作者：易贵荣，白宗禧，石晶 作者单位：（850007）中国西藏自治区拉萨市，西藏军区总医院眼科
【摘要】目的：探讨高原地区青光眼滤过手术后发生浅前房的原因与防治方法。方法：回顾总结620例（820眼）青光眼滤过手术治疗情况。结果：620例（820眼）青光眼滤过手术后，发生浅前房的98例（112眼）。其中滤过过强的102眼，结膜渗漏2眼，睫状体脉络膜脱离6眼，恶性青光眼2眼。浅Ⅰ度和部分浅Ⅱ度的病例可以通过散瞳、滤过区加压包扎及合理用药等保守治疗得以康复。对所有浅Ⅲ度的浅前房和部分前房炎症重的浅Ⅱ度浅前房应在保守治疗的同时严密观察，5d后不见好转的，针对性地采取手术治疗。结论：高海拔地区青光眼滤过手术后浅前房的发生率高，绝大部分是滤过过强所致。首选保守治疗。严重病例保守治疗无效，应尽早采取针对性手术，以减少并发症的发生。
【关键词】 高原；青光眼滤过手术；浅前房；治疗
Clinical study of 98 cases with shallow anterior chamber after glaucoma filtering operation in plateau area
GuiRong Yi, ZongXi Bai, Jing Shi
Department of Ophthalmology, General Hospital of Tibet Military Command of Chinese PLA, Lasa 850007, Tibet Autonomous Region, China
Correspondence to: ZongXi Bai.Department of Ophthalmology, General Hospital of Tibet Military Command of Chinese PLA, Lasa 850007, Tibet Autonomous Region, [email protected]
AbstractAIM: To investigate the cause and preventing method of the shallow anterior chamber after glaucoma filtering operation in plateau area.METHODS: We performed a retrospective analysis of 620 cases(820 eyes) who underwent glaucoma filtering operation .RESULTS: After glaucoma filtering operation, 98 cases (112 eyes) presented with shallow anterior chamber. Among them, excessive drainage occurred in 102 eyes; conjunctival leaking occurred in 2 eyes; ciliochoroidal detachment occurred in 6 eyes; and malignant glaucoma in 2 eyes. All the patients of shallow I degree and some patients of shallow II degree could be cured with nonsurgical therapy such as mydriasis, pressure bandage on drainage area and appropriate medicine. All cases of shallow III degree and some cases of shallow II degree combined with anterior chamber inflammation should be observed closely as well as receiving conservative treatment. If they did not improve after 5 days, surgical treatment should be adopted.CONCLUSION: The incidence of shallow anterior chamber after glaucoma filtering operation is high in plateau area. The main cause lies in excessive drainage. Conservative therapy is of first choice. Surgical intervention must be resorted to reduce the complications when conservative treatment failed.
KEYWORDS: plateau; glaucoma filtering operation; shallow anterior chamber; therapy
引言
海拔3 000m以上为医学高原[1]，高原地区青光眼滤过手术后发生浅前房是其最常见的并发症之一。我院地处海拔3 700m的西藏拉萨市，我们共做青光眼滤过手术620例（820眼）。术后发生浅前房98例（112眼），其百分比为13.6%，比低海拔地区浅前房发生率4.8%～7.0%[2]高。现总结报告如下。
1对象和方法
1.1对象
收集199501/200612期间在我院诊治的青光眼常规滤过手术的住院病历资料进行回顾性分析。共收集620例（820眼），术后发生浅前房的98例（112眼）；其中男41例（47眼），女57例（65眼），年龄35～76（平均52）岁；闭角型青光眼35例（40眼），开角型青光眼63例（72眼）；均在显微镜下做常规的以穹窿部为基底的结膜瓣及方形巩膜瓣的穿透性小梁切除术。术后浅前房判定：术后5d前房未恢复正常或前房形成后又变浅。按照Speath分级法[3]，浅Ⅰ度98眼，中央前房形成，周边虹膜与角膜内皮相接触；浅Ⅱ度12眼，除瞳孔区的晶状体前囊未与角膜内皮相贴外，整个虹膜面与角膜内皮相贴；浅Ⅲ度2眼，前房消失，整个虹膜和晶状体面均与角膜内皮相贴。其中滤过过强的102眼（占91.1%），结膜渗漏2眼（占1.8%），睫状体脉络膜脱离6眼（占5.3%），恶性青光眼2眼（占1.8%）。
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