白内障超声乳化摘除联合房角粘连分离术治疗青光眼合并白内障的临床研究

Clinical Study of Phacoemulsification Combined with Goniosychialysis for Glaucoma with Cataract

目的探讨白内障超声乳化摘除及人工晶体植入术治疗闭角型青光眼合并白内障的临床效果。方法对已诊断为闭角型青光眼合并白内障的161例患者的226只眼施行白内障超声乳化摘除及人工晶体植入术,对房角关闭区域用辅助钩和灌注头进行钝性分离。超声生物显微镜及房角镜观察手术前后的房角及前房变化,对视野及眼压进行追踪,随访时间≤3年者186眼,>3年者40眼。结果有1只眼再发作眼压升高,施行小梁切除术后又出现眼压升高,前房硅管植入后眼压得到控制。全部患者术后房角开放,中央前房平均加深1.1mm,周边前房平均加深0.2mm。除再发眼压升高的1只眼的视野继续损害外,215只眼均无视野缩小。结论除炎症引起的青光眼外,超声乳化白内障摘除联合房角分离术是治疗闭角型青光眼的有效方法,但具体适应证尚待进一步探讨。

Objective To study clinical effect of phacoemulsification and goniosychialysis for angle-closure glaucoma with cataract. Methods 226 eyes of 161 patients were undergone phacoemulsification and IOL implantation, combined with goniosychialysis. The main outcome measures were pre-operation and post-operation change of anterior chamber angle, depth of anterior chamber, visual field and intraocular pressure. 186 eyes were followed up within 3 years, 40 eyes over 3 years. Results The intraocular pressure of 1 eye raised again. The management of trabeculectomy could not control the IOP, after silicon tuber implantation the pressure was controlled. The anterior chamber angles of all patients were open, the depth of central anterior chamber deepened average 1.1 mm, the depth of peripheral anterior chamber average 0.2 mm. The visual fields of 215 eyes had no depression except for 1 eye with raised intraocular pressure. Conclusion Phacoemulsification combined with goniosychialysis is an effective surgery for angle-closure glaucoma except for inflammative glaucoma, the concrete indication of the surgery should be explored further.