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目的探讨前部玻璃体切除、晶状体超声乳化、后囊切开联合人工晶体植入治疗小梁切除术后恶性青光眼疗效。方法自2008年11月～2011年5月对10例10眼中小梁切除术后恶性青光眼、经保守治疗及前房成形术无效者,以前部玻璃体切除、晶状体超声乳化、后囊切开联合人工晶体植入治疗。结果全部患者人工晶体囊带内植入,前方形成,眼压稳定在11～21mmHg7例,5mmHg1例,作B超发现脉络膜脱离,用激素治疗10d后恢复。2例眼压21～30mmHg,考虑粘弹剂吸出不彻底,给用药及侧切口适量放出前房水后,1例眼压2d后恢复至14mmHg,1例经3d恢复至12mmHg,矫正视力得到不同程度的提高。结论①超声乳化晶状体摘除联合前部玻璃体切除是治疗小梁切除术后恶性青光眼、经保守治疗及前房成形术无效者有效术式;②后囊切开或YAG激光后囊造孔沟通房水流出途径,解除房水迷流是前房形成的保证;③人工晶体囊带内植入是视力恢复的保障。
Objective To investigate the effect of anterior vitrectomy, phacoemulsification and posterior capsulotomy combined with intraocular lens implantation in the treatment of malignant glaucoma after trabeculectomy. Methods From November 2008 to May 2011, 10 cases of traumatic glaucoma after trabeculectomy were treated by conservative treatment and anterior chamber atypical anterior surgery. All patients underwent anterior vitrectomy, phacoemulsification and posterior capsulotomy Crystal implantation treatment. Results All patients were implanted intraocular lens band in front of the formation of intraocular pressure was stable in 11 ~ 21mmHg7 cases, 5mmHg1 cases, for the discovery of choroidal detachment B, hormone treatment after 10d recovery. 2 cases of intraocular pressure 21 ~ 30mmHg, consider the viscoelastic aspiration is not complete, to the medication and lateral incision appropriate release of aqueous humor, 1 case of intraocular pressure returned to 14mmHg after 2d, 1 case restored to 3d by 12mmHg, corrected visual acuity was different The degree of improvement. Conclusions ① phacoemulsification combined with anterior vitrectomy is an effective treatment for traumatic glaucoma after trabeculectomy and conservative treatment and anterior chamber angioplasty. ② posterior capsulotomy or YAG laser posterior capsular access to aqueous humor Out of the way to lift the aqueous anterior chamber flow is the guarantee of the formation of the anterior chamber; ③ intraocular lens implantation with intraocular lens is the guarantee of visual acuity recovery.