激光虹膜成形联合白内障超声乳化吸除术治疗急性闭角型青光眼

The effect of laser iridoplasty combined phacoemulsification on attack of acute primary angle-closure glaucoma

目的 分析激光虹膜成形术联合白内障超声乳化吸除术,对药物治疗不能迅速缓解的合并白内障的原发性闭角型青光眼急性发作的治疗效果.方法 对药物治疗不能迅速缓解的合并不同程度白内障的原发性闭角型青光眼急性发作患者12例（14只眼）行激光虹膜成形术以开放房角、控制眼压,而后行白内障超声乳化吸除联合人工晶状体植人术,随访（3～12）月,观察房角、眼压、视力变化及并发症情况.结果 激光虹膜成形术后超声生物显微镜检查示所有术眼房角开放;激光虹膜成形术前眼压（44.5±6.3）mmHg,术后2h、4h的眼压分别为（20.5 4±3.5）mmHg、（11.9 4±2.9）mmHg,与光凝前眼压的差异均有统计学意义（t=21.4956,P=0.000;t=241.5631,P=0.000）;白内障超声乳化术后2周、3月的眼压均低于21mmHg,平均分别为（16.54±2.7）mmHg、（15.84±2.6）mmHg;激光虹膜成形术后和白内障超声乳化吸除术后视力不同程度提高;无严重并发症.结论 激光虹膜成形术能有效缓解药物治疗无效的原发性闭角型青光眼急性发作,并可作为白内障超声乳化吸除术治疗急性闭角型青光眼的前期治疗.

Objective To investigate the effect of laser iridoplasty combined phacoemulsification on attack of acute primary angle-closure glaucoma with cataract which could not abate rapidly by medication. Methods Twelve cases （14 eyes） with attack of acute primary angle-closure glaucoma and cataract which were unresponsive to medication were operated with laser iridoplasty to open anterior chamber angle and control intraocular pressure （IOP）, then were perfomed phacoemulsification for cataract extraction with intraocular lens implantation.Results Ultrasound biomicroscopy showed anterior chamber angle of all cases were opened after laser iridoplasty.IOP was reduced from （44.5± 6.3） mmHg before laser iridoplasty to （20.5± 3.5） mmHg at 2 hours and （11.9± 2.9） mmHg at 4 hours after laser iridoplasty respectively.IOP was （16.5± 2.7） mmHg at 2 weeks and （15.8± 2.6） mmHg at 3 months after phacoemulsification, and one of each was lower than 21 mmHg.The uncorrected visual acuity of all cases was improved after laser iridoplasty or phacoemulsifi-cation.Conclusions Laser iridoplasty could be effective to attack of acute primary angle-closure glaucoma with cataract which is unresponsive to medical therapy and could be performed as basal treatment before phacoemulsification for cataract extraction with intraocular lens implantation.