青光眼小梁切除术联合白内障吸除治疗原发性闭角型青光眼

Retrospective Study on the Treatment of Primary Angle-closure Glaucoma by Phaco-trabeculectomy and IOL Implantation

【目的】探讨超声乳化白内障吸除折叠式人工晶体植入联合青光眼小梁切除术治疗原发性型闭角型青光眼合并白内障的疗效。【方法】采用非随机临床回顾性研究分析了自2005年10月至2007年4月间,在本院36例38眼以超声乳化白内障吸除折叠式人工晶体植入联合青光眼小梁切除术(phacotrabeculectomy+IOL,PhaocTrab+IOL)治疗闭角型青光眼并发白内障患者的临床资料,急性闭角型青光眼组15眼,慢性闭角型青光眼组23眼,术后随访6个月以上。【结果】所有患者均顺利完成手术,未见后囊膜破裂和角膜内皮失代偿等严重并发症。患者手术后随访期内,最佳矫正视力均较手术前显著提高(P<0.01);眼压也由术前平均(38.78±7.93)mmHg降至术后6月的(19.05±2.75)mmHg(P<0.01),迄今患者中有3眼仍需要使用药物才能控制眼压,均为慢性闭角型青光眼患者;手术前中央部角膜内皮细胞密度为(2015.77±502.58)cells/mm2,手术后1周下降到(1869.22±439.03)cells/mm2。【结论】超声乳化白内障吸除折叠式人工晶体植入联合青光眼小梁切除术是治疗原发性闭角型青光眼合并白内障的一种安全、有效的方法,该术式可能对急性闭角型青光眼合并白内障更有效。

[Objective]To evaluate the therapeutic effect of phaco-trabeculeetomy and intraocular lens （IOL） implantation （PhacoTrab ＋ IOL） for treating primary angle-closure glaucoma （PACG）. [Methods] A retrospective study was performed to investigate 36 patients （38 eyes） who received PhacoTab＋IOL in our hospital during October 2005 to April 2007. There were 15 acute PACG eyes and 23 chronic PACG eyes, which were followed up for 6 months after operation. [Results] All the surgeries were performed successfully, and there were no posterior capsular rupture and corneal decompensation. During the follow-up period, the best corrected visual acuity was significantly improved compared to prior operation （ P d0.01）, and the intraocular pressure（IOP） （38.78±7.93mmHg） before operation decreased to 19.05±2.75mmHg at 6 months after operation （ P〈0.01）. There were only 3 eyes needing extra medication to control the IOP, and all of them were chronic PACG patients. The corneal endothelial cell density of central cornea was 2015.77±502.58 cells/ram2 before the operation,and decreased to 1869.22±439.03 cells/ram2 at one week after the operation. [Conclusion] PhaeoTrab＋IOL for treating PACG is a safe and effective therapy, and it may be more effective to acute PACG patients than chronic ones.