摘要 目的 讨论抗青光眼术后睫状体脉络膜脱离与恶性青光眼的关系。方法 回顾性总结我 院住院病人小梁切除术后睫状体脉络膜脱离并发恶性青光眼8例8只眼。结果 8只眼 均于术后1月内出现扁平前房，周边虹膜与角膜内皮相贴，眼压24～50mmHg，平均29 .5mmHg，其中7只眼行脉络膜上腔放液＋前房注气术，1眼行白内障囊外摘出＋人工 晶状体植入 ＋脉络膜上腔放液术，术中8眼均于脉络膜上腔放出淡黄色液体，术后前房加深，眼压降至 正常。结论 睫状体脉络膜脱 离可能是恶性青光眼发病过程中的一个步骤，或二者为同一病体中的两种表现。抗青光眼术 后出现扁平前房，眼压正常或偏高应警惕恶性青光眼。脉络膜上腔放液治疗有效。

Ciliochoroidal detachment and malignant glaucoma

Lu Yan　Dai Weijia　Guo Li

　　（Department of Ophtha lmology，Xuan Wu Hospital，Capital Univers ity of Medical

　　Sciences，Beijing 100053）

　　Abstract ObjectiveTo discuss the relati o nship between ciliochoroidal detachment and malignant glaucoma with normal or hi gher intraocular pressure（IOP） after gla u coma surgery．Methods8 eyes（8 cases） wi t h ciliochoroidal detachment and malignan t glaucoma after glaucoma surgery were r eviewed retrospectively．All 8 eyes were angle-closure glaucoma．After IOP was con trolled to normal with topical pilicarpi n，timolol and oral acetazolamide，8 eyes received trabeculectomy under topical an esthenia and were treated with antibioti cs，corticosteriods and eycloplegics．Res ults8 eyes showed flat anterior chamber ，high IOP（mean 29.5mmHg，range 24～50 mmHg ），iridocorneal apposition at one month a f ter trabeculectomy．Of 8 eyes，7 were trea ted with drainage of surachoroidal fluid and gas injection into anterior chamber，1 was t reated with extracapsular cataract extra ction，intraocular lens implantation，dra in age of surachoroidal fluid and gas injec tion into anterior chamber．Surachoroidal fluid was seen during sleostomy in 8 ey es．After the second surgery，8 eyes were treated with topical antibiotics cortico steriods，eyoloplegics，anterior chamber w as deeper，and IOP was normal again．C onclusionCiliochoroidal detachment may b e a step of the development of malignant glaucoma，or both of them may be the sam e disease with variations of clinical ap pearances；Malignant glaucoma should be c onsidered in different diagnosis of a fl at or shallow anterior chamber with norm al or higher IOP after glaucoma surgery． Drainage of surachoroidal fluid is effec tive．

　　Key words　glaucoma surgery cilioch oroidal detachment malignant glaucoma

　　睫状体脉络膜脱离与恶性青光眼均为闭角型青光眼滤过术后的并发症，二者均表现为扁平前房，但睫状体脉络膜脱离表现为低眼压，恶性青光眼则表现为高眼压。随着人们对恶性青光眼深入研究和认识，不少学者发现相当一部分恶性青光眼发作时，其眼压正常甚至偏低，而且与睫状体脉络膜脱离相关［1～5］。本文将就恶性青光眼的临床表现、发病机制、诱因和易感因素、睫状体脉络膜脱离与恶性青光眼的关系进行讨论。

　　1　临床资料与方法

　　1．1　临床资料：8例患者均为我院收治的闭角型青光眼患者，其中男性3例，女性5例，年龄55～76岁，平均62.9岁。

　　1．2　方法：局麻下于眼球上方行常规小梁切除术，术后局部给予阿托品、抗生素及地塞米松治疗。

　　2　结果

　　2．1　临床表现：8例患者均于术后30天内出现扁平前房，周边虹膜与角膜内皮相贴，眼压24～50mmHg(1mmHg＝0.133kPa)，平均29.5mmHg，其中1例经超声生物显微镜检查，诊断睫状体上腔积液，睫状体环形脱离1例B超提示脉络膜脱离。

　　2．2　手术处理：7例行脉络膜上腔放液＋前房注气术，1例行白内障囊外摘出＋人工晶状体植入＋脉络膜上腔放液＋前房注气术，均于脉络膜上腔放出淡黄色液体。术后前房加深，眼压恢复正常。

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