原发性闭角型青光眼中白内障超声乳化联合IOL植入术的疗效

目的:评价白内障超声乳化联合人工晶状体(intraocular lens,IOL)植入术治疗眼压控制的急性闭角型青光眼和慢性闭角型青光眼患者的疗效及安全性。方法:将45例60眼白内障眼压控制的急性闭角型青光眼和慢性闭角型青光眼随机分为两组,一组采用白内障超声乳化联合IOL植入术,一组采用激光虹膜切开术(laser iridotomy,LI)。比较两组眼内压、抗青光眼药物使用数目、并发症、前房内皮细胞计数的差别。结果:IOL组中,随访6mo后的眼内压由术前的14.82±4.23mmHg下降到10.94±1.24mmHg,而LI组的眼内压并无明显变化(15.34±4.13mmHgvs14.68±4.77mmHg),采用重复测量资料的方差分析显示两组的眼内压变化有显著统计学差异(F=36.452,P<0.01)。IOL组6mo后基本未采用抗青光眼药物,而LI组使用抗青光眼药物个数为0.24±0.41个(P<0.05)。两组在并发症及前房内皮细胞计数方面无统计学差异(P>0.05)。结论:白内障超声乳化联合IOL植入可有效降低眼压控制的急性闭角型青光眼和慢性闭角型青光眼的眼内压水平,该治疗方法安全有效,是这类患者首选的治疗方法之一。

Clinical observation of primary phacoemulsification plus intraocular lens implantation for primary angle-closure glaucoma

AIM:To evaluate the effects and safety of primary phacoemulsification plus intraocular lens implantation for controlled chronic angle-closure glaucoma(CACG)and acute angle-closure glaucoma(AACG).

METHODS: Sixty-eyes of 45 cases with CACG or CACG were randomly divided into two groups. Thirty-four eyes in IOL group underwent phacoemulsification plus intraocular lens(IOL)implantation. Twenty-six eyes in laser iridotomy(LI)group included treatment by LI. Intraocular pressure(IOP), numbers of antiglaucoma medications, complications, and corneal endothelial cell counts were examined in each group.

RESULTS: In IOL group, IOP was significantly reduced from a preoperative mean of 14.82±4.23mmHg to a 6-month postoperative mean of 10.94±1.24mmHg. However, in LI group, mean preoperative IOP was 15.34±4.13mmHg, and the 6-month postoperative IOP was 14.68±4.77mmHg. There was statistical significance in preoperative and postoperative IOP between two groups(F=36.452, P<0.01). In IOL group, no patient used anti-glaucoma medications 6-month postoperatively, whereas in LI group, mean number of anti-glaucoma medications was 0.24±0.41(P<0.05). There were no significant differences in preoperative and postoperative corneal endothelial cell counts between IOL and LI groups(P>0.05).

CONCLUSION: Primary phacoemulsification plus intraocular lens implantation for controlled CACG or AACG seems to be a safe and effective method in reducing IOP. This procedure might become the first treatment of choice for controlled CACG or AACG with cataract.