（优质课件）原发性开角型青光眼诊疗规范.ppt

144眼小梁切除术后恶性青光眼发生时间 时间跨度从术后1天到4.5年 中位数时间7天 术后1周以内发生的占55.4% 术后1月以内发生的占62.5% 术后1年以内发生的占78.6% within 1 year within 1 month within 1 week * 手术治疗方式 手术方式 例 眼 晶状体摘除(Phaco或ECCE)+前段玻璃体切除 86 100 PPL+PPV 16 16 玻璃体抽吸+前房成形术 23 27 单纯药物治疗 18 19 脉络膜上腔放液+前房成形术 1 1 角巩膜缘伤口修补术 1 1 前段玻璃体切除+前房成形 2 2 小梁切除+前房成形术 1 1 前房成形+人工晶体IOL取出+前切 1 1 睫状体光凝 5 5 YAG激光后囊及前界膜切开 3 3 眼内取材注药 1 1 总 计 158 177 * 大部分恶性青光眼是医源性的和可避免的 年轻的女性PACG患者在小梁切除术后更易发生恶性青光眼 89.6% (163/182 眼）的恶性青光眼发生在PACG患者的小梁切除术后 必须使用阿托品以加深或保持前房 恶性青光眼患者宜选用PPL而非Phaco的条件： - 角膜内皮计数 <1000/mm2 - 前房消失 临床体会 * PPL或抽吸或Phaco 试行抽吸及成形 摘除晶状体 45岁以上 年轻 45岁以下 手术治疗（后囊膜前界膜及前部玻璃体切除、向后压迫人工晶体周边部、取出IOL等） 药物+激光治疗（YAG后囊及前界膜切开等） 药物治疗 人工晶体眼 无晶体眼 有晶体眼 角膜内皮失代偿风险小 PPL 角膜内皮失代偿风险大 手术治疗（后囊膜前界膜及前部玻璃体切除） 恶性青光眼治疗路径 * 谢  谢  ！ * * 率先开展青光眼基因诊断与筛查研究，提出青光眼症状前诊断的基本策略，推动我国青光眼早期诊断3A模式的建立 * * A Consistently Low IOP Reduces Vision Loss This slide demonstrates the importance of maintaining a consistently low IOP over time. After surgery to reduce IOP, patients with IOP consistently below 18 mm Hg over the 6-year follow-up period had, on average, visual field progression close to zero. Mean IOP during this period in this group of patients was very low (12.3 mm Hg). At later time points during follow-up, the visual field worsened significantly more in patients with IOP of 18 or over at any visit compared with patients who always had IOP under 18. For example, the average visual field defect worsened more in patients with IOP < 18 at 75 to < 100% of visits (the mean IOP was 14.7 mm Hg in these patients) compared with patients with IOP under 18 mm Hg at all visits (the mean IOP was 12.3 mm Hg in these patients). Reference The advanced glaucoma intervention study (AGIS). 7. The relationship between control of intraocular pressure and visual field deterioration. The AGIS Investigators. Am J