论文部分内容阅读
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。
Objective To investigate the effect of hyaluronic acid sodium conjunctival flap and some cases of anterior chamber infusion on the clinical decompression effect of aqueous humor implant and the effects of intraoperative, postoperative and postoperative complications. Methods 34 cases of refractory glaucoma (including 26 cases of neovascular glaucoma) to take a modern aqueous humor anterior chamber implantation and vitreous cavity implantation combined with vitrectomy, at the end of surgery were performed sodium hyaluronate conjunctival flap In some cases, sodium hyaluronate was injected into the anterior chamber. The changes of intraocular pressure, visual acuity, anterior chamber depth and filtration bleb were observed before and after surgery. The average follow-up period was 17.5 months (range 3-40 months). Results The mean preoperative IOP was (46.4 ± 15.2) mmHg (1mmHg = 0.133kPa) and intraocular pressure (8.8 ± 2.4) mmHg one week after operation. The mean intraocular pressure (IOP) was (16.3 ± 8.2) mmHg at the follow - 64.9%. Twenty-one patients were completely successful and 6 were successful. The successful rate was 79.4% (21/34). The average type of antihypertensive drugs before surgery 3.2, an average of 1.3 after surgery. All cases of eye pain, headache symptoms were significantly improved or disappeared. Visual acuity: Postoperative visual acuity improved in 3 cases, accounting for 8.8%, unchanged in 30 cases, decreased in 1 case. Depth of anterior chamber: 5 cases were anterior or anterior chamber disappeared within one week after operation, accounting for 14.7%. There were 2 cases with shallow anterior chamber within 7 ~ 10 days, accounting for 5.9%. Both cases formed anterior chamber in two weeks. The main complications: 4 cases of postoperative anterior chamber hemorrhage, accounting for 11.8%; 1 case of drainage tube exposure, accounting for 2.9%; drainage tube fiber wrapped bleb scars in 7 cases, accounting for 17.6%. Conclusion Aqueous humor implantation combined with sodium hyaluronate can reduce intraoperative and postoperative complications and improve the success rate of surgery.