白内障超声乳化、人工晶体植入、房角分离联合虹膜根切术治疗原发性闭角型青光眼合并白内障的疗效观察

Efficacy observation of cataract phacoemulsification, intraocular lens implantation, goniosynechialysis combined with iridotomy in the treatment of primary angle-closure glaucoma with cataract

目的 探讨原发性闭角型青光眼合并白内障患者的手术方式及疗效。方法 20例(20只眼)原发性闭角型青光眼合并白内障患者,采用白内障超声乳化、人工晶体植入、房角分离联合虹膜根切术治疗。比较患者术眼手术前后中央前房深度、前房角宽度、眼压、视力,观察术后并发症发生情况。结果 患者术眼术后视力(0.52±0.25)高于术前的(0.21±0.16),眼压(13.53±6.51)mm Hg(1 mm Hg=0.133 kPa)低于术前的(34.25±9.78)mm Hg,差异具有统计学意义(P<0.05)。患者术眼术后中央前房深度(3.63±0.58)mm大于术前的(1.52±0.49)mm,差异具有统计学意义(P<0.05)。患者术眼术后前房角宽度较术前明显改善,差异具有统计学意义(P<0.05)。术后第1天发生2例(10.0%)角膜轻度水肿,1例(5.0%)Tyndall(+), 1例(5.0%)前房角下方少许积血,其余患者术眼情况良好,术眼常规局部用药3 d后相关并发症均全部消失。随访3个月有1例(5.0%)患者需使用1种降眼压药物维持眼压,其余患者眼压控制良好,无需使用降眼压药物。结论 原发性闭角型青光眼合并白内障患者采用白内障超声乳化、人工晶体植入、房角分离联合虹膜根切术治疗,手术操作相对简单,临床效果理想,手术安全性高。

Objective To discuss the surgical methods and efficacy in patients with primary angle-closure glaucoma complicated with cataract. Methods 20 patients(20 eyes) with primary angle-closure glaucoma and cataract were treated with cataract phacoemulsification, intraocular lens implantation, goniosynechialysis combined with iridotomy. The central anterior chamber depth, anterior chamber angle width, intraocular pressure, and visual acuity were compared before and after surgery, and occurrence of postoperative complications were observed.Results After surgery, the visual acuity(0.52±0.25) of patients was higher than(0.21±0.16) before surgery,and the intraocular pressure(13.53±6.51) mm Hg(1 mm Hg=0.133 kPa) was lower than(34.25±9.78) mm Hg before surgery, and the differences were all statistically significant(P<0.05). After surgery, the central anterior chamber depth was(3.63±0.58) mm, which was greater than(1.52±0.49) mm before surgery, and the difference was statistically significant(P<0.05). The anterior chamber angle width after surgery was significantly improved compared with that before surgery, and the difference was statistically significant(P<0.05). 2 cases(10.0%)of mild corneal edema, 1 case(5.0%) of Tyndall(+), and 1 case(5.0%) of slight blood accumulation below the anterior chamber angle occurred on the first postoperative day, and the rest of the patients had good conditions,and all related complications disappeared after 3 d of conventional topical medication in the operated eyes.During the 3-month follow-up, 1 patient(5.0%) needed to use an ocular hypotensive drug to maintain the intraocular pressure, and the remaining patients had good intraocular pressure control and did not need to use ocular hypotensive drugs. Conclusion For patients with primary angle-closure glaucoma and cataract, cataract phacoemulsification, intraocular lens implantation, goniosynechialysis combined with iridotomy is relatively simple, with ideal clinical effect and high surgical safety.