超声乳化白内障吸除术或联合房角分离术治疗原发性闭角型青光眼

Phacoemulsification or combined with Goniosynechialysis in the management of primary angle-closure glaucoma

目的:观察超声乳化白内障吸除人工晶状体植入术或同时联合房角分离术治疗原发性闭角型青光眼(primary angle closure glaucoma,PACG)的临床疗效,探讨手术适应证。方法:PACG患者29例(43眼),均合并不同程度晶状体混浊。根据术前房角粘连关闭的范围不同分为3组:A组16眼,术前房角粘连关闭≤180°,行超声乳化白内障吸除人工晶状体植入术。B组15眼,180°<术前房角粘连关闭≤270°,C组12眼,术前房角粘连关闭>270°,B组和C组行超声乳化白内障吸除人工晶状体植入联合房角分离术。术后随访9～24(平均12.7±5.4)mo。观察眼压、房角和视力等的变化。结果:A组16眼(100%)、B组14眼(93%)、C组2眼(17%),术后不用任何降眼压药物眼压正常。B组另1眼(7%)局部用药眼压控制正常。C组其余的10眼中,2眼(17%)局部用药眼压>21mmHg(<25mmHg),8眼(67%)行滤过性手术治疗。所有眼术后房角均增宽,术前房角关闭所在象限大部分重新开放。38眼(88%)术后最佳矫正视力提高。结论:超声乳化白内障吸除人工晶状体植入术可有效降低术前房角粘连关闭≤180°,合并有白内障的PACG的眼压,并可改善其视功能。对于180°<术前房角粘连关闭≤270°的患者,联合房角分离术可获得基本相同的治疗效果。如果术前房角粘连关闭>270°,则有必要联合小梁切除术。

AIM： To investigate the clinical effects and indications of phacoemulsification plus intraocular lens （IOL） implantation per se and combined with goniosynechialysis （GSL） in the management of primary angle-closure glaucoma（PACG）. METHODS： Twenty-nine cases （43 eyes） with PACG and cataract were divided into 3 groups according to preoperative degrees of synechial angle closure （SAC）：16 eyes of group A with equal to or less than 180 degrees SAC, 15 eyes of group B with more than 180 degrees but equal to or less than 270 degrees SAC, 12 eyes of group C with more than 270 degrees SAC. Group A was treated with phacoemulsification plus IOL implantation. Both group B and C was treated with phacoemulsification and IOL implantation combined with GSL. Intraocular pressure （IOP）, anterior chamber angle and visual acuity were monitored during follow-up for 9-24 months in these eyes. RESULTS： The IOPs of 16 eyes （100%） in group A, 14 eyes （93%%） in group B and 2 eyes （17%） in group C were nor-mal without any medications. The IOP of 1 eyes （7%） in group B was normal with a single antiglaucomatous eye drops. The IOPs of 10 eyes in group C were higher than 21mmHg after medications, 8 eyes required trabeculectomy. The chamber angles became wider and SAC were mostly reopened after surgery in all eyes, The postoperative outcome of best corrected visual acuity were ever improved in 38 of 43 eyes （88%）. CONCLUSION： Phacoemulsification plus IOL implantation is able to effectively control IOP and also improve the visual acuity of PACG with equal to or less than 180 degrees SAC and with cataract. For SAC ranging from180 to 270 degrees, the similar effects can also be obtained via phacoemulsification plus GSL. However, trabeculectomy may be necessary for cases of SAC more than 270 degrees.