作者：魏玉斌 任晓冬 董雪原 作者单位：(河北省张家口第四医院,河北 张家口 075000)
【摘要】 目的：观察部分睫状体冷冻联合小梁切除及丝裂霉素C治疗难治性青光眼的临床疗效。方法：分析200710—200902月收治的148例(166眼)难治性青光眼的临床资料。术前三天常规点眼，术前用高渗剂降低眼压。常规行球后及眼轮匝肌浸润麻醉，先行睫状体冷冻，再行显微小梁切除术加丝裂霉素C，术后随访3个月。结果：术后眼压在6～21mmHg者101眼;在22～30mmHg者46眼,其中39眼经眼球按摩可降至21mmHg以下，7眼经滴用噻吗心安眼水可降至21mmHg。眼压<6mmHg者11眼。眼压>30mmHg者8眼。结论：部分睫状体冷冻联合小梁切除及丝裂霉素C治疗难治性青光眼，大多数可取得较好治疗效果。
【关键词】 难治性青光眼;睫状体冷冻;小梁切除术;丝裂霉素
Observation for Treatment of Refractory Glaucoma with Part of Ciliary Body
Forzen Combined with Trabeculectomy and Mitomycin
WEI Yubin,REN Xiaodong,DONG Xueyuan
The Fourth Peoples Hospital of Zhangjiakou,Zhangjiakou,075000,Hebei,China
【ABSTRACT】 Objective:To investigate the frozen part of the ciliary body combined with trabeculectomy and mitomycin C,for refractory glaucoma clinical effect.Methods:Refractory glaucoma clinical data for 148 cases from oct. 2007 to Feb. 2009 were analyzed.Preoperative conventional threepoint eyes and preoperative hypertonic agents were used to reduce intraocular pressure.Conventional line after the ball and the orbicularis oculi muscle infiltration anesthesia,cyclodialysis were first frozen,then treated with microsurgical trabeculectomy plus mitomycin C,Patients were followed up for 3 months.Results:The postoperative IOP in 6～21mmHg was 101 eyes;22～30mmHg was 46 eyes,one of 39 eyes with eyeball massage can be reduced to 21mmHg below，7 eyes treated with the drops of timolol timolol could be reduced to 20mmHg.IOP<6mmHg De was eyes.Intraocular pressure>30mmHg was 8 eyes.Conclusion:For frozen part of the ciliary body combined with trabeculectomy and mitomycin C in the treatment of refractory glaucoma,the majority of refractory glaucoma can obtain a better therapeutic effect.
【KEY WORDS】 Refractory glaucoma,Ciliary body frozen,Trabeculectomy,Mitomycin
难治性青光眼在临床上较为常见，常发生于眼底出血、陈旧性虹膜炎、眼外伤、白内障术后患者、多次滤过术后眼压失控患者。难治性青光眼的治疗长期以来一直都是眼科临床较为棘手的难题之一。既往采用常规滤过性手术成功率仅为11%～52%[1]。经过临床观察，我们采用部分睫状体冷冻联合小梁切除、丝裂霉素C治疗难治性青光眼148例166眼取得较好效果，现报告如下。
1 资料与方法
1.1 一般资料 200710—200902月我科共用此手术方法治疗难治性青光眼148例(166眼)。其中新生血管性青光眼102例116眼，虹膜炎继发性青光眼23例25眼，外伤性青光眼10例12眼，无晶体性青光眼8例8眼，抗青光眼术后眼压失控5例5眼。男87例94眼，女61例72眼。年龄18～69岁，平均54.3岁。住院用药后，眼压<30mmHg(1mmHg=0.133kPa)15眼，<40mmHg 68眼,<50mmHg 63眼，>50mmHg 20眼。
1.2 术前准备 全部病例入院后行常规检查，术前三天常规滴用托百士眼水，术前30min静点20%甘露醇250mL降低眼压。
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