三种手术方式治疗闭角型青光眼临床前期及先兆期的疗效观察

Effects of three kinds of surgical treatment on angle-closure glaucoma at preclinical or presymptomatic stage

目的:探讨超声乳化晶状体摘除并人工晶状体植入术治疗急性闭角型青光眼临床前期、先兆期的疗效。方法:选择原发性闭角型青光眼临床前期或先兆期患者66例66眼,随机分为3组,A组行激光周边虹膜造孔术,B组行单纯超声乳化,C组行超声乳化联合虹膜周边切除术(各22眼)。并比较观察3组术后眼压、中央前房深度、视力、房角Scheie分级等的变化。平均随访11.72±0.96mo。结果:术后最终随访时发现:A,B,C组患者的前房角(Scheie分级法)均显著增宽(P<0.05),3组间的房角Scheie分级无显著性差异;A组中央前房深度无明显变化,B、C组中央前房深度较术前均显著加深(P<0.05),A组的中央前房深度明显低于B、C组(P<0.05),B、C组间的中央前房深度无显著性差异;3组平均眼压无明显变化,三组间的平均眼压无明显差异(P<0.05);A组暗室激发试验的阳性率无显著变化,B,C组暗室激发试验的阳性率均显著小于术前。A,B,C3组暗室激发试验的阳性率无显著差异;A组患者最佳矫正视力无明显提高,B,C组患者最佳矫正视力较术前均显著提高(P<0.05)。结论:在加深中央前房深度、降低术后暗室激发试验的阳性(潜在的可能)及提高术后视力的效果方面,超声乳化晶状体摘除并人工晶状体植入术优于激光周边虹膜造孔术;超声乳化晶状体摘除并人工晶状体植入术中不需要进一步做周边虹膜切除术。

AIM： To observe the clinical effect of phacoemul- sification and intraocular lens on patients with angleclosure glaucoma at preclinical or presymptomatic stage. METHODS： Sixty-six patients （66 eyes） with acute angle-closure glaucoma at preclinical or presymptomatic stage were chosen and randomly divided into three groups, with 22 eyes in each group. Group A received laser peripheral iridotomy. Group B received phacoemulsification and intraocular lens. Group C received phacoemulsification and intraocular lens combined with peripheral iridotomy. The changes of intraocular pressure, anterior chamber angle, corrected vision and anterior chamber depth were examined during the 11. 72 ± 0.96 months follow-up. RESULTS： The results in the final follow-up after operation were as follows ： the anterior chamber angle in group A, group B and group C widened significantly（ P〈 0.05）, the difference in the gonioscopy grading of the anterior chamber angle among the three groups was not statistically significant. The anterior chamber depth in Group A did not change significantly, the anterior chamber depth significantly increased in group B and group C（P〈0.05）, the anterior chamber depth in group A was lower than that in group B and group C, and the difference was statistically significant （P 〈 0. 05 ）, the difference between group B and group C was not statistically significant. The intraocular pressure in the three groups did not change significantly, the variance in the intraocular pressure among the three groups was not statistically significant. The sensitivity of dark room provocative test in group A did not change significantly, the sensitivity of dark room provocative test in group B and group C significantly decreased （ P 〈 0. 05）, the difference among the three groups was not statistically significant. The corrected vision in group A did not change significantly, the corrected vision in group B and group C improved significantly（ P〈 0.05）. CONCLUSION ： Phacoemulsification and intraocular lens is superior to laser peripheral iridotomy on the aspects of widening the anterior chamber angle, reducing potentialy the sensitivity of dark room provocative test and improving the corrected vision. It is not necessary to combine peripheral iridotomy with phacoemulsification and intraocular lens.