早期前房穿刺及激光周边虹膜成形联合超声乳化治疗持续性高眼压急性闭角型青光眼

Paracentesisand laser peripheral iridoplasty combined with phacoemulsificatio in the treatment of acute angleclosure glaucoma with persistent ocular hypertension

目的探讨早期前房穿刺及激光周边虹膜成形联合超声乳化治疗持续性高眼压急性闭角型青光眼的临床效果。方法入选病例为2015年1月至2016年11月在我院住院治疗的原发性急性闭角型青光眼患者50例(50只眼),入院后给予降眼压药物治疗无效后行前房穿刺术,必要时行激光周边虹膜成形术降低眼压,待眼压控制后,1周内行晶状体超声乳化摘除人工晶状体植入术。观察术前和术后最佳矫正视力、眼压、中央前房深度、前房角宽度和术中、术后并发症。术后随访6个月。结果 50只眼均顺利完成手术,未见严重手术并发症。入院时平均眼压(43.12±9.35)mm Hg,术后6个月降低至(13.91±4.65)mm Hg。术前和术后1、3、6个月差异均有统计学意义(F=812.332,P=0.000)。全部病例术后视力均有不同程度提高;中央前房深度较术前增加;术后6个月50只眼房角全部开放。结论早期前房穿刺及激光周边虹膜成形联合超声乳化治疗持续性高眼压急性闭角型青光眼能及时有效控制眼压、加深前房、增宽房角、提高视力。

Objective To evaluate the outcomes of paracentesisand laser peripheral iridoplasty combined withphacoemulsification in the treatment of acute angle-closure glaucoma with persistent ocular hypertension. Methods total of50 patients（ 50 eyes） enrolled in this study between Jan. 2015 and Nov. 2016. All patients received medication and do not respond to medical therapy. paracentesis andlaser peripheral iridoplasty were performed first to lower IOP,phacoemulsification and intraocular lens implantation was arranged within a week. Best-corrected visual acuity（ BCVA）,intraocular pressure（ IOP）,anterior chamber depth（ ACD） and the angle of anterior chamber of each eye were recorded with following-up ranged from 1 week to 6 months. Results Phacoemulsification with IOL implantation were performed in 50 eyes with no serious complication. The IOP was 43. 12 ± 9. 35 mm Hg on admission day,Which was to 13. 91 ± 4. 65 mm Hg postoperative 6 months. The IOP had an statistically significance in preoperative and postoperative 1 month,3 months and6 months（ F = 812. 332,P = 0. 000）. All cases visual acuity was increased to some exten tpostoperative; the central anterior chamber depth increased postoperative; the anterior chamber of 30 eyes was opened postoperative 6 months. Conclusions Paracentesisand laser peripheral iridoplasty combined with phacoemulsification is an efficient treatment for acute angle-closure glaucoma. It can deepen the anterior chamber,widen anterior chamber angle,can effectively control intraocular pressure and improve visual acuity.