顽固高眼压性青光眼治疗的临床观察.DOCVIP

临床医学论文-顽固高眼压性青光眼治疗的临床观察 【摘要】? 目的? 观察治疗顽固高眼压性青光眼中的临床数据，探索治疗顽固高眼压性青光眼的临床经验。方法? 在常规使用强力的降压措施后，在高眼压下对患者进行手术治疗。在手术患者中选取两组患者，分别进行常规小梁切除术或巩膜板层下巩膜条前房引流术，对术后眼压进行分析统计，比较两者的差异。结果? 常规小梁切除术组或巩膜板层下巩膜条前房引流术组的两组患者术后眼压均比术前下降(P0.01)。且常规小梁切除术与巩膜板层下巩膜条前房引流术相比，两者差异无显著性(P0.05)。结论? 顽固高眼压性青光眼的患者进行手术是必要的。术后眼压控制也能达到满意的效果。??? ??? 【关键词】? 青光眼；顽固高眼压??????????? 【Abstract】? Objective? To investigate the clinical statistics in treatment of glaucoma with durative intraocular hypertension and to explore the clinical methods of therapy.Methods? Some patients were randomly divided into two groups as trabeculectomy group and sclerocleisis group. The outcomes of intraocular pressure of two groups were compared.Results? After surgery， the intraocular pressures of two groups were significantly decreased (P0.01).There was no statistical difference between intraocular pressures with surgery of two groups (P0.05).Conclusion?It is necessary that the surgical operation of glaucoma patients with durative intraocular hypertension would be taken. The intraocular pressure had a satisfactory control with surgery.牋?牋?【Key words】? glaucoma；durative intraocular hypertension??? ??? 有学者［1］认为：青光眼患者，尽管利用各种降眼压药物治疗，但其眼压还保持在40～50mmHg或以上者，称之为顽固高眼压性青光眼。这类青光眼常常包括：新生血管性青光眼，无晶体或人工晶体性青光眼，滤过手术失败的青光眼，先天性及青少年型青光眼，葡萄膜炎性青光眼，角膜移植术后青光眼，外伤性青光眼，视网膜或玻璃体术后青光眼，虹膜角膜内皮综合征等。顽固高眼压性青光眼不仅局部病情复杂，而且患眼难以建立有效的滤过通道，最终导致滤过性手术失败。该类青光眼患者，由于术前、术中持续高眼压，所以手术难度大，术中、术后并发症多。??? ??? 1? 资料与方法??? ??? 1.1? 一般资料? 顽固高眼压性青光眼患者82例122眼，男25例38眼，女57例84眼。病因：急、慢性闭角型青光眼36例，中央性静脉栓塞继发性青光眼9例，慢性虹膜睫状体炎继发性青光眼10例，慢性单纯性青光眼5例，白内障继发性青光眼10例，高血压或糖尿病致眼底出血继发性青光眼4例，眼外伤继发性青光眼8例。术前眼压在40mmHg以上。术前均经系统降眼压治疗无效。术式选择：常规小梁切除术59眼，巩膜板层下巩膜条前房引流术［2，3］40眼，小梁切除加晶体摘除或加人工晶体植入联合手术16眼，眼球摘除术3眼，睫状体冷冻治疗术4眼。术后眼压均控制在21mmHg以下。严重术中并发症：前房出血25眼，玻璃体前界膜破裂致玻璃体溢出6眼，驱逐性出血(本组病例之眼球摘除就是因此而致)3眼。术后并发症：前房积血43眼，虹膜后粘连23眼、玻璃体疝6眼，浅前房34眼。??? ??? 1.2? 方法? 本组病例全部应用各种药物治疗24～48h或以上。局部用缩瞳药；1％Pilocarpine加 Timolol眼药水点眼，继发虹膜睫状体炎青光眼用散瞳剂，应用房水生成抑制剂Diamox加Soda口服，静脉滴入20％甘露醇或50％甘油，辅助用镇静药物等。眼压测量均用Schiots眼压计测定。全组所有患者均在高眼压下进行手术治疗。其