内窥镜在原发性闭角型青光眼房角分离术中的临床价值

Endoscope-assisted goniosynechialysis with phacoemulsification and intraocular lens implantation for treatment of primary angle-closure glaucoma

目的在原发性闭角型青光眼的房角分离术中应用内窥镜,探讨内窥镜在房角分离术中的作用,并观察其早期疗效。方法31例(31眼)原发性闭角型青光眼患者,采用内窥镜直视下房角分离术联合白内障超声乳化摘除人工晶体植入术。其中急性闭角型青光眼17例(17眼),慢性闭角型青光眼14例(14眼)。随访并观察其并发症、眼压、视力、前房深度及房角情况。结果术后有3例发生前房出血、渗出,均可逐渐吸收。两组术后眼压均有所下降(P均<0.05),相同时间段两组间眼压比较差异均无统计学意义(P均>0.05)。术后6个月时仅有1例慢性闭角型青光眼的眼压仍>21 mmHg,应用降眼压药物可控制在正常范围内。两组术后视力、前房深度均有不同程度提高,两组间比较差异无统计学意义(P>0.05)。急性和慢性闭角型青光眼组术后分别为16眼(94.1%)和9眼(64.3%)房角全部开放,两组间比较差异有统计学意义(P<0.05)。术后6个月有1眼急性闭角型青光眼和5眼慢性闭角型青光眼仍存在不同程度和范围的房角粘连,随访过程中未见房角粘连范围明显扩大。结论对于原发性闭角型青光眼,内窥镜引导的房角分离术直观、精准、安全,近期疗效确切,具有临床应用价值。

Objective To evaluate the early therapeutic effect of endoscope-assisted goniosynechialysis combined with phacoemulsification and intraocular lens implantation for management of primary angle-closure glaucoma. Methods Endoscope-assisted goniosynechialysis combined with phacoemulsification and intraocular lens implantation was performed in 31 patients （31 eyes） with primary angle-closure glaucoma, including 17 eyes with acute angle closure glaucoma and 14 eyes with chronic angle closure glaucoma. The patients were regularly followed up to observe the postoperative complications and changes in the intraocular pressure, visual acuity, anterior chamber depth and anterior chamber angle. Results Hyphema occurred in 3 eyes after the operation and was absorbed gradually. The intraocular pressure decreased significantly in all the patients after the operation （P〈0.05） but showed no significant differences between the acute and chronic cases （P〉0.05）. The intraocular pressure was over 21 mmHg in only one eye in the chronic group, and could be controlled by ocular hypotensive agents. Visual acuity improved and the anterior chamber depth increased in all the patients, showing no significant differences between the two groups （P〉0.05）. The anterior chamber angle all opened after the operation in 16 eyes （94.1%） in acute group, a rate significantly higher than that in the chronic group （9 eyes, 64.3%） （P〈0.05）. Anterior chamber angle was adhesive in 1 eye in the acute group and in 5 eyes in the chronic group. No further extension of goniosynechiae was found in these cases during the follow-up period. Conclusions Endoscope-assisted goniosynechialysis has such advantages as optimized visualization, accuracy and safety in the management of primary angle-closure glaucoma.