白内障超声乳化联合房角分离与微创前段玻璃体切割术治疗持续性高眼压下的原发性闭角型青光眼

Phacoemulsification combined with goniosynechialysis and micro-invasive vitrectomy for primary angle-closure glaucoma with persistent high intraocular pressure

目的探讨原发性闭角型青光眼持续高眼压下行白内障超声乳化联合房角分离与微创前段玻璃体切割术的安全性及有效性。方法回顾性分析在我院行白内障超声乳化联合房角分离与微创前段玻璃体切割术治疗的原发性闭角型青光眼患者29例（35眼）,比较术前及术后视力、眼压、前房深度及术中、术后并发症等情况。结果所有患眼均未发生严重的术中及术后并发症。术后1周20眼（57.14%）视力较术前提高2行或以上,在术后1个月及6个月时分别提高至25眼（71.43%）及30眼（85.71%）。术前周边前房约为1/4角膜厚度（corneal thickness,CT）者12眼,〈1/4 CT者23眼;术后1 d周边前房深度约1/4 CT者6眼,〉1/4~1/2 CT者13眼,〉1/2~1 CT者14眼,2眼超过1 CT。术后所有患眼均较术前周边前房深度明显加深。术后3个月时31眼眼压恢复正常,2眼眼压需使用局部降眼压药物控制,2眼因眼压控制不佳行小梁切除术。术后6个月时所有患眼眼压均保持在正常范围内。结论采用白内障超声乳化联合房角分离与微创前段玻璃体切割术治疗持续高眼压状态下的原发性闭角型青光眼,不仅可有效降低眼压,避免了视神经的不可逆性损害,还为外滤过手术保留了完整的结膜组织,是安全有效的。

Objective To evaluate the clinical effects of phacoemulsification combined with goniosynechialysis and micro-invasive vitrectomy for primary angle-clo- sure glaucoma （PACG） with persistent high intraocular pressure （IOP）. Methods Phacoemulsification combined with goniosynechialysis and micro-invasive vitrectomy were performed on 29 cases （35 eyes） of PACG with cataract under high IOP. The visu- al acuities, depth of anterior chamber, IOP and complications were observed. Results There was no serious complication happened in all cases after the surgery. The postop- erative visual acuity improved in 20 eyes （57.14%） at 1 week,25 eyes （71.43%） at l month and 30 eyes （85.71%） at 6 months after operation, respectively. The peripheral anterior chamber depth （PACD） was 1/4 corneal thickness（CT）in 12 eyes and less than 1/4 CT in 23 eyes preoperatively,while PACD was less than 1/4 CT in 6 eyes,from1/4 CT to 1/2 CT in 12 eyes ,from 1/2 CT to 1 CT in 12 eyes and more than 1 CT in 2 eyes postoperatively. The postoperative PACD were increased significantly than pre-operation （P = 0. 000）. The postoperative IOP was in normal in 31 eyes and 2 eyes needed additional medical treatment,2 eyes recovered after additional trabeculectomy. IOP in all cases were in normal at postoperative 5 months. Canelusion Phacoemulsification combined with goniosynechialysis and micro-invasive vitrec- tomy is effective and safe for PACG with persistent high IOP.