方法：回顾性分析2013-01/2015-01在我院眼科住院治疗的持续高眼压状态的原发性闭角型青光眼患者45例46眼，患者年龄43～81(56.9±9.4)岁，术前常规进行视力、最佳矫正视力、裂隙灯、眼底、眼压、视野和眼B超检查。Ⅰ期局部麻醉下对患者行前房穿刺术，术后局部用醋酸泼尼松滴眼液和妥布霉素地塞米松眼膏点眼，联合降眼压滴眼液和甘油果糖注射液静滴等进一步控制眼压。术后第2d行小梁切除羊膜植入+前房注气(部分病例进行睫状体扁平部穿刺放液术)。术后随访观察视力、最佳矫正视力、眼压，裂隙灯、眼底检查和记录并发症发生情况。

结果：患者眼压在前房穿刺术后1、2d分别为21.4±5.2、20.3±4.8mmHg(1kPa=7.5mmHg)，与术前眼压相比显著降低(F=492.601，P<0.01)； 青光眼滤过手术后1、3、7d，1mo随访时眼压分别为20.1±4.8、14.9±2.7、13.6±2.7、14.5±2.2mmHg，与术前眼压分别比较，差异均有统计学意义(F=857.508，P<0.01)； 常规青光眼滤过手术联合前房注气术后1d眼压与术后3、7d和1mo随访的眼压比较，差异均有统计学意义(t=10.191、10.950、9.523，P<0.01)。末次随访时100%形成功能性滤过泡，手术完全成功率为94%，部分成功率为7%，最佳矫正视力较术前显著提高(P<0.05)，大部分患者恢复了有用的视力。术后3眼发生浅前房、2眼脉络膜脱离，未观察到恶性青光眼、脉络膜上腔出血、眼球萎缩等严重并发症发生。

结论：对持续高眼压状态的急性原发性闭角型青光眼患者先行前房穿刺术后择期行青光眼滤过联合前房注气手术是一种安全有效可行的手术方法，减少了术中、术后严重并发症，并能获得良好的眼压控制，改善大部分患者的视力。

METHODS:From January 2013 to January 2015, 45 patients(46 eyes)with high IOP in primary angle-closure glaucoma were treated in the department of ophthalmology in our hospital. The age of patients was(56.9±9.4)years old, ranged from 43～81 years. All the patients underwent the examinations of visual acuity, best corrected visual acuity(BCVA), slit lamp, fundus IOP, perimetry and ultrasound B scan. Under local anesthesia, the patients underwent anterior chamber paracentesis, postoperative they received topical acetate prednisolone eye drops and tobramycin and dexamethasone eye ointment, combining with IOP lowering eye drops and glycerol fructose injection intravenous to further control IOP. Two days after surgery, the patients received trabeculectomy with amniotic membrane implantation and intracameral gas injection(some cases underwent pars plana puncture). Visual acuity, BCVA, IOP, slit lamp, fundus were observed postoperative and complications occurred during the operation were recorded.

RESULTS:The average IOP at 1 and 2d after anterior chamber puncture were 21.4±5.2, 20.3±4.8mmHg(1kPa=7.5mmHg), which was significantly lower than that before surgery(F=492.601, P<0.01); the average IOP after glaucoma filtration surgery was(20.1±4.8mmHg at 1d, 14.9±2.7mmHg at 3d, 13.6±2.7mmHg at 7d and 14.5±2.2mmHg at 1mo, which was significantly lower than those before surgery(F=857.508, P<0.01). After glaucoma filtration surgery, comparison between IOP at 1, 3, 7d and 1mo was performed, there was statistically significant differences were found(t=10.191, 10.950, 9.523, P<0.01). At the last visit, the functional filtering bleb formed in all cases. The fully success rate was 94%, the partially success rate was 7%. BCVA was significantly improved(P<0.05), and most of cases regain useful visual acuity. There were shallow anterior chamber in 3 eyes and chorildal detachment in 2 eyes, which were treated medically. Malignant glaucoma, retinal hemorrhage, suprachoriodal hemorrhage, eyeball atrophy and other severe complications did not occur.

CONCLUSION:For acute primary angle closure glaucoma with persistent high IOP, anterior chamber puncture and intracameral gas injection combined with trabeculectomy is a safe and effective method, which can reduce intraoperative and postoperative complications and improve the visual acuity of most patients.