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目的 观察 3种途径 (经角膜缘植入前房、经角膜缘后植入后房及经睫状体平坦部植入玻璃体腔 )植入房水引流物治疗难治性青光眼的效果。方法 对 99例 (99只眼 )难治性青光眼患者行房水引流物植入术。根据植入途径分为 3组 :经角膜缘植入前房组 5 8例 (5 8只眼 ) ,经角膜缘后植入后房组 16例 (16只眼 ) ,经睫状体平坦部植入玻璃体腔组 2 5例 (2 5只眼 )。结果 术后随访 6～ 34个月 ,平均 19 6个月。引流物经角膜缘植入前房组眼压 <2 1mmHg(1mmHg =0 133kPa)者 46例(79 3%) ,其中需加用局部降眼压药物者 6例 (10 3%) ;经角膜缘后植入后房组眼压 <2 1mmHg者 12例 (75 0 %) ,其中需加用局部降眼压药物者 1例 (6 2 %) ;经睫状体平坦部植入玻璃体腔组眼压 <2 1mmHg者 13例 (5 2 0 %) ,其中需加用局部降眼压药物者 3例 (12 0 %)。 3组的手术成功率差异有显著性 (χ2 =6 5 2 5 ,P <0 0 5 )。经睫状体平坦部植入玻璃体腔组成功率较低。但经除外新生血管性青光眼患者后 ,3组的手术成功率分别为 83 3%、75 0 %及 5 8 8%,差异无显著性 (χ2 =4 2 31,P >0 0 5 )。结论 通过 3种途径植入房水引流物治疗难治性青光眼的效果基本相同 ,可根据患者具体情况选择合适的植入途径。
Objective To observe the effect of three kinds of approaches (implantation of anterior chamber through the limbus, posterior limbal implantation and posterior ciliary body implantation into the vitreous cavity) for the treatment of refractory glaucoma. Methods 99 cases (99 eyes) refractory glaucoma patients underwent aqueous humor implantation. According to the route of implantation, the rats were divided into 3 groups: 58 cases (58 eyes) were implanted into the anterior chamber through the limbus, 16 cases (16 eyes) were implanted into the posterior chamber by the limbus and the ciliary body flat part Intravitreous implantation was performed in 25 patients (25 eyes). Results Postoperative follow-up 6 to 34 months, an average of 19 6 months. 46 cases (79.3%) were treated with drainage of corneal limbal anterior chamber intraocular pressure <2 1mmHg (1mmHg = 0 133kPa), including 6 cases (10 3% In the posterior chamber implantation group, 12 cases (75 0%) had intraocular pressure <21 mmHg, of which 1 case (62%) required local topical intraocular hypertension, and the ciliary body was implanted into the vitreous cavity group Intraocular pressure <2 1mmHg in 13 cases (52.0%), including the need to add local intraocular pressure medication in 3 cases (120%). There was a significant difference in the success rate of operation between the three groups (χ2 = 6525, P <0 05). Posterior ciliary body implanted into the vitreous chamber with a flat lower power. However, with the exception of neovascular glaucoma patients, the successful rates of the three groups were 83.3%, 75.0% and 58.8%, respectively, with no significant difference (χ2 = 4231, P> 0.05). Conclusion There are basically the same effect of implanting aqueous humor drainage through three ways to treat refractory glaucoma. According to the specific conditions of patients, the appropriate implantation route can be selected.