白内障超声乳化在闭角型青光眼中的应用

Phacoemulsification and IOL implantation for primary angle closure glaucoma with cataract

目的探讨白内障超声乳化吸除合并人工晶状体(intraocular lens,IOL)植入术对伴有白内障的闭角型青光眼的手术效果。方法对31例(33眼)闭角型青光眼伴白内障患者行白内障超声乳化吸除合并IOL植入术。观察手术前后前房角、前房深度、眼压及视力变化。术后随访1.5～3年。结果术后所有术眼眼压下降,平均(14.99±0.65)mmHg(1mmHg=0.133kPa),比术前用药后平均眼压(24.43±1.61)mmHg明显降低。手术前后眼压差异有显著性(t=5.28,P=0.000)。UBM检查中央前房深度,由术前的(1.60±0.25)mm增加到术后的(3.30±0.35)mm,两者差异有显著性(t=6.24,P=0.000);术后前房角宽度均增加,房角开放。前房角镜检查前房角均增宽,睫状体带易于看见。术后视力明显提高(χ2=63.47,P<0.01)。结论对由晶状体因素引起的瞳孔阻滞型闭角型青光眼合并白内障患者,白内障超声乳化吸除合并IOL植入术是可供选择的治疗方法之一。

Objective To study the preliminary clinical outcome of phacoemulsification and IOL implantation for angle closure glaucoma with cataract. Methods Thirty-three eyes of 31 patients with primary angle closure glaucoma with cataract who had undergone phacoemulsification and IOL implantation were included in the study. Changes in the anterior chamber angle, central anterior chamber depth （CACD）, IOP and preoperative and postoperative visual acuity were observed. The patients were followed up from 1.5 to 3 years. Results After a mean postoperative follow up of （22.50±4.50）months, the anterior chamber angles were wider and the ciliary bands were easy to observe when examined by gonioscopy. The CACD had increased from a preoperative mean of （1.60±0.25）mm to （3.30±0.35）mm postoperatively （t=6.24, P= 0.000）. The anterior chamber angle had become wider and more open when examined by ultrasound biomicroscopy postoperatively. Mean IOP had significantly decreased from a preoperative mean of （24.43±1.61）mmHg that was controlled by medication to a postoper-ative mean of （14.99±0.65）mmHg （t=5.28, P=0.000）. Best corrected visual acuity had improved postoperatively in all eyes （X^2=63.47, P〈0.01）. Among the results for best corrected visual acuity, 6 eyes improved to 4.4-4.5, 18 eyes improved to 4.6-4.7, 6 eyes improved to 4.8-4.9, and 3 eyes improved to ≥4.9. Conclusion Phacoemulsification and foldable IOL implantation can be a good alternative for primary angle closure glaucoma that is caused by cataract of the lens. It not only decreased IOP but also improved visual acuity.