摘 要：目的 探讨青光眼术后浅或无前房发生的原因、预后及处理。方法 每日裂隙灯显微镜追踪观察63例(101眼)青光眼术后患者并辅以直接眼底镜和B超检查。结果 101眼中有22眼(21.78%)术后出现浅或无前房，其中浅Ⅰ度9眼，浅Ⅱ度11眼，浅Ⅲ度2眼，大部分经药物治疗后痊愈，仅2例手术。结论 青光眼术后浅或无前房与术前浅前房及眼压控制不理想有密切关系。与青光眼术式及类型无明显关系。
Clinical study on the flat or absence of anterior chamber after glaucoma operation
SHI Bai-Fang,CHEN Wei-Zhen
(Department of Ophthalmology,Baogang Hospital,Shanghai Second Medical University,Shanghai 201900,China)
Abstract：Objective To discuss the cause of the flat or absence anterior chamber after operation,and its prevention and therapy.Methods Sixty-three cases(101 eyes)were observed with slit lamp microscopes,and direct ophthalmoscope everyday and ultrasound-B examination were used everyday if necessary.Results Among the 101 eyes,22 eyes(21.78%) presented flat or absence anterior chambers,Ⅰ degree in 9 eyes,Ⅱ degree in 11 eyes and Ⅲ degree in 2 eyes,of which most had been cured,only 2 eyes were necessary to be operated.Conclusion The fat or absence anterior chamber after operation was closely related to the condition of flat anterior chamber before operation and has less relation to the operative ways or the type of glaucoma.
Key words：glaucoma;flat or absence anterior chamber;operations of glaucoma▲
青光眼术后浅或无前房是各种青光眼手术后常见的并发症之一。均需积极处理，否则长期浅前房将给术眼带来严重损害。作者就本院1994年4月～1996年5月所行青光眼滤过手术63例101眼作临床研究。
1 资料与方法
1.1 临床资料 本组63例101眼，男33例，女30例。年龄9mo～77a，平均53.56a，其中50a以上48例85眼，患高血压、心血管疾病者21例。闭角型36例70眼，开角型8例11眼，继发性13例13眼，新生血管性4例4眼，先天性2例3眼。小梁切除术35眼，小梁切除+巩膜瓣下虹膜嵌顿12眼，小梁切除+巩膜瓣下巩膜嵌顿6眼，小梁切除+巩膜瓣下虹膜嵌顿+前部玻璃体切割7眼，虹膜嵌顿2眼，小梁切除+巩膜瓣下硅胶管植入2眼，预防性虹膜周边切除37眼。
1.2 方法 除有些病例不得已在高眼压(＞4kPa)状态下手术外，所有病例入院后均经局部或全身降压治疗1wk左右，在尽量使术眼充血消退，眼压恢复正常后手术。术后每天给予托吡卡胺和100g·L-1新福林，欧可芬点眼1次，并裂隙灯观察前房情况，检查眼底，必要时行B超检查。
2 结果
浅或无前房是指滤过术后1wk，前房仍未恢复者。据文献报告发生率为48.70%［1］。但在显微型抗青光眼滤过性手术后术后浅或无前房的发生率已明显降低。按Speath分类［2］本组术后浅前房22眼(21.78%)，其中浅Ⅰ度9眼，浅Ⅱ度11眼，浅Ⅲ度2眼。术前即有浅前房16眼，眼压控制不理想(＞4kPa)18眼。虹膜周边切除眼无1例出现浅或无前房。本组浅或无前房患者大多经保守治疗痊愈，前房恢复最迟于术后第22天。仅2眼需手术，1眼于术后第14天行后巩膜切开、前房注水而愈。另一绝对期青光眼在做小梁切除+巩膜瓣下硅胶管植入术后第41天因巩膜瓣粘连而再次行眼外引流术：拆除原巩膜瓣缝线，分离原切口粘连，角膜缘前房穿刺口注入生理盐水，见水从巩膜创口流出结束手术。术后第5天出现恶性青光眼而尊重患者意愿于第2次手术后第10天摘除眼球。
表1 青光眼术后浅或无前房与青光眼类型的关系
Table 1 Relation between flat or absence anterior chamber after glaucoma operation and type of glaucoma
| Type |
No.of eyes |
D |
E |
C |
M |
| Angle-closure |
11 |
4 |
8 |
1 |
| Angle-open |
5 |
2 |
1 |
| Secondary |
2 |
|
2 |
|
1 |
| Neovascular |
2 |
|
1 |
| Congenital |
1 |
|
1 |
| Total |
21 |
6 |
13 |
1 |
1 |
D=detached choroid,E=excess filter,C=conjunctive flap leak,M=malignant glaucoma
表2 青光眼术后浅或无前房与青光眼术式的关系
Table 2 Relation between flat or absence anterior chamber after glaucoma operation and operative ways
| Operative ways |
No.of eyes |
D |
E |
C |
M |
| T |
10 |
4 |
8 |
| T+I |
6 |
1 |
3 |
1 |
| T+S |
1 |
1 |
1 |
| T+I+V |
1 |
| I |
2 |
|
1 |
| T+ST |
1 |
|
|
|
1 |
| Total |
21 |
6 |
13 |
1 |
1 |
D,E,C,M are same to table 1
T=trabeculectomy,I=iridencleisis,S=scleral inlay,V=vitreotomy,ST=silicon tube
[1] [2] 下一页 |
