小切口白内障囊外摘除人工晶状体植入联合房角分离治疗原发性闭角型青光眼合并白内障的临床观察

Clinical observation on small incision extracapsular cataract extraction and intraocularlens implantation combined with goniosynechialysis in treating primary angle closure glaucoma with cataract

目的观察小切口白内障囊外摘除人工晶状体（IOL）植入联合房角分离术治疗原发性闭角型青光眼（PACG）合并白内障的患者临床疗效及手术适应证的探讨。方法已确诊为PACG患者92例（92眼）,均合并有程度不同的晶状体混浊。所有患者行小切口白内障囊外摘除IOL植入联合房角分离术,术后随访9~24个月。随访观察手术前后眼压、视力、中央前房深度、房角形态、房水流畅系数与压畅比和降眼压用药数量等的变化情况。结果术后随访最终平均眼压明显低于术前平均眼压（P〈0.01）,术后最佳矫正视力好于术前（P〈0.01）。前房深度加深（P〈0.01）。房角全部开放72眼（78.26%）。术后房水流畅系数与压畅比有明显改善（P〈0.01）。术后平均使用降眼压药数量明显减少（P〈0.01）。另14眼（15.22%）虽经联合降眼压,术后眼压仍大于25 mm Hg（1 mm Hg=0.133 k Pa）,遂加行小梁切除术。结论小切口白内障摘除IOL植入联合房角分离术,能有效降低眼压、加深前房、开放房角、改善视功能,对合并白内障的闭角型青光眼,是安全经济有效的手术方法,对于无超声乳化设备的基层医院值得推广应用。但对于术前房角粘连关闭大于270°的患者,联合采用小梁切除术,对于挽救患者的视功能,是必要和稳妥的。

Objective To observe the clinical effects and surgical indications of small incision extracapsular cataract extraction and intraocular lens （IOL） implantation combined with goniosynechialysis in the patients diagnosed primary angle closure glaucoma （PACG） complicating cataract. Methods Totally 92 cases （92 eyes） of PACG complicating different degrees of pha- eoscotasmus were treated with small incision extracapsular cataract extraction and IOL implantation combined with goniosynechjalysis. The mean follow-up duration was 9-24 months,The preoperative and postoperative intraocular pressure （IOP）, visual acuity, depth of anterior chamber, anterior chamber angle, outflow facility of aqueous humor （C values） and Po/C ratio, and number of glaucoma eye drops were followed up and observed. Results The final mean IOP during postoperative follow up was significantly lower than preoperative mean IOP（P〈0.01 ）, the postoperative optimal corrected visual acuity was better than before operation （P〈 0.001 ） ,the depth of anterior chamber was deepened（P〈0.01 ） and the anterior chamber angle was completely open in 72 eyes （ 78.26% ）, the outflow facility of aqueous humor （ C values ） and Po/C ratio were obviously improved （P〈0.01）, the number of required glaucoma eye drops was decreased （P〈0.01）. IOP in other 14 eyes（15.22%） was still more than 25 mm Hg（ 1 mm Hg=0.133 kPa） although performing the combined lowering IOP,thus trabeculectomy was added. Conclusion Small incision extraeapsular cataract extraction and IOL implantation combined with goniosynechialysis can effectively drop IOP, deepens the anterior chamber, opens the angle, improves the visual function, is a safe, economical and effective operation method for treating PACG compli- cating cataract and is worthy to be promoted and applied in the primary hospitals without ultrasonic emulsification instrument. But for the patients with anterior adhesion and angle closure 〉270°, the combination with trabeculectomy is necessary and reliable for rescuing the visual function of the patients.