白内障超声乳化治疗闭角型青光眼临床分析

Clinical study on the effect of phacoemulisification in the management of angle-closure glaueorna

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2007年5月～2011年3月手术的闭角型青光眼合并白内障患者52例(64只眼),按照其房角关闭粘连状态分为2组,A组40只眼,房角关闭粘连≤1/2周,B组24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入术。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24只眼(A组),房角粘连关闭≤1/4周16只眼(A组8只眼B组8只眼),1/4<房角粘连关闭≤1/2周,16只眼(A组8只眼,B组8只眼),1/2<房角粘连关闭≤3/4,有6只眼(B组),房角粘连关闭>3/4,2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 IOP after phacomulsification with foldable posterior chamber intmocular lens implantation（PHA＋IOL）in management primary angle closure glaucoma（PACG）in different extent closure angle with cataract.Methods Phacomulsification with foldable PC-IOL implantation was performed in 52 patients（64 eyes）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：40 eyes with less than 1/2 perimeter closure angle and periphcral anterior chamer,Group B：12 eyes with more than 1/2 perimeter closure angle and peripheral anterior chamber.The best corrected visual acuity（BCVA）,intmocular pressure（IOP）,anterior chamber angle width and anterior chamber depth（ACD）were measured and recorded.Results Vision ofall 64 eyes improved differently and deepening of anterior chamber depth were found.Intraoculur pressure（IOP）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 postoprration.The angles examined by gonioscopy and UBM were wider than that of preoperation.the extent of any touch or adhesion between iris and trabeabeculae reduced.All angle circumference opened again in 24 eyes（group A）,there were less than 1/4 perimeter angle closure or synechia in 16 eyes（8 eyes in group A,8eyes in group B）,1/4-1/2 perimeter angle closure in 16 eyes（8 eyes in group A,8 eyes in group B）,1/2-3/4 perimeter angle closur in 6 eyes（group B）,more than 3/4 perimeter angle closure in 1 eyes（group B）.Conclusion 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.