青光眼白内障四联手术治疗极浅前房持续性高眼压

目的：探讨玻璃体放液+白内障超声乳化吸出+人工晶状体植入+复合式小梁切除四联手术治疗急性闭角型青光眼持续高眼压的效果及安全性。

方法：回顾分析对我院62例62眼，男26例26眼，女36例36眼，符合诊断急性闭角型青光，前房深度浅Ⅰ-浅Ⅱa级，经最大剂量药物治疗48～72h后眼压仍>40mmHg的患者。根据患者术前视力分为两组，其中33例33眼实施玻璃体放液+白内障超声乳化吸出+人工晶状体植入+复合式小梁切除四联手术治疗(试验组)，29例29眼实施前房穿刺放液+复合式小梁切除两联手术治疗(对照组)，术后通过观察视力、眼压、并发症及滤过泡情况等，比较两组患者治疗效果。

结果：所有患者经手术治疗后高眼压均得到控制，术后1wk四联手术组眼压明显低于两联手术组(P<0.05)。两组观察6mo，四联术后视力及手术完全成功率明显优于两联手术，在术后并发症及有效滤过泡形成率方面两组无显著差异(P>0.05)。

结论：极浅前房的急性闭角型青光眼患者在持续高眼压下，玻璃体放液+白内障超声乳化吸出+人工晶状体植入+复合式小梁切除术四联手术及治疗是安全有效的，在持续高眼压状态下，应积极手术治疗，以挽救患者视力。

Study on the combined four-surgery of cataract-glaucoma in managing extremely shallow anterior chamber and sustained high intraocular pressure

AIM: To study the efficacy and safety of the combined four-surgery of vitreous humour extraction, phacoemulsification cataract, artificial lens implantation, and compound trabeculectomy in managing sustained high intraocular hypertension of acute angle-closure glaucoma.

METHODS: Retrospectively analyzed the post-operation result of 62 patients(62 eyes), consisting of 26 males(26 eyes)and 36 females(36 eyes), who were diagnosed as acute angle-closure glaucoma with anterior chamber depth of shallow class-I-IIa. Their IOP were greater than 40mmHg after 48-72h being dosed at the maximum. The patients were divided into two groups with their preoperative visual acuity. The combined four-surgery of vitreous humour extraction, phacoemulsification cataract, artificial lens implantation, and compound trabeculectomy were performed on 33 patients(33 eyes)in the experimental group, while the binary-sugery of anterior chamber paracentesis and compound trabeculectomy was performed on 29 patients(29 eyes)in the control group. Post-operative visual acuity, IOP, complications and filtering bleb were observed to compare the treatment results.

RESULTS: The high IOP of all eyes were controlled after surgeries. The IOP of the four-surgery group was obviously lower than the binary-surgery group after 1wk post the surgeries(P<0.05). Both groups were observed for 6mo. Post-operative visual acuity and complete success rate of the four-surgery were distinctly better than the binary-surgery, and no distinct difference was found in complications and filtering bleb occurrence(P>0.05).

CONCLUSION: The combined four-surgery of vitreous humour extraction, phacoemulsification cataract, artificial lens implantation, and compound trabeculectomy is safe and effective in managing acute angle-closure glaucoma with extremely shallow anterior chamber and sustained high IOP. Such surgeries should be actively performed on the patients with sustained high IOP to rescue their visual acuity.