白内障超声乳化吸除术治疗原发闭角型青光眼疗效观察

Clinical study on the effect ofphacoemulisification inthe management of angle-closure glaucoma

目的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对闭角型青光眼的治疗作用。方法回顾性分析自2005年3月至2007年3月手术的闭角型青光眼合并白内障患者26例（32只眼），按照其房角关闭粘连状态分为2组，A组20只眼，房角关闭粘连≤1／2周，B组12只眼，房角关闭粘连〉1／2周，常规术前术后测量视力，最佳矫正视力，眼压，超声生物显微镜，中央前房深度，Goldman前房角镜检查。均在眼压得到最大控制后行单纯白内障超声乳化吸除联合后房型人工晶状体植人术。结果视力两组术后均有不同程度提高。术后两组中央前房深度明显增加。UBM和前房角镜观察房角不同程度开放加宽，周边前粘范围缩小，部分房角重新开放。全部开放12只眼（A组），房角粘连关闭≤1／4周8只眼（A组4只眼B组4只眼），1／4〈房角粘连关闭≤1／2周8只眼（A组4只眼，B组4只眼），1／2〈房角粘连关闭~〈3／4有3只眼（B组），房角粘连关闭≥3／41只眼（B组）。眼压：B组术前术后比较有明显变化，具有统计学意义。但组间没有统计学意义。其中，B组1例2只眼术后一周内眼压再次升高，药物控制不理想，术后8周行小梁切除术控制眼压正常。结论单纯白内障超声乳化吸出术对于房角关闭范围≤1／2周且术前药物控制良好不伴有视野损害的闭角型青光眼具有确切疗效。尤其对于首次发作的急性闭角青光眼有效。但对于术前房角粘连关闭范围≥1／2周且用药后控制眼压不理想伴有视野损害者，单纯晶体摘除，术后可能青光眼复发，需要长期随诊，且需联合小梁切除可有确切疗效。

Objective To evaluate the effectiveness of anterior chamber angle and lOP after phacomulsification with foldable posterior chamber intraocular lens implantation （PEA＋IOL） in management of primary angle closure glaucoma （PACG） in different extent closure angle with cataract. Methods Phacomulsification with foldable PC-IOL implantation was performed in 26 patients （32eyes） with ACG in our hospital. According to angle closure degrees and peripheral anterior chamber before operation, the patients were divided into two groups. Group A： 20 eyes with less than 1/2 perimeter closure angle and peripheral anterior chamber; Group B： 12 eyes with more than 1/2 perimeter closure angle and peripheral anterior chamber. The best cor- rected visual acuity （BCVA）, intraocular pressure （IOP）, anterior chamber angle width and anterior chamber depth （ACD） were measured and recorded. Results Vision of all 32 eyes improved differently and deepening of anterior chamber depth were found. Intraocular pressure （lOP） was fall obviously in two groups without medication. There was significant difference between preoperation and postoperation. But there were 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 12 eyes （group A）, there were less than 1/4 perimeter angle closure or synechia in 8 eyes （4 eyes in group A, 4 eyes in group B）, 1/4-1/2 perimeter angle closure in 8 eyes （4 eyes in group A, 4 eyes in group B ）, 1/2- 3/4 perimeter angle closur in 3 eyes （ group B ）, more than 3/4 perimeter an- gle closure in 1 eyes （group B ）. Conclusions Phacomulsification with foldable PC-IOL implantation can manage the ACG with all anterior chamber closure or synechia abroad effectively, but the ACG possibly recurred in that more than 1/2 perimeter even whole angle closure with uncontrolled IOP preoperation.