Effective treatment for secondary angle-closure glaucoma caused by traumatic lens subluxation:phacoemulsification with capsular-tension-ring implantation combined with ophthalmic endoscope-controlled goniosynechialysis

AIM:To investigate the safety and efficacy of phacoemulsification with capsular-tension-ring implantation and posterior chamber intraocular lens implantation combined with ophthalmic endoscope-controlled goniosynechialysis(Phaco-CTR-IOL-OE-GSL)for treating secondary angle-closure glaucoma induced by traumatic lens subluxation.METHODS:A retrospective and descriptive study was performed on patients with lens subluxation,angle closure,goniosynechia,and evaluated intraocular pressure(IOP)that cannot be controlled with medication,who underwent Phaco-CTR-IOL-OE-GSL.The postoperative best-corrected visual acuity(BCVA),IOP,range of goniosynechia and complications were retrospectively observed.RESULTS:Nine patients with secondary angle-closure glaucoma induced by traumatic lens subluxation were included.The follow-up period was 51.1±8.6 mo.The preoperative range of zonule rupture was 158.2°±33.0°,and the range of goniosynechia was 220.0°±92.5°.The baseline BCVA was 0.9±1.0 logMAR,IOP was 30.7±17.3 mm Hg and number of anti-glaucoma medication was 3.2±1.1.Mild intraoperative hyphaemia with 8 eyes(88.8%)in the anterior chamber,and was absorbed two days postoperatively.One eye(11.1%)had postoperative ciliary body detachment and was recovered after five days of topical drug treatment.BCVA was 0.2±0.2 logMAR at 3 mo postoperatively.The average IOP at the last follow-up was 16.7±2.0 mm Hg,and no anti-glaucoma medications were used.The average range of recurrent goniosynechia was 54.9°±33°at the final postoperative gonioscopic examination.CONCLUSION:Phaco-CTR-IOL-OE-GSL is safe and effective in the treatment of secondary angle-closure glaucoma induced by traumatic lens subluxation.The use of an endoscope provides a more direct and clear examination for GSL,and 360°dissection is easily achieved.

氩离子及Nd:YAG联合激光虹膜切除术治疗PAACG的远期疗效观察

目的:观察激光周边虹膜切除术(laser peripheral iridoplasty,LPIP)治疗房角广泛粘连的原发性急性闭角型青光眼(primary actue angle-closure glaucoma,PAACG)的长期效果。方法:回顾性总结原发性闭角型青光眼(primary angle-closure glaucoma,PACG)急性发作后房角广泛粘连33例33眼的LPIP治疗的远期效果,主要观察患者眼压控制情况及房角粘连的变化。以不使用或使用不超过3种局部降眼压药物,眼压≤21mmHg视为眼压控制。结果:患者24眼随访21～37mo,眼压成功控制,其中15眼使用1～2种局部降眼压药物;9眼因眼压控制不满意最终行小梁切除术,其中6眼于LPIP后3d内手术治疗,另3眼分别于LPIP后18,42d;9mo手术治疗。LPIP治疗后短期内27眼房角粘连不同程度开放,6～12mo后,6眼的房角粘连程度较治疗早期扩大。LPIP治疗后3眼出现核性白内障,其中1眼于激光后3a行白内障超声乳化术。结论:LPIP是治疗房角广泛粘连的急性闭角型青光眼的有效手段,但部分患者在激光后不同时间出现眼压升高,房角再次粘连,应定期检查。

激光周边虹膜成形术治疗房角广泛粘连的急性闭角型青光眼

目的观察激光周边虹膜成形术(LPIP)治疗房角广泛粘连的急性闭角型青光眼的长期效果。方法回顾性总结原发性闭角型青光眼急性发作后房角广泛粘连24例(24眼)的LPIP治疗的远期效果,主要观察患者的眼压控制情况及房角粘连的变化。以不使用或使用不超过3种局部降眼压药物眼压≤21mmHg视为眼压控制。结果16眼随访21～38个月,眼压成功控制,其中6眼使用1～2种局部降眼压药物。8眼因眼压控制不满意最终行小梁切除术,其中5眼于LPIP后3d内手术治疗,另3眼分别于LPIP后18d、42d及9个月手术治疗。LPIP治疗后短期内19眼房角粘连不同程度开放,6～12月后,5眼的房角粘连程度较治疗早期扩大。LPIP治疗后3眼出现核性白内障,其中1眼于激光后3年行白内障超声乳化术。结论LPIP是治疗房角广泛粘连的急性闭角型青光眼的有效手段,但部分患者在激光后不同时间出现眼压升高,房角再次粘连,应定期检查。