激光周边虹膜成形术序贯超声乳化治疗伴白内障的急性闭角型青光眼

目的：：观察激光周边虹膜成形术序贯白内障超声乳化术,治疗应用药物眼压控制不理想的伴白内障的急性闭角型青光眼患者的临床疗效。方法：收集2011-01/2015-06我院收治合并白内障的急性闭角型青光眼大发作,经药物治疗12 h后眼压仍大于40 mmHg以上的患者47例49眼。行激光周边虹膜成形术,术后3d后序贯行白内障超声乳化及人工晶状体植入术。回顾性分析患者治疗情况。结果：激光周边虹膜成形术前平均眼压为62.35±10.31mmHg,激光术后第1d平均眼压17.96±4.64mmHg,白内障超声乳化及人工晶状体植入术后第1d平均眼压16.58±3.19mmHg,术后1mo平均眼压13.50±2.74mmHg,术后3mo平均眼压13.46±2.48mmHg,治疗前后有显著差异(F=10.02,P<0.05)；序贯治疗术后1d,1、3mo的眼压与激光前相比明显下降,均有统计学意义( t=4.35、6.43、6.97,P<0.05)。术前平均最佳矫正视力为0.06±0.02,激光术后第1d平均最佳矫正视力为0.20±0.18,白内障超声乳化及人工晶状体植入术后第1d平均最佳矫正视力为0.45±0.19,术后1mo平均最佳矫正视力为0.60±0.11,术后3mo平均最佳矫正视力为0.65±0.09,治疗前后有显著统计学差异(F=8.36,P<0.05)；序贯治疗术后1d、1、3mo的平均最佳矫正视力与激光前相比明显提高,均有统计学意义(t=3.97、5.12、5.89,P<0.05)。序贯治疗术后1d,3 mo的平均前房深度、房角开放距离、小梁虹膜夹角以及术后1、3 mo的房角粘连与激光前相比明显改善,均有统计学意义(P<0.05)。结论：激光周边虹膜成形术序贯超声乳化治疗伴白内障的急性闭角型青光眼,且应用药物眼压控制不理想患者,可降低眼压、提高视力,并且能改善前房深度、房角开放距离、小梁虹膜夹角以及房角粘连。

Application of phacoemulsification with laser peripheral iridoplasty for acute angle-closure glaucoma with cataract

AIM: To observe the application of phacoemulsification combined with laser peripheral iridoplasty(LPIP)for acute angle-closure glaucoma with cataract which could not be controlled well by drugs.

METHODS: From January 2011 to June 2015, 49 eyes in 47 patients with acute angle-closure glaucoma and cataract were recruited while their intraocular pressure remained higher than 40mmHg 12h after drug treatment. LPIP were performed and phacoemulsification and intraocular lens implantation were carried out 3d after. Their clinical data and follow-up results were reviewed.

RESULTS: The intraocular pressure before treatment, 1d after LPIP, 1d after phacoemulsification, 1mo after phacoemulsification and 3mo after phacoemulsification were 62.35+10.31mmHg, 17.96±4.64 mmHg, 16.58±3.19mmHg, 13.50±2.74 mmHg and 13.46±2.48 mmHg respectively(F=10.02,P<0.05); the intraocular pressure of 1d(t=4.35), 1mo(t=6.43)and 3mo(t=6.97)after phacoemulsification were all lower than the initial pressure(P<0.05). The visual acuity showed the same trendy, while the visual acuity before treatment, 1d after LPIP, 1d, 1 and 3mo after phacoemulsification were 0.06±0.02,0.20±0.18,0.45±0.19,0.60±0.11,0.65±0.09 respectively(F=8.36,P<0.05). The best corrected visual acuity at 1d, 1 and 3mo after phacoemulsification were better than that before laser treatment(t=3.97, 5.12, 5.89,P<0.05). At 1d and 3mo after phacoemulsification, the anterior chamber depth, angle opening distance, trabecular/iris angle were all better than the initial ones(P<0.05). At 1 and 3mo after phacoemulsification, the goniosynechia got better as well(P<0.05).

CONCLUSION: Phacoemulsification combined with LPIP can reduce intraocular pressure, improve the visual acuity and make the anterior chamber depth, angle opening distance, trabecular/ iris angle, goniosynechia better for patients with acute angle-closure glaucoma and cataract when drug cannot control intraocular pressure well.