【摘要】 目的观察探讨透明质酸钠结膜瓣下及部分病例前房注入对房水引流物植入术临床减压效果及术中、术后早期、术后晚期并发症的影响。方法对34例难治性青光眼(其中新生血管青光眼26例)采取现代的房水引流物前房植入及玻璃体腔植入联合玻璃体切除术,手术结束时均行透明质酸钠结膜瓣下注入,部分病例行透明质酸钠前房注入,观察手术前后的眼压、视力、前房深度及滤过泡等变化,平均随访观察17.5个月(3~40个月)。结果术前平均眼压(46.4±15.2)mmHg(1mmHg=0.133kPa),术后一周眼压(8.8±2.4)mmHg,随访时眼压平均值为(16.3±8.2)mmHg,眼压平均下降率64.9%。手术完全成功者21例,基本成功者6例,手术成功率79.4%(21/34)。术前平均用降压药种类3.2种,术后平均1.3种。全部病例眼痛、头痛症状均明显改善或消失。视力:术后视力改善者3例,占8.8%,不变者30例,下降者1例。前房深度:术后一周内浅前房或前房消失者5例,占14.7%,7~10天浅前房者2例,占5.9%;均于两周后前房形成。主要并发症:术后前房出血4例,占11.8%;引流管外露1例,占2.9%;引流管纤维包裹滤过泡瘢痕化7例,占17.6%。结论房水引流物植入术联合应用透明质酸钠可减少术中、术后并发症,提高手术成功率。更多还原

【Abstract】 Objective To evaluate the clinical results of subcojunctival retention of sodium hyaluronic acid or injection of anterior chamber in glaucoma valve implanation for treatment glaucoma and the effectiveness of the surgery and post-operative complications.Methods 34 refractory glaucoma(neovascular glaucoma 26)underwent classical glaucoma valve implanation and vitrectomy,with hyalaronic acid injected undercojunctive flaps when operation was over,Hyalaronic acid in some patients injected into anterior chamber.The changes of IOP,visual acuity,the anterior chamber depth,intraocular irritations and the bleb appearances was observed postoperation.The follow-up was 17.5 months(3～40 months)after surgery.Results The preoperative IOP of patients were(46.4±15.2)mmHg(1mmHg=0.133kPa).The post operative IOP after one week was(8.8±2.4)mmHg,the average IOP was(16.3±8.2)mmHg during follow-up,the decrease rate of IOP was 64.9%.The number of the surgery success was 21 cases,the general success rate was nearly 79.4%(21/34).The preoperative amount of glaucoma medications was average 3.2 comparely,the postoperative amount was 1.3.Visual acuity improved in 3 eyes(8.8%),not change in 30 eyes,reduced in 1 eye.The patients of flat anterior chamber were 5(14.7%) and 2 eyes(5.9%) respectively after one week and 7～10 days,all of the patients with normal anterior chamber after two weeks.Postoperative complicated included anterior chamber hyphema 4 cases(11.8%),the exposure of tube tip 1 case(2.9%) and bleb scarring around the tube tip 7 cases(17.6%).Conclusions Glaucoma setion implanation with subcojunctival retention of hyaluronic acid is benefit to preventing surgery complacation and enhancing the success rate of surgery.更多还原