Clinical Research Of Malignant Glaucoma After Glaucoma Surgery

Objective:Exploring the incidence of malignant glaucoma after glaucoma surgery,the factors related to the disease,management and its effect,in order to help clinical diagnosis and management of malignant glaucoma in the future.Method:1.From 2013 February to 2016 January,249 cases(362 eyes)with glaucoma patients received glaucoma surgery in our hospital,among whom 108 were male and 141 were female,and 9 cases(10 eyes)developed malignant glaucoma after filtration surgery,among whom 2 were male and 7 were female.The youngest of these 9 patients was 48 years old and the oldest was 77 years old,and the average age of them was 65.00±6.44 years old.First they tried medical management for approximately 4 to 5 days.If they couldn't help,we used surgical intervention.The surgical intervention separated into three parts.First we did 23G minimally vitrectomy plus anterior chamber formation.The purpose of this period is to depressing intraocular pressure,deepening the depth of anterior chamber so these patients would suffer much less.Then we did phacoemulsification and posterior capsulotomy.The purpose of this period is excluding capsular block and pupillary block caused by abnormal position of lens,changing the abnormal anatomical structure of anterior chamber angle,deepening anterior chamber,and finally depressing intraocular pressure,communicating anterior chamber and vitreous chamber directly,and restoring the normal circulation of aqueous,preventing recurrence of malignant glaucoma.Last but not least,we did implantation of IOL.The purpose of this period is providing better visual quality.After the surgery,we use mydriatic-cycloplegic agents,and if inflammation happens,we use antibiotics and hormones topically to release corneal edema.After the surgery,we pay attention to the vision,intraocular pressure,the depth of anterior chamber,horizon,filtering bleb and some other things.Follow up for 3 months after the surgery.Results:1.The incidence of malignant glaucoma after glaucoma surgery was 2.762%(10/362),and the incidence of male patients was 1.48%(2/135),the incidence of female patients was 3.52%(8/227).The youngest of these 9 patients was 48 years old and the oldest was 77 years old,and the average age of them was 65.00±6.44 years old.One case was in the 40s,one case was in the 50s,6 cases were in the 60s,and two cases were in the 70s.So we can found that in our research,the incidence of female is more than the incidence of male,and most patients were over 60 years old.2.After the second surgery,intraocular pressure was depressed and became normal,the pain caused by hill intraocular pressure disappeared.Before the operation,the average depth of central part of anterior chamber was(1.02±0.11)mm,three months after the operation,the average depth of central part of anterior chamber was(2.26±0.03)mm,obviously,the anterior chamber were deepened(F=9.28,P<0.001).Vision of the patients at any point after the surgery was much better compared with the vision pre-operation.After 3 months of the operation,we did perimetry,and the damage degree of their horizon didn't develop.It means that the surgery in our research is effective to treat malignant glaucoma.3.8 of the 9 patients didn't have any complications while the other patient ran into a suprachoroidad expulsive hemorrhage during the surgery.Heteropathy was taken immediately and the patient ended up well.It means the surgery in our research is mature and reliable.Conclusions:1.The incidence of malignant glaucoma after glaucoma surgery is a complicated pathological progress caused by various factors.It has some connections with the depth of anterior chamber,axial length and gender.2.There are many ways to treat malignant glaucoma.After the diagnosis is made,medical management is usually tried for approximately 4 to 5 days.If it's not effective,we should do the surgery.The key to the success of the operation is minimally vitrectomy and separating the surgery into three periods,and it's really effective.