原发性急性闭角型青光眼白内障摘出疗效观察

Cataract extraction for primary acute angle-closure glaucoma

目的观察原发性急性闭角型青光眼白内障摘出的疗效。方法27例(27眼)伴有白内障的原发性急性闭角型青光眼发作眼,采用白内障囊外摘出联合人工晶状体植入术,术中用黏弹剂分离前房角。结果术前平均眼压为(27.85±6.84)mmHg,其中眼压>21mmHg者22眼,眼压≤21mmHg者5眼(18.52%)。术后1周平均眼压为(16.52±4.60)mmHg,眼压≤21mmHg为25眼(92.59%),术后1月平均眼压为(19.93±5.13)mmHg,眼压≤21mmHg者22眼(81.48%)。术后1周和术后1月平均眼压与术前相比,差异均有统计学意义。术后1周视力提高15眼(55.56%),与术前相同11眼,视力下降1眼;术后1月视力提高18眼(66.67%),与术前相同7眼,视力下降2眼。术中眼压高前房浅12眼(44.44%),虹膜脱出3眼(11.11%);术后角膜水肿10眼(37.04%),虹膜渗出或人工晶状体前形成渗出膜8眼(29.63%),瞳孔散大(术前已存在)7眼(25.93%)。结论伴有白内障的原发性急性闭角型青光眼发作眼采用白内障囊外摘出联合人工晶状体植入,术中以黏弹剂分离前房角治疗有一定疗效,但远期效果还需要长期的观察。

Objective To investigate the clinical results of cataract extraction in the management of acute episode eyes of primary angle-closure glaucoma. Methods 27 eyes （27cases） with primary acute angle-closure glaucoma and lens opacity were treated by extracapsular cataract extraction with intraocular lens implantation, and viscoelastic agents applied to separate anterior chamber angle. Results After the follow-up of 1 week and 1 month, the intraocular pressure （IOP） was reduced from a preoperative IOP of （27.85 ± 6.84 ） mmHg （ 22eyes, IOP 〉 21 mmHg; 5 eyes, IOP ≤ 21mmHg） to a postoperative IOP of （ 16. 52± 4. 60） mmHg （25eyes, IOP≤21mmHg） and that of（19.93± 5. 13） mmHg （ 22eyes, IOP≤ 21 mmHg） respectively. Statistical significant differences were found in the mean lOP before and after the operation （ 1week, 1 month）. After 1 week, the better postoperative vision was in 15 cases（55, 56%）,no changes in 11 cases, worse in 1 case compared with preoperative. After 1 month, the better postoperative vision was in 18 cases（ 66.67% ） , no changes in 7 cases, worse in 2 cases compared With preoperative. 12 patients（44.4% ） developed high IOP and shallow anterior chamber, and prolapse of iris occurred in 3 cases （ 11.11% ） during operation. In postol？crative complications, corneal edema occurred in 10 cases （37.04%） , exudates of iris or the exudative membrane of preartiphakia in 10 cases（29.63% ）, corectasis in 7 cases（ 25.93% ）. Conclusions Extracapsular cataract＂ extraction with intraocular lens implantation, and viscoelastic agents applied to separate anterior chamber angle can be a good alternative in treating primary acute angle-closure glaucoma with lens opacity, but the long-term efficiency should be observed.