超声乳化白内障吸除人工晶状体植入治疗闭角型青光眼

目的：观察超声乳化白内障吸除联合人工晶状体植入术治疗合并白内障的原发性急、慢性闭角型青光眼的疗效和安全性。方法：选择收住本院的非青光眼的单纯白内障26例（28眼），连续选择原发性闭角型青光眼60例（70眼），其中急性闭角型青光眼（以下简称急闭）临床前期14眼，发作期29眼，慢性闭角型青光眼（以下简称慢闭）27眼。术前视力手动／眼前～0．8，均有不同程度的晶状体混浊。入院后行超声乳化术。随访时间为3～24个月，平均（8．5±4．5）个月。结果：①单纯白内障组术前术后眼压无显著差异（t=1．9201，P〉0．05）。急闭临床前期组术后平均眼压下降（t=3．9910，P〈0．01）。急闭发作期组术后平均眼压比术前明显下降（t=4．7441，P〈0．01）。慢闭组术后平均眼压比术前明显下降（t=4．4976，P〈0．01）。②急闭发作期，慢闭组平均使用青光眼药物术后较术前明显减少。⑧急、慢闭组术后前房角均较术前增宽。④前房深度急、慢闭组术后较术前增加；周边前房深度两组术后均较手术前增加。⑤56只原发性闭角型青光眼术后48只眼（85．7％）最佳矫正视力提高，28只眼（50．0％）矫正视力〉0．5。结论：超声乳化白内障吸除术对单纯白内障术后眼压无影响，对急闭临床前期产生降低眼压作用，可治疗急、慢闭，急闭疗效优于慢闭。

Management of primary angle-closure glaucoma by phacoemulsification with foldable posterior chamber intraocular lens implantation

OBJECTIVE: To evaluate the efficacy and safety of phacoemulsification with foldable posterior chamber intraocular lens(PC-IOL) implantation in the management of acute or chronic primary angle-closure glaucoma(APACG or CPACG) with cataract. METHODS: Twenty-six cases(28 eyes) with simple cataract and 60 cases(70 eyes)of PACG with cataract, including 14 eyes of preclinical APACG, 29 eyes of paroxysmal APACG, 27 eyes of CPACG. Visual acuity distributed from hand movement to 0.8. Phacoemulsification and intraocular lens implantation were performed and patients were followed up for(8.5+/-4.5) months. RESULT: In simple cataract group, postoperative IOP did not decrease(t=1.9201, P>0.05); in preclinical APACG group, postoperative IOP decreased (t=3.9910, P<0.01); in paroxysmal APACG group, postoperative IOP decreased (t=4.7441, P<0.01); in CPACG groups, postoperative IOP decreased (t=4.4976, P<0.01). In APACG and CPACG groups postoperative antiglaucoma medication reduced. In APACG and CPACG groups, angle of anterior chamber was widen. Preoperative central and peripheral ACD of APACG and CPACG were much less than those of postoperative. In 56 eyes of PACG, visual acuity was corrected in 48 eyes(85.7%) including 28 eyes(50%) with corrected visual acuity>0.5. Conclusion: The phacoemulsification with foldable posterior chamber intraocular lens implantation is beneficial for PACG with cataract, and the curative efficacy of APACG is better than that of CPACG.