不同类型急性闭角型青光眼行晶状体超声乳化吸出术后眼压控制率比较

Intraocular pressure and anterior chamber angle changes after phacoemulsification in different types of acute angle-closure glaucoma

目的比较不同类型急性闭角型青光眼行晶状体超声乳化吸出术后的眼压控制率及其与前房角改变的关系。设计回顾性病例系列。研究对象急性闭角型青光眼合并白内障以晶状体超声乳化治疗病例173例173眼。方法2005年1月～2007年6月,安溪明仁眼科医院的上述患者173例,通过超声生物显微镜(UBM)检查确定其前房角关闭类型为单纯瞳孔阻滞型(52.0%,90/173)、非瞳孔阻滞型(17.9%,31/173)、混合机制型(30.1%,5/173)。行超声乳化白内障吸除联合折叠型人工晶状体植入术,随访48W;通过UBM对比术前、术后前房深度、前房角变化以及眼压变化。主要指标眼压、前房角开放程度、并发症情况。结果手术后8W三种类型急性闭角型青光眼其眼压控制率分别为单纯瞳孔阻滞型88.9%(64/72)、非瞳孔阻滞型52.0%(13/25)、混合机制型83.4%(35/42),差异有统计学意义(χ2=7.13,P=0.022);随访48W时分别为54.2%(13/24)、33.3%(3/9)、35.8%(5/14),差异有统计学意义(χ2=12.56,P=0.003)。手术中及术后并发症发生率与同期单纯白内障超声乳化手术相当。48W时前房角开放率(UBM检查)分别为单纯瞳孔阻滞型66.7%(16/24)、非瞳孔阻滞型33.3%(3/9)、混合机制型33.3%(4/12)。结论急性闭角型青光眼患者行晶状体超声乳化吸出术其眼压控制有效率依次为单纯瞳孔阻滞型、混合机制型、非瞳孔阻滞型;眼压控制率与前房角开放程度有关。

Objective To evaluate the relationship between intraocular pressure （IOP） and anterior chamber angle in patients with different types of acute angle-closure glaucoma after phacoemulsification and intraocular lens implantation. Design Retrospective case series. Participants 173 cases of acute angle-closure glaucoma coexisting cataract （173 eyes） in Mingren Eye Hospital from January, 2005 to June, 2007. Methods All patients with acute angle-closure glaucoma underwent phacoemulsification and intraocular lens implantation, and were examined with high-frequency ultrasound biomicroscopy （UBM）. Anterior chamber depth （ACD）, intraocular pressure （IOP） and anterior chamber angle （ACA） were measured. Follow-up was 1-48 weeks after surgery. Main Outcome Measures Intraocular pressure, phacoemulsification complications, re-open rate of anterior chamber angle. Results At 8th week after surgery, the rate of lOP control in pupillary block group, non-pupillary blocking group, and multimechanism group was 88.9%, 52.0%, 83.4%, respectively and there was a statistically significant between these groups （X^2=7.13, P=0.022）. At 48th week, the rate of lOP control was 54.2%, 33.3%, 35.8%, respectively （X^2=12.56, P=0.003）. Fifty patients were follow up with UBM, and 66.7% in pupillary block group, 33.3% in non-pupillary blocking group and 33.3% in muhimechanism group in 48 weeks postoperatively showed evidence of the widened anterior chamber angle. No specific postoperative complications were found in this study compared with those with phacoemulsification without glaucoma. Conclusions The use of phacoemulsification and intraocular lens implantation for acute angle-closure glaucoma coexsiting cataract can get best lOP-controlled rates in pupillary block group. It is related to the degree of widened anterior chamber angle.