白内障超声乳化术后急性瞳孔阻滞型高眼压原因分析及处理

Analysis of the reasons for high intraocular pressure caused by acute pupillary block after phacoemulsification and its management

目的探讨白内障超声乳化人工晶状体（IOL）植入术后急性瞳孔阻滞型高眼压症的原因和处理方法。方法回顾性病例研究。2000年1月至2011年12月期间在台州市眼科医院行白内障超声乳化术后早期由于瞳孔阻滞所致的急性高眼压症者17例（17眼），其中IOL瞳孑L夹持所致5例，囊袋阻滞综合征（CBS）所致12例。对IOL瞳孔夹持所致的5例采用复方托吡卡胺眼药水散瞳和静脉滴注20％甘露醇浓缩玻璃体治疗。对CBS所致的12例，其中行Nd：YAG激光前囊孔边缘切开2例和前囊周边部切开5例；手术行前囊孔边缘放射状切开2例和补充扩大前囊口直径3例，并作前房及囊袋冲洗。观察处理后的眼压、视力、IOL位置、前房和囊袋情况。结果术后随访2～3个月，所有术眼瞳孔阻滞消失，眼压正常，视力提高，前房加深，IOL位置正常。IOL瞳孔夹持所致的5眼末次随访时眼压为11—19mmHg，平均（15．0±4．0）mmHg。最佳矫正视力为0．7—1．0。CBS所致的12眼末次随访时眼压为12～18mmHg，平均（15．0~3．0）mmHg。最佳矫正视力为0．8～1．0。结论IOL瞳孔夹持和CBS可以引起白内障超声乳化术后早期瞳孔阻滞型急性高眼压症。对IOL瞳孔夹持者采用散瞳，对CBS所致者行Nd：YAG激光或手术治疗，均可有效解除其所致的高眼压。

ObjectiVe To study the causes of acute high intraocular pressure （HIOP） caused by pupillary block after phacoemulsification with intraocular lens （IOL） implantation and the treatments to manage the condition. Methods Seventeen patients （17 eyes） with early postoperative acute HIOP caused by pupillary block who underwent cataract phaeoemulsification with IOL implantation in Taizhou Eye Hospital between January 2000 and December 2011 were retrospectively analyzed. Among the 17 cases, 5 cases were caused by onset IOL pupillary capture and 12 cases by capsular block syndrome （CBS）. Conservative approaches were adopted that included tropicamide phenylephrine eye drops for mydriasis and 250 ml of intravenous drip with 20% mannital to the concentrated vitreous for the 5 cases of acute pupillary block HIOP caused by onset IOL pupillary capture. For the other 12 cases with CBS, Nd： YAG laser was used for anterior capsulotomy to cut the margin of the continuous circular capsulorhexis （CCC） in 2 cases and anterior peripheral capsulotomy was performed in 5 cases. Radialization was performed surgically to cut the margin of the CCC in 2 cases and supplied the CCC to enlarge the diameter in 3 cases. And finally, aspiration-irrigation was performed to flush the anterior chamber and the capsule. Intraocular pressure （IOP）, visual acuity, position of IOL, and the conditions of the anterior chamber and capsule were measured after treatment. Results The patients were followed up for 2-3 months after treatment. Pupillary block disappeared, IOP was normal, visual acuity improved, the anterior chamber deepened and the position of the IOL was normal in all operated eyes. At the last follow-up, IOP was 11-19 mmHg （mean 0.85＋0.15 mmHg） and best corrected visual acuity （BCVA） was 0.7-1.0 in 5 cases with IOL pupillary capture. IOP was 12-18 mmHg （mean 15＋3.0 mmHg） and BCVA was 0.8-1.0 in 12 cases with CBS. Conclusion IOL pupillary capture and CBS can that induces acute pupillary block HIOP. Applying mydriasis can effectively resolve acute pupillary block HIOP caused by the IOL pupillary capture. Using ND： YAG laser and operation are the effective measures to treat acute pupillary block HIOP caused by CBS.