Surgical management of chronic glaucoma in aphakia.
Surgical management of chronic glaucoma in aphakia.
复制标题
无晶状体眼慢性青光眼的手术治疗。
DOI：
10.1016/s0161-6420(83)34483-3
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发表时间：
1983
期刊：
影响因子：
13.7
通讯作者：
M. Johnstone
中科院分区：
文献类型：
--
作者：
A. Bellows;M. Johnstone
由于眼压控制不佳和严重的术后并发症威胁视力，无晶状体眼青光眼的手术治疗一直受到限制。对术前平均眼压为38 mm Hg的无晶状体眼进行一系列连续的小梁切除滤过手术，平均随访26个月，结果显示62%的眼压控制在21 mm Hg或以下。另外5名患者(24%)在数字按摩后血压低于21毫米汞。手术后视力下降的并发症是显著的，但与手术操作没有直接关系。另一位患者患有青光眼和无晶状体眼，术前平均压力为25毫米汞柱，接受了激光小梁成形术。在15名患者中，有12名(80%)平均8个月的眼压低于22毫米汞柱，不需要青光眼手术。术后无明显并发症发生，所有患者视力均保持在术前水平。在接受最大限度药物治疗的无晶状体眼患者中，青光眼未得到控制，建议手术治疗。我们推荐以下手术方法：(1)如果房角开放，对小梁网进行激光治疗；(2)如果失败，或房角广泛闭合，建议进行小梁切除术；(3)睫状体冷凝治疗在控制压力方面有效，但不可预测的视力丧失促使人们在看到眼睛时谨慎；(4)睫状体脱离；以及(5)经睫状突或经巩膜治疗睫状突是另一种治疗模式。青光眼和无晶状体眼手术治疗的改善结果令人鼓舞，应该在最大限度的药物治疗无效的情况下使用。
The surgical management of glaucoma in aphakia has been limited by poor success in the control of intraocular pressure and serious postoperative complications that threaten vision. A consecutive series of trabeculectomy filtering procedures in aphakic eyes with a mean preoperative intraocular pressure of 38 mmHg was followed for an average of 26 months and revealed a 62% control of intraocular pressure at 21 mmHg or less. Five additional patients (24%) had pressures lower than 21 mmHg following digital massage. The complication of decreased visual acuity following surgery was significant but not directly related to the surgical procedure. Another patient population with glaucoma and aphakia with a mean preoperative pressure of 25 mmHg was treated with laser trabeculoplasty. In 12 of 15 patients (80%) intraocular pressure was lower than 22 mmHg for an average of eight months and did not require glaucoma surgery. There were no significant complications following this therapy and all patients retained preoperative level of visual acuity. In aphakic patients who have uncontrolled glaucoma on maximal medical therapy, surgery is indicated. We recommend the following approach to surgical management: (1) Laser treatment to the trabecular meshwork if the angle is open; (2) if this fails, or the angle is extensively closed, a trabeculectomy filtering procedure is suggested; (3) cyclocryotherapy has been effective in controlling pressure but the unpredictable loss of vision has prompted caution in seeing eyes; (4) cyclodialysis; and (5) transpupillary or transscleral treatment of the ciliary processes are additional modes of therapy. Improved results of surgical treatment for glaucoma and aphakia have been encouraging and should be used when maximal medical therapy is ineffective.