激光联合白内障超声乳化术对急性闭角型青光眼房角的重塑作用

目的:评估激光联合超声乳化白内障手术(phacoemulsifi-cation and intraocular lens,Phaco+IOL)作为初始治疗手段对急性闭角型青光眼房角的重塑作用。方法:选取37例39眼合并白内障首次发作的急性闭角型青光眼,平均眼压69.22±21.23mmHg,经过药物降眼压,完成激光虹膜成形联合周边切开术,病情稳定7～14d后,行超声乳化白内障吸除联合人工晶状体植入术,观察手术前后视力、眼压、房角开放状况和虹膜形态的变化。结果:随访时间3～27mo,患者术后视力均有提高,其中29眼未再使用用抗青光眼药物,最后4次随访平均眼压14.90±2.19mmHg,较激光术前明显下降(P<0.05),随访期间38眼眼压控制平稳,视野无进行性损害,1眼眼压波动在18～28mmHg,同时存在进行性视野损害,于术后10mo接受了滤过手术。OCT对虹膜形态的观察表明,所有患者虹膜均由术前的膨隆形变化为平坦型,房角开放度由激光术前平均10.86±5.11度增加为术后46.34±13.32度(P<0.01)。结论:激光联合Phaco+IOL治疗合并白内障的急性闭角型青光眼有助于开放房角,达到解除瞳孔阻滞,疏通房水引流的作用,避免滤过手术的风险,白内障术前激光治疗可以迅速缓解急性发作的症状,开放房角,控制眼压,加深前房,使白内障手术更安全稳定。

Angle configuration of acute angle-closure glaucoma after phacoemulsification and intraocular lens implantation combining with initial laser treatment

AIM:To evaluate the angle configuration after primary phacoemulsification and intraocular lens (Phaco+IOL ) implantation combining with initial laser treatment for acute angle-closure glaucoma. ·METHODS: Thirty-nine eyes of 37 cases with first attack of acute angle-closure glaucoma(IOP was 69.22±21.23mmHg) as well as with different extent of cataract were treated by initial laser iridoplasty and iridectomy, followed by phaco+IOL. Visual acuity, intraocular pressure (IOP), angle opening degree and appearance of iris shape of convexity were observed. ·RESULTS: Follow-up from 3 to 27 months, all patients had improved visual acuity. IOP of 29 eyes free from hypotensive medication was controlled to 14.90±2.19 mmHg of last four times measurement (P<0.01). Further filter surgery was necessary in 1 case. Angle opening degree changed from 10.86±5.11 pre-laser to 46.34±13.32 postsurgery (P<0.01). ·CONCLUSION: Phaco+IOL combined with initial laser treatment turned out to be safe and effective in controlling IOP, improving visual acuity, opening closed angle and improving aqueous outflow for acute angle-closure glaucoma. Initial laser intervention was effective in eliminating papillary block, deepening anterior chamber and reducing IOP, which made the following Phaco+IOL more safe and easy.