闭角型青光眼合并白内障行超声乳化术的临床观察

Clinical observation of primary angle-closure glaucoma and cataract underwent phacoemulsification

目的:探讨超声乳化白内障摘除联合人工晶状体植入术治疗白内障合并不同房角关闭程度的闭角型青光眼患者的临床疗效。方法:白内障合并闭角型青光眼患者31例35眼,根据房角关闭程度分为A,B两组。A组(房角关闭粘连≤90°)19眼,B组(房角关闭粘连90°～180°)16眼。均施行超声乳化白内障摘除联合人工晶状体植入手术。观察两组手术前后视力、眼压、前房深度、房角变化情况。结果:白内障合并闭角型青光眼患者31例35眼术后视力均有提高,房角加深。房角镜检查:A组19眼房角完全开放者16眼(84%),B组16眼中房角完全开放者13眼(81%)。A,B两组房角开放差异无统计学意义(P>0.05)。眼压:术前A组眼压为35.13±4.18mmHg,B组为45.01±5.31mmHg。术后1wk,A组眼压控制在14.25±3.22mmHg,B组眼压控制在14.30±3.19mmHg。A,B两组术后眼压差异无统计学意义(P>0.05)。结论:白内障合并闭角型青光眼的患者,单纯行超声乳化白内障可以有效治疗房角关闭粘连≤180°的患者,对于房角关闭粘连>180°的患者,可以考虑联合青光眼手术的治疗。

AIM ： To study the clinical efficacy of phacoemulsification and intraocular lens implantation for cataract patients with different angle-closure degree of angle-closure glaucoma. METHODS： There were 31 patients 35 eyes who were with angle-closure glaucoma and cataract. According to the degree of angle closure adhesions, they were divided into groups A, B. Group A （the angle closure adhesions≤ 90 °） had 19 eyes, group B （the angle closure adhesions 90° -180°） had 16 eyes. Phacoemulsification and intraocular lens implantation were performed for both groups. The preoperative and postoperative visual acuity, intraocular pressure（10P）, anterior chamber depth, angle changes and the length of the axial length, lens thickness, vitreous length in the two groups were observed and statistically analyzed. RESULTS： The angle-closure glaucoma with cataract patients＇ visual acuity was improved and the angle deepened. Gonioscopy： The number of fully open angle was 16 in the group A（84%）. And in the group B, completely open angle was13 eyes （81%）. The difference of A and B was not statistically significant （P〉0.05）. lOP： preoperative lOP was 35.13± 4.18mmHg in A, and in B was 45.01±5.31 mmHg. After 1 week, lOP in group A was controlled in 14.25 ±3.22mmHg and group B was 14.30± 3.19mmHg, there was no statistical significance （P〉0.05）. CONCLUSION： Positive relationship exists between the proportion of axial length, lens thickness and vitreous length. For angle- closure glaucoma with cataractpatients, a simple surgery of the phacoemulsification can effectively treat angle-closure adhesions ≤ 180 °, and for patients with angle-closure adhesions〉 180 °, the joint treatment of glaucoma surgery can be considered.