysis was observed in 1 case of high IOP group and 2 cases of the control group without significant difference (P>0.05).［Conclusion］Trabeculectomy for AACG with persistent high IOP is safe and effective. Trabeculectomy should be performed promptly after using adequate remedies. UBM is good to find cyclodialysis and anterior choriodal shallow detachment which conventional scan ultrasound can′t collect. UBM is very important for instructing the therapy of glaucoma preoperatively and postoperatively.