白内障超声乳化吸除术治疗不同房角关闭状态的闭角型青光眼的临床疗效观察

Clinical study on the effect of phacoemulisification in the management of angle-closure glaucoma in different extent closure angle

目的比较观察单纯白内障超声乳化吸除联合后房型人工晶状体植入术治疗不同房角关闭状态的闭角型青光眼合并白内障患者手术前后房角的改变及对眼压的影响。方法收集2005年1月至2007年12月收治的闭角型青光眼合并白内障31例(36只眼),患者均接受白内障超声乳化吸除联合后房型人工晶状体植入术。根据术前房角关闭粘连范围分组,A 组8只眼,房角关闭粘连≤1/2周;B 组10只眼,1/2周<房角关闭粘连≤3/4周;C 组18只眼,房角关闭粘连>3/4周。术前及术后常规行最佳矫正视力、裂隙灯、Goldmann 前房角镜及超声生物显微镜检查,中央前房深度和眼压检查。结果三组36只眼术后视力均有不同程度提高,前房深度增加。除 A组外,B、C 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性,术后组间眼压差异无显著性。房角镜及 UBM 检查术后房角均有增宽,房角关闭及周边虹膜前粘连范围明显减小甚至消失,部分患者房角重新开放,其中房角全部开放15只眼,1/4周<房角关闭粘连≤1/2周7只眼(C 组),房角关闭粘连≤1/4周12只眼(A 组2眼 B 组4眼 C 组6眼),随访6～24月未见房角关闭粘连扩大及眼压再次升高;房角关闭粘连仍>3/4周2只眼(C组),术后早期出现青光眼复发。结论单纯白内障超声乳化吸除联合后房型人工晶状体植入术可以有效治疗房角关闭粘连的范围超过1/2周甚至达3/4周以上的闭角型青光眼。但是对于房角关闭粘连超过3/4周以上甚至全闭,且术前用药后眼压仍较高者,术后可能出现青光眼复发。

Objective To investigate the changes of anterior chamber angle and IOP after phacomulsification with foldable posterior chamber intraocular lens implantation （ PC-IOL ） in management of angle-closure glaucoma （ ACG） in different extent closure angle with cataract. Methods Phacomulsification with foldable PC-IOL implantation was performed in 31 patients（36 eyes）with ACG in Gongli hospital. According to angle closure degrees and peripheral anterior synechiae before operation, the patients were divided three groups, group A was 8 eyes with less than 1/2 perimeter closure angle and peripheral anterior syneehiae, group B was 10 eyes with more than 1/2 perimeter but less than 3/4 perimeter closure angle and peripheral anterior synechiae, gloup C was 18 eyes with more than 3/4 perimeter closure angle and peripheral anterior synechiae. The best corrected visual acuity （BCVA） ,intraocular pressure （IOP）, anterior chamber angle width and anterior chamber depth （ACD） were measured and recorded. Results Vision of all 36 eyes improved differently and deepening of anterior chamber depth were found. Except group A, IOP was fall obviously in group B and group C without medication. There was significant difference between preoperation and postoperation, but there was no significant difference between the two groups postoperation. The angles examined by gonioscopy and UBM were wider than that of preoperation, the extent of any touch or adhesion between iris and trabeculae reduced. All angle circumference opened again in 15 eyes, there were still 1/4 - 1/2 perimeter angle closure or synechia in 7 eyes （ group C ） ,less than 1/4 perimeter in 12 eyes （ 2 eye s in group A, 4 eyes in group B, 6 eyes in group C ）, peripheral anterior synechiae formation or closure angle and IOP elevation did not recur after 6 months postoperation up to 24 months; more than 3/4 perimeter in 2 eyes （ group C ）and glaucoma recured ather surgery earlier period. Conclusion Phacomulsification with foldable PC - IOL implantation can manage the ACG with anterior chamber angle closure or synechiae abroad effectively, but the ACG possibly recured in that more than 3/4 perimeter even whole angle closure with uncontrolled lOP preoperation.