超声乳化白内障吸出联合折叠式人工晶体植入术治疗慢性闭角型青光眼合并白内障的临床观察

Clinical observations on phacoemulsification plus foldable IOL implantation for chronic angle-closure glaucoma with cataract

目的探讨超声乳化白内障吸出联合折叠式人工晶体植入术治疗慢性闭角型青光眼合并白内障的疗效。方法回顾分析2003年7月至2005年3月我院收治的慢性闭角型青光眼合并白内障患者19例19眼,行超声乳化白内障吸出联合后房型折叠式人工晶体植入术,对比术前、术后的眼压、视力、中央和周边前房深度(PAC)及前房角变化。结果术后眼压较术前显著降低(P值均<0．01)。94．7％(18／19例)患者术后最佳矫正视力较术前显著提高(P值均<0．01)。术后中央PAC平均为(3．36±0．35)mm,较术前[(1．62±0．23)mm]显著增加(t=2．36,P<0．05)。术后19眼PAC均≥1角膜厚度(CT),虹膜平坦,周边部膨隆消失。术后房角粘连闭合范围小于1／2圆周的有6眼,1／2～3／4圆周的有11眼,>3／4圆周的有2眼。术后房角均较术前不同程度地增宽,房角关闭所在象限可见不同程度开放,周边虹膜粘连范围变小。19眼术中均未发生晶体后囊膜破裂及角膜失代偿。结论采用超声乳化白内障吸出联合后房型折叠式人工晶体植入术治疗慢性闭角型青光眼合并白内障是安全、有效的。

Objective To appraise the clinical efficacy of phacoemulsification plus foldable IOL implantation for the treatment of chronic angle-closure glaucoma with cataract. Methods 19 eyes of 19 cases of chronic angleclosure glaucoma with cataract admitted to our hospital from July 2003 to March 2005 were retrospectively analyzed. The visual acuity was worser than 0.3. After pbacoemulsification plus foldable IOL implantation, the pa- tients were followed up fOr 3 to 12 months. The IOP, eye vision, depth of central and peripheral anterior chamber （AC） and angle before and after surgery were compared. Results The postoperative IOPs were significantly decreased comparing to the preoperative ones ranged from 15-26 mmHg, it was statistically significant （t=2.73, P 〈0.02）. The best corrected visual acuity of 18 eyes （94.74%） was proved postoperatively, whilst that of one eye （5.26%） remained unchanged. The difference of vision before and after surgery was also statistically significant （t = 2.89, P 〈0.01）. The depth of central AC was （1.62 ± 0.23）mm before surgery and （3.36 ± 0.35）mm after surgery showed that it was deepened after surgery and the difference was statistically significant （t =2.36, P 〈 0.05）. The depth of peripheral AC was less than 1/4 CT before and more than 1 CT after surgery. The closed angle in some quadrants was reopened to some degre after surgery. Conclusion It＇s safe and effective to treat chronic angle-closure glaucoma with cataract by pbacoemulsification plus foldable IOL implantation.