摘要
目的观察穿透性角膜移植术(PKP)术后继发性青光眼患者行小梁切除术的效果及转归,以指导临床治疗。方法对56例(56只眼)PKP术后继发性青光眼行小梁切除术的住院患者进行术后随访观察。患者先予局部或联合全身应用降眼压药物治疗以及处理影响眼压的其他因素,眼压仍>30 mmHg者行小梁切除术。分别记录分析PKP术前原发病、术前眼压、术后滤过泡情况、角膜内皮细胞丢失率以及手术成功率,术后随访1年。结果患者术前眼压平均(39.77±8.08)mmHg,小梁切除术后5只眼(8.9%)发生了术后浅前房,其中3只眼发生于人工晶状体眼、2只眼发生于圆锥角膜。9只眼(16%)出现滤过泡局限包裹,其中7只眼予以针刺分离联合5-氟尿嘧啶(5-Fu)结膜下注射、2只眼行滤过泡分离术。小梁切除术前内皮细胞计数为(1668.52±578.38)个/mm^2,术后1个月角膜内皮计数为(1507.77±467.03)个/mm^2,内皮丢失率为12.67%;术后随访1年,角膜内皮细胞计数为(948.81±516.17)个/mm^2,较术前差异有统计学意义(P<0.001);排斥率为10.7%;角膜植片透明率76.8%。术后1年52只眼(92.8%)眼压控制在21 mmHg以下,4只眼(7.2%)眼压控制不良而行睫状体冷冻术。结论PKP术后继发性青光眼行滤过手术成功率相对较低,术后病情更为复杂多样化,需要长期随访。
Objective To observe the effect and clinical outcome of trabeculectomy for patients with secondary glaucoma after penetrating keratoplasty(PKP).Methods A total of 56 inpatients(56 eyes)with secondary glaucoma after PKP who underwent trabeculectomy were followed-up postoperatively.Patients were treated with topical or combined systemic intraocular pressure(IOP)lowering medication and other factors affecting IOP was also treated.Patients whose IOP remained above 30 mm Hg after conservative treatment were treated with trabeculectomy.The primary diseases before PKP,preoperative IOP,postoperative filtration bubble status,corneal endothelial cell loss rate and surgical success rate were recorded and analyzed.The postoperative follow-up period was 1 year.Results The preoperative IOP was 39.77±8.08 mmHg on average.After trabeculectomy,5 eyes(8.9%)developed postoperative shallow anterior chamber,among which 3 eyes were intraocular lens eyes and 2 eyes were keratoconus.Nine eyes(16%)developed limited follicular encapsulation,of which 7 eyes were separated by acupuncture combined with 5-Fu subconjunctival injection,the other 2 eyes were separated by follicular separation.The endothelial cell count before trabeculectomy was 1668.52±578.38/mm^2,and the corneal endothelial count was 1507.77±467.03/mm^2 at 1 month after the surgery,resulting in a endothelial loss rate of 12.67%.The corneal endothelial cell count was 948.81±516.17/mm^2 at 1 year postoperatively,which was significantly different from that before the surgery(P<0.001).The rejection rate was 10.7%and the transparency rate was 76.8%.At 1 year after the surgery,the IOP remained below 21 mmHg in 52 eyes(92.8%),and ciliary body cryotherapy was performed for 4 eyes(7.2%)with poor IOP control.Conclusions The success rate of filtering surgery for glaucoma after PKP is relatively low,and the postoperative conditions are more complex and diversified,requiring long-term follow-up.
作者
王正艳
李凤洁
赵灿
王利英
王婷
Wang Zhengyan;Li Fengjie;Zhao Can;Wang Liying;Wang Ting(Shandong Academy of Medical Institute of Medicine and Life Sciences,Jinan University,Shandong Eye Hospital,Shandong Eye Institute,Jinan 250021,China)
出处
《临床眼科杂志》
2020年第1期1-5,共5页
Journal of Clinical Ophthalmology
基金
山东省重点研发计划(2015GGH318010)
