白内障超声乳化吸除术治疗闭角型青光眼术后房角改变

Changes in anterior chamber angle after phacoemusification in eyes with primary angle closure glaucoma in different extent closure angle

目的比较观察单纯白内障超声乳化手术治疗不同房角关闭状态的闭角型青光眼，手术前后房角改变。方法本组临床研究对象为采用白内障超声乳化联合人工晶体植入术治疗合并有白内障的闭角型青光眼病例中，非随机选取不同房角关闭状态及药后眼压低于或高于21mmHg29例47眼，其中A组19眼，房角关闭粘连〈180°，药后眼压低于21mmHg，B组28眼，房角关闭粘连〉180°，药后眼压大干21mmHg。术前及术后常规行视力、裂隙灯、Goldmann前房角镜检查，前房深度．眼压检查。统计学分析处理。结果两组47眼术后视力均有不同程度提高，前房深度增加。两组术后眼压均明显降低，统计学处理组内手术前后差异有显著忡，两组问术后眼压比较无统计学差异。房角镜检查术后前房角均有增宽，房角关闭及周边虹膜前粘连范围减小，部分患者关闭的房角重新开放，其中房角全部开放25眼，仍存1／4～1／2圆周前房角粘连7眼（A组3眼B组4眼），小于1／4圆周前房角粘连15眼（A组6眼B组9眼），随访3～18月未见前房角关闭及粘连范围扩大以及眼压再次升高。结论单纯白内障超声乳化吸除术治疗合并有白内障的原发性闭角型青光眼，其房角关闭粘连的范围广泛超过1／2圆周甚至达到3／4圆周以上，仍可达到增加视力，加深前房，开放房角，降低眼压的治疗目的。

Objective To investigate the changes of anterior chamber angle after phaeoemulsification with intraocular lens implantation in the management of angle closure glaucoma with different extent of closure angle. Methods 29 patients （47 eyes） who underwent phacoemusification for primary angle closure glaucoma with cataract were included in a non randomized clinical study, group A was 19 eyes with less than 180 degrees closure angle and peripheral anterior synechiae with controlled IOP under 21mmHg with medication, group B was 28 eyes with more than 180 degrees angle closure and peripheral anterior synechiac with uncontrolled IOP. The effects of visual acuity, intraocular pressure, anterior chamber angle and anterior chamber depth were examined. Results Vision of all 47 eyes improved differently and deepening of anterior chamber depth were found. Intraocular pressure was fall obviously in 47 eyes for both groups without medication. There was significant difference between preoperation and postoperation, but there was no significant difference between the two groups postoperalively. The angles examined by gonloscopy were wider than that of preoperation, the extent of any touch or adhesion between iris and trabeculae reduced. 360 degrees of angle circumference opened again in 25 eyes, there were still angle closure or synechia 90°- 180° in 7 eyes （group A have 3 eyes, group B 4 eyes）, 〈90° in 15 eyes （6 eyes in group A, 9 eyes in group B）, Peripheral anterior synechiae formation or closure angle and lOP elevation did not recur after 3 months after surgery up to 18 months. Conclusions Phacoemulsification can manage the angle closure glaucoma with anterior chamber angle closure or synechiae abroad effectively.