目的:通过在持续高眼压状态下选择性地施行周边虹膜切除术与小梁切除术的对比研究,探讨急性闭角型青光眼持续高眼压状态下更合理的手术选择方式。方法:54例54眼经最大剂量降眼压药物紧急处理后眼压仍(40mmHg的急性闭角型青光眼急性发作期患者,根据高眼压持续时间分成两组:A组:急性闭角型青光眼首次发作,高眼压持续时间≤48h,选择周边虹膜切除术20眼;B组:高眼压持续时间>48h,选择小梁切除术34眼。结果:术后随访6～18(平均12.3)mo。A组手术成功率85%,B组82%,两组比较无统计学差异;A组术后眼压17.98±4.25mmHg,B组17.12±4.65mmHg,两组比较无统计学差异;A组术后视力0.51±0.09,B组0.3±0.07,P<0.01,有非常显著性差异;A组术后房角恢复开放比率较B组高,P<0.05;A组术后18眼(90%)瞳孔可调节,B组13眼38%,P<0.01;A组术后并发症少,无伤口渗漏、脉络膜脱离及恶性青光眼,眼前节炎症反应轻微(10%),与B组比较P<0.05。结论:急性闭角型青光眼急性发作期持续性高眼压合理的急诊手术方式,对于首次发作,高眼压持续时间≤48h的可选择周边虹膜切除术,该手术简便快捷、安全有效,手术并发症少,术后视力好,并可保持瞳孔调节性;对于多次发作,高眼压持续时间>48h的应选择小梁切除术联合术中应用MMC(丝裂霉素C)和巩膜瓣可拆缝线,可有效地控制眼压,挽救视力。

·AIM:To find a more rational surgical method of the sustained high intraocular pressure(SHIOP)of acute angle-closure glaucoma,a contrast study on selective peripheral iridectomy and trabeculectomy under the SHIOP was completed.·METHODS:A total of 54 patients(54 eyes)whose intraocular pressure(IOP)were still higher than 40mmHg after maximum dose of drug medicine were divided into 2 groups according to their duration of high intraocular pressure(DOHIOP):In Group A,all patients with first-episode,whose DOHIOP was no longer than 48 hours,peripheral iridectomy(20 eyes)was adopted;In Group B,the DOHIOP was longer than 48h,trabeculectomy(34 eyes)was implemented.·RESULTS:The patients were followed up for 6 to 18 months(an average of 12.3 months)after operation.The success rate of operation was 85.0% after peripheral iridectomy and 82.4% after trabeculectomy(P>0.05);The postoperative IOP in the peripheral iridectomy group was 17.98±4.25mmHg,and 17.12±4.65mmHg in the trabeculectomy group(P>0.05).The postoperative visual acuity in Group A and in Group B was 0.51±0.09 and 0.3±0.07 respectively(P<0.05).The opening rate of chamber angle of Group A were higher than that of Group B(P<0.05);the pupils of 18 eyes in Group A(90%)were adjustable,while 13 eyes(38.2%)in Group B(P<0.01);compared with Group B,Group A had few postoperative complications,mild inflammation of anterior segment,no wound leakage,choroidal detachment or malignant glaucoma(P<0.05).·CONCLUSION:Reasonable emergency surgical method for the SHIOP in the acute attack of acute angle-closure glaucoma:when the DOHIOP is no more than 48 hours,in the first attack,peripheral iridectomy should be selected,which is a fast,convenient,safe and effective operation with few complications,and is able to maintain better visual acuity and adjustable pupils;while more than once attack,and the DOHIOP is longer than 48 hours,trebculectomy with MMC and sclera lamella removable suture should be used to control the intraocular pressure and save the visual acuity.·

R779.6