闭角型青光眼手术前后前房角超声生物显微镜下的变化

目的：探讨应用超声生物显微镜(ultrasound biomicroscopy,UBM)观察瞳孔阻滞型的原发性闭角型青光眼(primary angle-closure glaucoma,PACG)行传统虹膜周边切除术前后前房角的变化。方法：分析我院自2013年6月至2015年1月收治的确诊PACG(瞳孔阻滞型)26例(37眼),男7例,女19例,年龄42~76岁,其中闭角型青光眼临床前期25眼,前驱期7眼,间歇期5眼,均行虹膜周边切除术。分析术后的治愈率：根据术前、术后应用UBM进行前房测量,对UBM提供的眼前段剖面图进行定性观察和分析,比较术前、术后小梁虹膜夹角、房角开放距离;同时观察虹膜形态的改变。结果：1)本组治愈26例36眼,97.3%(36/37),无效1例1眼,2.7%(1/37);2)治疗前后小梁虹膜夹角、前房角开放距离(AOD500)比较(t=2.155,2.172;P<0.05);3)虹膜周边切除术后虹膜根部组织远离小梁网,房角粘连范围减小。结论：利用UBM观察瞳孔阻滞型闭角型青光眼行虹膜周边切除术前后前房角的变化,可以观察到经手术治疗后,前房角解剖结构的改变,根据小梁虹膜夹角、前房角开放距离、术后虹膜形态改变情况,表明临床上虹膜周边切除术是预防和治疗瞳孔阻滞型闭角型青光眼安全有效的方法。     

原发性急性闭角型青光眼高眼压持续状态下的手术治疗

目的探讨闭角型青光眼高眼压持续状态下手术的特点，并评价其临床疗效。方法对52例54只眼，使用局部和全身药物治疗，眼压不能良好控制的原发性闭角型青光眼进行改良小梁切除术治疗。结果54只眼顺利完成手术，术后其中2眼出现前房出血，2眼出现脉络膜脱离，6眼出现浅前房经过相应的处理后稳定。术后1月随访时，视力提高或保持不变的有47只眼占87％，眼压≤21mmHg者有44只眼占81．5％。结论原发性急性闭角型青光眼高眼压持续状态下施行改良小梁切除术是必要、可行，安全有效的。     

复合式小梁切除术对眼前节结构的影响

目的 应用超声生物显微镜(UBM)评价原发性闭角型青光眼患者复合式小梁切除术后眼前节结构的改变.方法 原发性闭角型青光眼30例30眼,对照组30例30眼,利用UBM检测所有眼的眼前节,青光眼患者在术前1d和术后1月进行检查.结果 青光眼患者术前、术后分别与对照组的差异均有统计学意义,术后较术前房角开放程度增加,前房深度其他参数无改变.结论 原发性闭角型青光眼行复合式小梁切除术可以部分改变眼前节形态.     

超声乳化术治疗闭角型青光眼84例的临床分析

目的 探讨超声乳化术对闭角型青光眼的治疗效果.方法 回顾分析2008年7月至2010年6月在我院住院治疗的84例(94只眼)闭角型青光眼患者的临床资料,患者均有不同程度的晶状体混浊,行超声乳化联合人工晶体植入术,术后随访6个月至3年,平均(18.40 ±9.51)个月.结果 患者术后视力明显提高,眼压降低,前房深度增加,与术前比较差异均有统计学意义(P<0.05).结论 超声乳化术治疗原发性闭角型青光眼安全有效、简便经济,值得推广应用.     

三种手术方式在合并白内障的原发性急性闭角型青光眼中的疗效对比

目的 探究在合并白内障的原发性急性闭角型青光眼临床治疗中复合式小梁手术、青光眼白内障联合手术以及超声乳化的疗效对比。方法 选取2016年4月~2018年4月我院收治的58例（76眼）原发性急性闭角型青光眼合并白内障患者,按手术治疗方法分为单纯抗青光眼组（20例28眼）、超声乳化组（15例25眼）和青白联合手术组（23例23眼）。单纯抗青光眼组患者行复合式小梁切除术,超声乳化组患者行超声乳化白内障吸出+折叠人工晶体植入术,青白联合手术组行小梁切除术+周边虹膜切除术+超声乳化白内障吸出+折叠人工晶体植入术。比较三组患者视力、眼压、前房深度、术后并发症情况。结果 治疗后,超声乳化组及青白联合组视力均有提高[（0.22±0.05）D vs（0.77±0.11）D,（0.23±0.05）D vs （0.55±0.09）D]（P＜0.05）;治疗后三组患者眼压水平均有所改善[（49.40±8.25）mmHg vs（16.25±2.34）mmHg,（49.31±8.20）mmHg vs （17.15±2.42）mmHg,（50.51±8.30）mmHg vs （17.25±2.53）mmHg]（P＜0.05）;单纯抗青光眼组前房深度加深幅度较小[（1.65±0.22）mm vs（2.96±0.50）mm]（P＜0.05）,超声乳化组及青白联合组前房深度加深[（1.64±0.20）mm vs（3.68±0.70）mm,（1.66±0.24）mm vs （3.53±0.67）mm]（P＜0.05）。超声乳化组患者术后并发症发生率低于青白联合组及单纯抗青光眼组（0 vs 17.39% vs 17.86%）（P＜0.05）。结论 临床上需要根据PACG合并白内障患者不同的房角情况选择不同的手术方式。     

白内障超声乳化摘除术联合房角粘连分离术治疗慢性闭角型青光眼的临床疗效观察

目的 观察白内障超声乳化摘除术联合人工晶体植入联合房角粘连分离术治疗慢性闭角型青光眼的临床疗效。方法 采取自身对照研究,对按照标准纳入我院的慢性闭角型青光眼患者30例（48眼）,行白内障超声乳化摘除术联合房角粘连分离术,术前及术后1 d、1周、1个月、3个月进行最佳矫正视力、眼压、前方深度、视野、房角开放程度、神经上皮层厚度等结局指标检测。结果 经治疗后,患者术前眼压（36.542±5.624）mmHg,术后3个月（13.958±1.821）mmHg,术后眼压均明显降低,达到正常范围（P＜0.001     

焦虑情绪对青光眼滤过手术后前房恢复的影响

焦虑情绪对青光眼滤过手术后前房恢复的影响山西省晋中地区第一人民医院眼科秦斌山西省晋中地区第一人民医院儿科董文兰前房是抗青光眼手术后重点考察的部位，术后前房恢复的早迟与深浅是手术成功与否的关健所在，它受多种原因影响￣（１）。本文对８０例急性闭角型青光眼...     

超声乳化白内障吸除术对老年闭角型青光眼患者血液流变学的影响

目的 探讨利用超声乳化白内障吸除术治疗老年闭角型青光眼患者前后血流动力学变化及治疗效果的影响。方法 86例老年闭角型青光眼患者,随机分为对照组(n=43)和干预组(n=43),并分别进行小梁切除、超声乳化白内障吸除手术治疗。观察分析两组患者的眼压、血液流变学指标,及其与视力、并发症发生率、前房深度、房角黏连闭合等治疗疗效相关性。结果 治疗前,两组患者的视力及眼压,血浆黏度、红细胞压积及血小板黏附率,前房深度及房角黏连闭合度,均没有显著性差异(P>0.05);治疗后,与对照组相比,干预组视力升高(P<0.05),且眼压降低(P<0.05),并发症发生率降低(P<0.05),血浆黏度、红细胞压积及血小板黏附率等指标均明显降低(P<0.05),前房深度及房角黏连闭合度改善程度均明显提高(P<0.05),治疗疗效明显提高(P<0.05)。结论 老年闭角型青光眼患者接受超声乳化白内障吸除术治疗可有效增强治疗疗效,使并发症发生率进一步降低,并促进患者眼压及视力改善,使患者前房深度及血流动力学稳定性显著提升,并能对房角黏连闭合进行有效控制,在老年青光眼治疗中...     

联合手术治疗急性闭角型青光眼合并白内障的临床疗效

目的观察原发性急性闭角型青光眼(APACG)合并白内障两种手术方式的临床疗效及并发症。方法选择APACG合并白内障患者72例(96只眼),其中男性28例(38只眼),女性44例(58只眼)。将患者配对分为观察组和对照组,两组各36例(48只眼),观察组男性16例(24只眼),女性20例(24只眼),年龄49~75岁,平均年龄57.6岁;对照组男性12例(14只眼),女性24例(34只眼),年龄50~75岁,平均年龄58.5岁。观察组行超声乳化白内障吸除术并植入人工晶状体联合小梁切除术;对照组行超声乳化白内障吸除术并植入人工晶状体联合房角分离术。随访时间为4~18个月,随访期间,定期密切观察患者的视力、眼压、房角、前房深度及并发症等临床指标。结果对比眼压控制方面的术后疗效,观察患者在第1周、1个月、3个月、6个月、12个月随访发现,两组患者在术前和术后眼压降低幅度分别为(4.10±1.69)k Pa、(2.84±1.00)k Pa,差异具有统计学意义(t=2.168,P0.05)。中央前房深度加深幅度和房角形态变化及术后并发症,观察组和对照组术后中央前房深度加深幅度分别为(1.810 4±0.347 0)mm、(2.168 4±0.283 5)mm,差异有显著统计学意义(t=3.462,P0.01)。术后并发症,观察组术后虹膜纤维素样渗出及前房炎症、术后浅前房、角膜水肿的发生率分别比对照组高出8%、3%、2%,表明观察组术后并发症多于对照组。结论两种手术方式对APACG合并白内障患者的临床疗效安全有效;超声乳化白内障吸除术并植入人工晶状体联合小梁切除术在眼压控制更具有优势;在临床疗效方面,超声乳化白内障吸除术并植入人工晶状体联合房角分离术在中央前房深度加深幅度、房角形态变化和术后并发症控制更具有优势;观察组术后并发症多于对照组。     

20例青光眼患者临床治疗体会

目的 观察复合式小梁切除术治疗青光眼的临床效果.方法 对20例(25只眼)青光眼施行复合式小梁切除术(小梁切除术+前房穿刺+丝裂霉素C+巩膜瓣可调缝线),观察术后前房、视力、眼压、滤过泡及其他并发症的情况.结果 术后浅前房、低眼压、视力下降等并发症减少,临床效果满意.结论 复合式小梁切除术治疗青光眼安全性高,术后并发症少,提高手术的成功率,疗效确切,是一种值得推广且安全有效的治疗手段.     

The plateau iris component of primary angle closure glaucoma: developmental or acquired

Primary angle closure glaucoma has been called the most common form of glaucoma in the world, and the leading cause of bilateral blindness. Pupillary block is felt to be the main mechanism of outflow obstruction in this condition. Recent advances in morphologic assessment of angle closure, specifically by means of ultrasound biomicroscopy, have revealed that plateau iris in eyes with angle closure glaucoma is more common than had previously been thought. The most characteristic finding in this disease is thicker and more anteriorly positioned lens. This induces the pupillary block that relives by laser iridotomy. Residual angle closure after laser iridotomy is due to the plateau iris. Peripheral iridoplasty, the standard treatment of plateau iris, tights the peripheral iris and opens the angle but has no effect on the ciliary processes configuration. The ciliary processes are positioned posteriorly after lens extraction but dose not disappears completely. Considering these facts we hypothesized that the plateau iris in primary angle closure glaucoma is a developmental entity that reaches to a critical stage with aging owing to the thickening and forward movement of the lens. Cataract surgery deeps the anterior chamber, widens the irido-corneal angle and reposits the ciliary processes posteriorly, so it can prevents synechia formation and progressive lens-induced angle narrowing and plateau iris progression, the acquired component, with aging.     

双切口行白内障超声乳化联合小梁切除术的临床应用

目的通过双切口行白内障超声乳化联合小梁切除术治疗青光眼和白内障,观察患者手术前后视力、眼压改变及术后并发症情况。方法选取我院自2010年1月至2013年12月青光眼合并白内障患者60例(78眼),将双切口行白内障超声乳化联合小梁切除病例32例(40眼)作为观察组,另外28例(38眼)行白内障超声乳化手术作为对照组,观察2组患者手术前后视力、眼压及前房情况,并随访3~6个月。结果 2组患者手术后视力均有明显提高,眼压有明显改善,但观察组更显著,P0.05,差异有统计学意义。观察组患者前房出现不同的炎症反应,有2例发生前房渗出,对照组前房炎症反应稍轻;2组患者无前房出血、浅前房、脉络膜脱离等发生。结论采用双切口行青光眼白内障联合手术后视力恢复好,眼压控制满意;虽然术后前房反应稍重,但用药后很快缓解,减少了患者多次手术的痛苦及经济负担,但要严格选择病例。     

有晶体眼后房型人工晶体植入术早期并发症观察及其处理

目的观察有晶体眼后房型人工晶体(ICL)植入治疗高度近视早期的并发症及处理情况,并探讨其原因。方法观察在我院行ICL/TICL植入术的患者46例(92眼),在虹膜周切手术和ICL植入手术中及术后半年出现的并发症,记录并发症处理方法以及处理后的情况。结果无1例瞳孔阻滞性青光眼发生,术前虹膜周切后有8眼眼压升高,ICL植入术后有7眼眼压升高,均未超过28 mmHg,未做特殊处理;术前YAG激光虹膜周切组虹膜出血及色素播散的发生率明显高于手术虹膜周切组(P0.05),术中晶体损伤2眼,1眼行透明晶体摘除及人工晶体植入;术后TICL旋转2眼,术后视觉干扰主要表现阴影及眩光各1例,术后视觉心理改变1例。结论 ICL植入治疗高度近视早期并发症少,基本可预防和控制,术后患者满意度极高,该手术方式值得大力推广。     

眼前段光学相干断层扫描仪与超声生物显微镜测量中央前房深度的比较

目的 比较眼前段光学相干断层扫描仪（AS-OCT）与超声生物显微镜（UBM）测量中央前房深度（ACD）的差异和两者的可重复性.方法 分别用AS-OCT和UBM测量急性原发性闭角型青光眼（APACG）患者29例55眼（发作眼32眼,未发作眼23眼）,慢性原发性闭角型青光眼（CPACG）患者4l例74眼的ACD.采用配对t检验进行不同仪器ACD测量值比较;相关分析法分析两种仪器测量值之间的相关性.完全随机法选择1只眼分别用AS-OCT和UBM依次重复测量ACD 10次,比较测量的可重复性.结果 APACG发作眼用AS-OCT测量的ACD值与UBM的测量值之间差异无统计学意义.APACG对侧眼、CPACG眼的AS-OCT测量值比UBM测量值大[（1.923＋0.287）mm比（1.860±0.243）mm,（2.017±0.054）mm比（1.913±0.052）mm,均P=0.012].AS-OCT和UBM的ACD测量值呈正相关（r=0.928,P〈0.001）.AS-OCT与UBM测量ACD的变异系数分别为0.66%和0.82%.结论 AS-OCT比UBM测量的ACD值大,两种仪器测量值相关性良好.AA-OCT的可重复性优于UBM.     

Pattern of presentation and outcome of surgical management of primary open angle glaucoma in Kano, Northern Nigeria

BACKGROUND: Primary open angle glaucoma (POAG) is one of the leading causes of avoidable blindness. Unlike blindness from cataracts, glaucomatous optic nerve damage is irreversible, and prevention of glaucoma is one of the priorities of World Health Organization (WHO) Vision 2020 program. POAG is the commonest type of glaucoma and affects about 33.1 million people worldwide. This study is a five year review of 71 eyes of 63 patients who had trabeculectomy. The study evaluates the pattern of presentation and modality of surgical treatment in our environment. METHODS: Records of all patients with primary open angle glaucoma operated over a five year period was retrieved. Information extracted included patients bio data, visual acuity, gonioscopic findings, intra ocular pressure as measured with applanation tonometer before and after surgery, and recorded in mmHg. Perimetry was done with 2 m tangent screen and recorded in a perimetry chart. All the patients had trabeculectomy with application of antimetabolite (5-fluorouracil). Extra capsular cataract extraction with or, without posterior chamber intra ocular lens implantation was done on 13 patients. Biometry was not done on patients with cataract. Surgery was done on better eye first in all patients. RESULTS: There were 71 eyes of 63 patients. The male to female ratio was 3:1. The age ranged between 18 to 75 years. 8 patients were below the age of 30 years. One third of the patients were between the ages of 50 to 59 years. At presentation 12 patients (19%) had normal vision (WHO vision category O), 26 patients (41%) were visually impaired, 12 patients (19%) were severely visually impaired and 13 patients (21%) were blind (from co existing cataracts). The cup disc(c: d) ratio assessed before surgery was 0.5 in 9 eyes (13%), 31 eyes (53%) had c: d ratio 0.6 to 0.8 and 18 eyes had c: d ratio of 0.9. All the patients had open anterior chamber angles (Schafer grade 3 and 4). Perimetric changes were; mild peripheral constriction in 5 eyes (8%), peripheral constriction with arcuate scotoma in 19 eyes (26%), constricted fields of 300 or less in 34 eyes (48%), and in 13 eyes there was inability to fixate on target. IOP before surgery was 21 to 30 mm Hg in 12 eyes (17%), and above 31 mm Hg in 69 eyes (83%). Post operative IOP of 10 to 15 mm Hg was obtained in 58 eyes (82%) and 11 eyes (15%) had IOP of 16 to 20 mm Hg. Only 2 eyes (3%) had IOP in the lower twenties. CONCLUSION: Primary open angle glaucoma is characterized by late presentation. Trabeculectomy with application of 5FU is the surgical treatment of choice in our environment and give good intra ocular pressure control. There is need to increase public awareness on glaucoma to limit this type of avoidable blindness.     

应用超声生物显微镜观察小梁切除术后的房角改变

目的 应用超声生物显微镜（UBM）观察原发性闭角型青光眼（PACG）小梁切除术后的房角改变。方法：PACG患者30人（30只眼），行巩膜板层下小梁切除术，分别于术前和术后使用UBM观察房角形态并测量。结果：术前2只眼存在睫状体脱离。ACD、AOD500,TIA、TCPD、ID1术前术后比较差异均无显著性（P〉0．05）。结论：UBM有利于发现青光眼手术前后的睫状体脱离。小梁切除术对PACG的房角结构无改善。     

Spontaneous Anterior Lens Capsular Dehiscence Causing Lens Particle Glaucoma

To report acute onset lens particle glaucoma associated with a spontaneous anterior capsular dehiscence. A 66-year-old man presented with spontaneous anterior lens capsule dehiscence with an acute onset of right eye pain that was associated with white particles in the anterior chamber angle and intraocular pressure (IOP) of 55 mmHg. No trauma or other inflammatory antecedents were reported. A hypermature cataract was observed at slit lamp exam. After medical treatment without IOP control, we performed extracapsular cataract extraction and anterior vitrectomy. Anterior chamber aspirate confirmed the presence of macrophages. The postoperative IOP at one month was 16 mmHg OD without medication. Spontaneous dehiscence of the anterior lens capsule in a patient with a hypermature cataract may release lens cortical material, resulting in lens particle glaucoma. Prompt surgical removal of the lens material usually controls the high IOP, and the need for additional glaucoma surgery is not common.