超声乳化术治疗青光眼合并白内障临床研究

Clinical study of ultrasonic emulsification operation in the treatment of glaucoma with cataract

目的：观察超声乳化白内障吸除联合后房型折叠式人工晶体植入术治疗原发性闭角型青光眼合并白内障的临床疗效。方法对82例（82眼）原发性闭角型青光眼合并白内障患者行超声乳化白内障吸除联合后房型折叠式人工晶体植入术，观察术后6个月视力、眼压、前房深度及房角开放程度的变化，并观察术后并发症的发生情况。结果术后最佳矫正视力≥0．5者54眼，0．4者12眼，0．1～0．3者10眼，＜0．1者6眼，与术前差异有统计学意义（χ2＝43．244，P＜0．01）。急性闭角型青光眼临床前期、急性闭角型青光眼发作期及慢性闭角型青光眼三组眼压术后分别与术前比较，差异均有统计学意义（ t＝7．955、4．741、5．638，均P＜0．01）。且三组前房深度术后分别与术前相比，差异均有统计学意义（ t ＝13．080、11．890、16．124，均P＜0．01）。急性闭角型青光眼和慢性闭角型青光眼术后房角开放程度明显好于术前，且急性闭角型青光眼术后房角开放程度优于慢性闭角型青光眼（χ2＝9．246，P＜0．05）。术后均未出现人工晶体夹持、角膜失代偿、视网膜脱离及黄斑囊样水肿等严重并发症。结论采用超声乳化白内障吸除联合人工晶体植入术治疗原发性闭角型青光眼合并白内障能有效提高视力，控制眼压，加深前房，开放房角，且不良反应发生少，值得推广应用。

Objective To investigate the clinical effects of phacoemulsification with foldable posterior cham-ber intraocular lens implantation in the treatment of primary angle closure glaucoma with cataract .Methods 82 patients（82 eyes） with primary angle closure glaucoma with cataract were selected as the research objects ,and taken the treatment of combination of phacoemulsification and posterior chamber foldable intraocular lens implanta -tion.c The vision,intraocular pressure ,anterior chamber depth and angle opening changes before and after 6 months of operation were ompared ,and the postoperative complications were observed .Results 54 eyes achieved best corrected visual acuity of more than 0.5,12 eyes achieved best corrected visual acuity of 0.4,6 eyes achieved best corrected visual acuity among 0.1 to 0.3 and 6 eyes achieved best corrected visual acuity of less than 0.1.The difference between postoperative best corrected visual acuity and that before operation had significant statistical differences （χ2 =43.244,P〈0.01）.After having the operation ,the intraocular pressure of acute closed angle glaucoma pre clinic , onset period and chronic angle closure glaucoma had significantly improved compared to pre -operation （ t=7.955, 4.741,5.638,all P〈0.01）.The chamber depth of the three groups had also improved substantially compared to that of pre-operation（t=13.080,11.890,16.124,all P〈0.01）.The degree of angle opening of acute closed angle glau-coma and chronic angle closure glaucoma were better than that of pre-operation,and postoperatively ,the degree of an-gle opening of the former turned out to be wider than that of the latter （χ2 =9.246,P〈0.05）.There were no postop-erative intraocular lens clamping,corneal decomposition,severe complication of retinal detachment and macular cys-toids edema .Conclusion The phacoemulsification combined with intraocular lens implantation for the treatment of primary angle closure glaucoma with cataract can effectively improve visual acuity ,control intraocular pressure ,deepen the anterior chamber ,open angle ,and the adverse reactions occurred less ,which is worthy of clinical application .