原发性闭角型青光眼白内障术后房角形态的改变

The change of configuration about anterior chamber angle of primary angle closure glaucoma before and after extraction of cataract

目的 :研究原发性闭角型青光眼合并白内障患者在白内障摘除及人工晶体植入术后房角形态的改变 ,揭示白内障手术对闭角型青光眼房角形态的影响。方法 :分别用中央前房深度仪、前房角镜、裂隙灯显微镜、Schi tz压陷式眼压计对 2 8例 ( 2 8只眼 )闭角型青光眼合并白内障连续病例手术前后的中央前房深度、房角形态、眼压进行对照观察 ,其中有 6例病人用UBM检查手术前后的房角情况。结果 :术后中央前房深度加深者 2 8例 ( 1 0 0 % ) ,眼压不同程度下降者 2 3例 ( 82 % ) ,房角增宽者 2 1例( 75% ) ,术前房角有粘连者 2 1例 ,术后粘连范围减少者 1 1例 ( 52 % )。UBM检查发现瞳孔阻滞性闭角型青光眼在白内障术后 ,中央前房加深 ,虹膜由膨隆变为平坦 ,房角入口由狭窄、关闭变为增宽、开放 ,睫状体在白内障术后发生后移 ;非瞳孔阻滞性闭角型青光眼在白内障术后 ,虹膜根部附着位置与形态及睫状体的形态与位置无明显改变 ,房角没有增宽和开放。结论 :瞳孔阻滞性闭角型青光眼合并白内障患者在白内障术后由于瞳孔阻滞解除 ,房角均可较术前不同程度增宽 ,甚至部分非牢固粘连区可再开放 ,所以 ,应先行单纯白内障摘除及人工晶体植入术 ,术后对房角和眼压再评价 ,然后针对术后房角和眼压状态作出对青光眼的处理 ;非瞳孔?

Objective:To reveal the influence of extraction of cataract on the anterior chamler angle(ACA) of patients with primary angle closure glaucoma(PACG). Methods:28 PACG patients (28 eyes),who underwent cataract extraction,were examined pre and post operatively with Haag Streit slitlamp、gonioscope and Schitz applanation tonometer,to observe the anterior chamber depth (ACD)、configuration of chamber angle,intraocular pressure (IOP) and marphology of iris and ciliary body.Some patients had UBM examination.Results:The central ACD in 28 patients (100%) became deeper after cataract extraction,and IOP were lowered in varying degree in 23 patients(82%),while ACA became wider in 21 patients(75%).Before extraction of cataract,there were 21 patients having synechia of ACA,and among them,11 patients (52%) synechiae reopened postoperatively.With UBM, following changes were seen in the pupillary blocking PACG patients,but not in the non pupillary blocking patients:iris bombé became flat、central ACD deeper、ACA wider and reopened and ciliary body moving backward.Conclusion:Extraction of cataract may change the ACA configuration in pupillary blocking PACG patients but not in non pupillary blocking PACG patients.In most of the pupillary blocking PACG patients,the ACD become deeper and pupillary block relieved.Thus,after extraction of cataract in PACG patients,the anterior chamber should be reevaluated,and approprriate managemeut given according to the condition of ACA and IOP.