【摘要】 目的探讨术前眼压对原发性急性闭角型青光眼行复合式小梁切除术的手术效果和安全性。方法选取2017年1月至2019年5月在我院治疗的原发性急性闭角型青光眼患者84例(86只眼),其中高眼压组42例(43只眼)(术前经常规降眼压处理后眼压仍>40 mm Hg;高眼压持续3 d以上),眼压控制组42例(43只眼)(术前眼压控制<40 mm Hg)。两组均行复合式小梁切除术,观察两组的手术效果和术后并发症发生等情况。结果高眼压组术后3个月视力较术前提高、不变和下降的比例分别为72%、21%和7%,与眼压控制组比较差异无统计学意义(Z=1. 096,P=0. 273);两组术后眼压均较术前明显降低,差异有统计学意义(P <0. 05);术后早期高眼压组高眼压发生率大于眼压控制组,差异有统计学意义(χ~2=4. 074,P=0. 044);术后3个月两组眼压控制情况比较差异无统计学意义(t=0. 847,P=0. 2163)。高眼压组术后并发症发生率为32. 6%,眼压控制组并发症发生率9. 3%,比较差异有统计意义(χ~2=7. 026,P=0. 008)。结论对术前眼压不能控制在正常范围的急性闭角型青光眼患者行复合式小梁切除术可以有效地降低眼压保留患者视功能,但在围手术期内要加强抗炎治疗,积极处理并发症。更多还原

【Abstract】 Objective To explore the effect of preoperative intraocular pressure( IOP) on the surgical outcome and safety of patients with primary acute angle-closure glaucoma after compound trabeculectomy. Methods A total of 84 patients( 86 eyes) with primary acute angle-closure glaucoma were recruited in our hospital From January 2017 to May2019. The patients were divided into two groups,with the high IOP group consisted of 42 patients( 43 eyes) with preoperative IOP ≥ 40 mmHg and lasted for more than 3 days even after conventional IOP-lowering treatment,and the control group consisted of 42 patients( 43 eyes) with preoperative IOP < 40 mmHg. Patients in both groups were treated with compound trabeculectomy and followed up for 3 months. The surgical effectiveness and postoperative complications were compared.Results In the high IOP group,the percentage of patients with improved,unchanged and decreased visual acuity at 3 months postoperatively were 72%,21% and 7%,respectively,which were not significantly different as compared with the control group( Z = 1. 096,P = 0. 273). The postsurgical IOP were lower than that before the surgery in both groups( P< 0. 05). The incidence of intraocular hypertension in the high IOP group was significantly higher than the control group at early stage after the surgery( χ~2= 4. 074,P = 0. 044). The IOP between the two groups was not statistically different at 3 months postoperatively( t = 0. 847,P = 0. 2163). The postoperative complication rate was 32. 6% in the high IOP group and 9. 3% in the control group,with a statistically significant difference( χ~2= 7. 026,P = 0. 008). Conclusions Compound trabeculectomy is safe and effective for primary acute angle-closure glaucoma patients whose preoperative IOP cannot be controlled in normal range. Meanwhile,antiinflammation therapy should be strengthened and complications should be treated actively during the perioperative period.更多还原