目的 探讨23G前部玻璃体切除联合白内障超声乳化、内镜下房角分离、前后房沟通术治疗恶性青光眼的方法及疗效观察.方法 回顾性分析2014年6月至2015年6月就诊于北京同仁医院的恶性青光眼24例 (30只眼) (有晶状体眼), 均曾行小梁切除手术, 且药物及激光治疗无效.所有患者接受了白内障超声乳化、人工晶状体植入、前房成形、内镜下房角分离、前玻璃体切除、前后房沟通术.联合手术治疗后, 对术眼术中、术后的并发症及各项指标进行观察随访, 并对结果进行分析.结果 入院时平均最佳矫正视力为0. 17±0. 16;平均眼压 (26. 04±8. 09) mm Hg;平均前房深度 (1. 02±0. 45) mm, 平均眼轴 (21. 35±0. 75) mm.术中及术后无严重并发症, 术后随访6～12个月, 眼压平稳, 前房稳定.末次随访平均最佳矫正视力提高到0. 30±0. 15, 平均眼压下降至 (13. 70±4. 19) mm Hg, 平均前房深度加深至 (2. 58±0. 27) mm, 与术前对比, P <0. 05, 均有显著差异.结论 前部玻璃体切除联合白内障超声乳化、内镜下房角分离、前后房沟通术治疗恶性青光眼有效, 观察期内复发率低, 联合手术减少了多次手术风险并减轻了患者精神及经济压力.%Objective To evaluate the efficacy of 23-g pars plana vitrectomy combined with phacoemulsification surgery and anterior synechia separation using endoscope and iridectomy in the treatment of malignant glaucoma. Methods30 eyes of 24 patients with malignant glaucoma were reviewed retrospectively from May 2014 to May 2015 in Beijing Tongren Hospital. All the eyes underwent combined surgery. Control of intraocular pressure (IOP), pre-and postoperative best-corrected visual acuity (BCVA), anterior chamber depth (ACD), and development of intra-and postoperative complications were evaluated during follow-up. Results The pre-operative mean BCVA in Log MAR was 0. 17 ± 0. 16, the mean IOP was (26. 04 ± 8. 09) mm Hg, the mean value of ACD (1. 02 ± 0. 45) mm. No severe intraoperative complications were observed. BCVA at the last follow-up improved to 0. 30 ± 0. 15 and the mean IOP was (13. 70 ± 4. 19) mm Hg. UBM results showed that the ACD was (2. 58 ± 0. 27) mm after surgery. Conclusions 23-g pars plana vitrectomy combined with phacoemulsification surgery is safe and effective for treating malignant glaucoma.
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