| Glaucoma is a irreversible vision of an eye disease, which is characterized by the progressive optic nerve atrophy,that is caused by the increase in intraocular pressure. World Health Organization indicate that glaucoma has been ranked as the world's second irreversible blinding eye diseases. Glaucoma filtration surgery is to create a room of water drainage channels from the anterior chamber to the subconjunctival space (bleb),which is for the purpose of reducing intraocular pressure of a surgery. Trabeculectomy in glaucoma filtration surgery is the most classic surgical approach and which is the most widely used in clinical practice. Choroidal detachment (choroidal detachment) after glaucoma filtration surgery is common and early complications. If it is not timely symptomatic treatment, Long-term choroidal detachment will lead to filtered bleb which is disappeared,decreased visual acuity, cataract increased, corneal endothelial damage,failure of glaucoma surgery and other serious consequences. Generally believed that reduction of intraocular pressure in the filtration surgery is a major risk factor,which is causing the choroidal detachment,however it also has other Non-stress pathogenic factor that are concerned by Ophthalmology academics and clinicians.Method:In this study,we 502 cases (632 eyes) which is the advanced angle-closure glaucomatous patients and have received trabeculectomy in our Glaucoma Section of our hospital from November 2007 to January 2010,the aim are analyzed choroidal detachment of risk factors, pathogenesis, clinical treatment.311 cases (407 eyes) of 502 cases (632 eyes) with angle-closure glaucomatous patients are acute angle-closure glaucomatous patients, accounting for 64.4%; 191 cases (225 eyes) are chronic angle-closure glaucomatous patients, accounting for 35.6%. (1) According to the type of glaucoma,we are divided into two groups, and then the number of two groups of patients which are secondary to choroidal detachment after filtering surgery were analyzed statistically. (2) The number of two groups of patients which have preoperative ciliary body detachment before filtering surgery were analyzed statistically. (3) According to (1) (2) data in the×2 test, derived from the analysis of the correlation of postoperative choroidal detachment of angle-closure glaucoma filtration surgery with preoperative ciliary body detachment. (4) The 29 cases (30 eyes) that are secondary to choroidal detachment after filtering surgery of 502 cases (632) with angle-closure glaucomatous patients are set to A group, and randomly selected cases (35 eyes) with angle-closure glaucoma patients are not secondary to the choroidal detachment after filtering surgery during the same period are set to B group. Gender composition gender, age distribution, the central anterior chamber depth before surgery, preoperative IOP, postoperative IOP and decrease in intraocular pressure after surgery of AB groups are statistically analyzed.Results:(1)The incidence of 311 cases (407 eyes) with acute closure group that are secondary to choroidal detachment after filtering surgery was 3.44%,and the slow closed group of 191 patients (225 eyes) was 7.11%, there was a significant difference between acute closure group and slow closed group (P<0.05). The incidence of slow closed group that are secondary to choroidal detachment after filtering surgery was higher than the acute closure group. (2) The incidence of the acute closure group that have preoperative choroidal detachment before filtering surgery was 5.16%, and the slow closed group was 0.89%, there was a significant difference between acute closure group and slow closed group (P <0.05). The incidence of acute closure group that have preoperative choroidal detachment before filtering surgery was higher than the slow closed group. (3) Compare the number of acute closure group who have preoperative choroidal detachment before filtering surgery with the patients who are secondary to choroidal detachment after filtering surgery, there was no significant difference (P>0.05). (4) Compare the number of slow closed group who have preoperative choroidal detachment before filtering surgery with the patients who are secondary to choroidal detachment after filtering surgery, the difference was statistically significant (P<0.05). The correlation of postoperative choroidal detachment of chronic angle-closure glaucoma filtration surgery with preoperative ciliary body detachment is relevant. (5) Compare the gender composition of A group with B group, the difference was not statistically significant (p> 0.05); Compare the Age distribution of A group with B group, the difference was statistically significant (p<0.05), The older,the incidence of postoperative choroidal detachment is higher. (6) Compare central anterior chamber depth of A group with B group, the difference was statistically significant (p<0.05),mean that the more shallow anterior chamber, the more easy to cause postoperative choroidal detachment.(7) Compare preoperative IOP, postoperative IOP and decrease in intraocular pressure after surgery of A group with B group, there was a significant difference between A group and B group in preoperative IOP and decrease in intraocular pressure (p<0.05), there was no significant difference between A group and B group in postoperative IOP(p> 0.05),mean that the higher preoperative IOP, the greater decrease in IOP after filtration surgery, the more easy to cause postoperative choroidal detachment. (8)The patients of postoperative choroidal detachment recovered completely with conservative treatment.Conclusion:(1) Postoperative choroidal detachment after filtering surgery is a pathological process.that is led by many complex variety of factors. (2) The higher preoperative IOP, the greater decrease in IOP after filtration surgery, the more easy to cause postoperative choroidal detachment. (3) The correlation of postoperative choroidal detachment of chronic angle-closure glaucoma filtration surgery with preoperative ciliary body detachment is relevant. (4) The incidence of acute angle-closure glaucoma that have postoperative choroidal detachment after filtering surgery was higher than chronic angle-closure glaucoma; The incidence of postoperative choroidal detachment postoperative choroidal detachment was lower than chronic angle-closure glaucoma. (5) The preferred treatment for postoperative choroidal detachment after filtering surgery which associated with shallow I Eyes or shallowⅡEyes is conservative treatment.
|
PDF Full Text Request