白内障超声乳化术后恶性青光眼临床分析
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摘要
目的:探讨白内障超声乳化术后恶性青光眼的临床特点及阶梯治疗法。方法:回顾性分析2010-06/2018-05我院收治的常规囊袋内植入人工晶状体的白内障超声乳化术后发生恶性青光眼患者16例18眼的临床资料。采用阶梯式的治疗方案,首先采用睫状肌麻痹剂和降眼压药联合治疗,再采用YAG激光晶状体后囊切开联合玻璃体前界膜切开,然后前房成形术,最后采用晶状体后囊切开联合前部玻璃体切除术。对治疗前后屈光度、前房深度、房角及眼压进行分析。结果:恶性青光眼倾向于白内障超声乳化术后4.1±2.3wk发生,1眼单纯接受药物治疗,7眼接受YAG激光晶状体后囊切开,6眼接受前房成形术,4眼接受晶状体后囊切开联合前部玻璃体切除术。阶梯治疗后屈光度+0.48±0.89D,前房深度3.14±0.33mm,眼压15.3±4.7mmHg,14眼房角开放。结论:白内障超声乳化术后恶性青光眼控制表现为近视减轻、中央前房加深、房角开放、眼压下降。
?AIM: To investigate the clinical features and stepwise treatment method of malignant glaucoma after phacoemulsification.?METHODS: A retrospective analysis was made on clinical data of 16 cases(18 eyes) with malignant glaucoma after phacoemulsification with in-the-bag IOL placemen from June, 2010 to May, 2018 in Gansu Provincial Hospital. Malignant glaucoma was treated by a stepwise treatment method. First, the combination of ciliary muscle paralysis and hypotensive drugs were used to treat malignant glaucoma, followed by laser iridozonulohyaloidotomy, then anterior chamber reformation, and finally with surgical iridozonulohyaloidovitrectomy. Data of diopter, anterior chamber depth, anterior chamber angle and intraocular pressure were analyzed before and after treatment.?RESULTS: Malignant glaucoma tends to occur after phacoemulsification and in-the-bag IOL placement 4.1±2.3 wk. One eye received drug therapy alone,7 eyes received YAG laser crystal posterior capsule incision, 6 eyes received anterior chamber angioplasty, and 4 eyes received crystal posterior capsule incision+front vitrectomy. After treatment, the diopter was +0.48±0.89 D, the anterior chamber depth was 3.14±0.33 mm, the intraocular pressure was 15.3±4.7 mmHg, 14 eyes with wide anterior chamber angle.?CONCLUSION: The stepwise treatment of malignant glaucoma after phacoemulsification showed a reduction in myopia, deepening of the central anterior chamber, opening of the anterior chamber, and decreased intraocular pressure.
?AIM: To investigate the clinical features and stepwise treatment method of malignant glaucoma after phacoemulsification.?METHODS: A retrospective analysis was made on clinical data of 16 cases(18 eyes) with malignant glaucoma after phacoemulsification with in-the-bag IOL placemen from June, 2010 to May, 2018 in Gansu Provincial Hospital. Malignant glaucoma was treated by a stepwise treatment method. First, the combination of ciliary muscle paralysis and hypotensive drugs were used to treat malignant glaucoma, followed by laser iridozonulohyaloidotomy, then anterior chamber reformation, and finally with surgical iridozonulohyaloidovitrectomy. Data of diopter, anterior chamber depth, anterior chamber angle and intraocular pressure were analyzed before and after treatment.?RESULTS: Malignant glaucoma tends to occur after phacoemulsification and in-the-bag IOL placement 4.1±2.3 wk. One eye received drug therapy alone,7 eyes received YAG laser crystal posterior capsule incision, 6 eyes received anterior chamber angioplasty, and 4 eyes received crystal posterior capsule incision+front vitrectomy. After treatment, the diopter was +0.48±0.89 D, the anterior chamber depth was 3.14±0.33 mm, the intraocular pressure was 15.3±4.7 mmHg, 14 eyes with wide anterior chamber angle.?CONCLUSION: The stepwise treatment of malignant glaucoma after phacoemulsification showed a reduction in myopia, deepening of the central anterior chamber, opening of the anterior chamber, and decreased intraocular pressure.
引文
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3 Snyder ME.August consultation #3.J Cataract Refract Surg 2014;40(8):1391-1396
4黄志坚,张文强,周和政,等.优化恶性青光眼治疗方法.国际眼科杂志2015;15(1):141-143
5 Shaffer RN.A new classification of the glaucomas.Trans Am Ophthalmol Soc 1960;58:219-225
6 Quigley HA,Friedman DS,Congdon NG.Possible mechanisms of primary angle-closure and malignant glaucoma.J Glaucoma 2003;12:167-180
7 Day AC,MacLaren RE,Bunce C,et al.Outcomes of phacoemulsification and intraocular lens implantation in microphthalmos and nanophthalmos.J Cataract Refract Surg 2012;39(1):87-96
8 Dave P,Senthil S,Rao HL,et al.Treatment outcomes in malignant glaucoma.Ophthalmology 2013;120:984-990
9 Trope GE,Pavlin CJ,Bau A,et al.Malignant glaucoma;clinical and ultrasound biomicroscopic features.Ophthalmology 1994;101:1030-1035
10 Ching-Costa A,Chen TC.Malignant glaucoma.Int Ophthalmol Clin 2000;40(1):117-125
11 Lynch MG,Brown RH,Michels RG,et al.Surgical Vitrectomy for Pseudophakic Malignant Glaucoma.Am J Ophthalmol 1986;102(6):803-804
12 Quigley HA,Broman AT.The number of people with glaucoma worldwide in 2010 and 2020.Br J Ophthalmol 2006;90(3):262-267
13 Foster P,Alsbirk PH,Baasanhu J,et al.Anterior chamber depth in Mongolians:variation with age,sex,and method of measurement.Am J Ophthalmol 1997;124(1):53-60
2 Ruben S,Tsai J,Hitchings R.Malignant glaucoma and its management.Br J Ophthalmol 1997;81:163-167
3 Snyder ME.August consultation #3.J Cataract Refract Surg 2014;40(8):1391-1396
4黄志坚,张文强,周和政,等.优化恶性青光眼治疗方法.国际眼科杂志2015;15(1):141-143
5 Shaffer RN.A new classification of the glaucomas.Trans Am Ophthalmol Soc 1960;58:219-225
6 Quigley HA,Friedman DS,Congdon NG.Possible mechanisms of primary angle-closure and malignant glaucoma.J Glaucoma 2003;12:167-180
7 Day AC,MacLaren RE,Bunce C,et al.Outcomes of phacoemulsification and intraocular lens implantation in microphthalmos and nanophthalmos.J Cataract Refract Surg 2012;39(1):87-96
8 Dave P,Senthil S,Rao HL,et al.Treatment outcomes in malignant glaucoma.Ophthalmology 2013;120:984-990
9 Trope GE,Pavlin CJ,Bau A,et al.Malignant glaucoma;clinical and ultrasound biomicroscopic features.Ophthalmology 1994;101:1030-1035
10 Ching-Costa A,Chen TC.Malignant glaucoma.Int Ophthalmol Clin 2000;40(1):117-125
11 Lynch MG,Brown RH,Michels RG,et al.Surgical Vitrectomy for Pseudophakic Malignant Glaucoma.Am J Ophthalmol 1986;102(6):803-804
12 Quigley HA,Broman AT.The number of people with glaucoma worldwide in 2010 and 2020.Br J Ophthalmol 2006;90(3):262-267
13 Foster P,Alsbirk PH,Baasanhu J,et al.Anterior chamber depth in Mongolians:variation with age,sex,and method of measurement.Am J Ophthalmol 1997;124(1):53-60