超声乳化联合房角分离术治疗闭角型青光眼合并白内障

目的探讨超声乳化吸出联合房角分离术治疗闭角型青光眼合并白内障的临床疗效。方法闭角型青光眼合并白内障20例（22眼）。男12例（14眼），女8例（8眼）。年龄64～85岁，平均（76．80±3．12）岁。其中急性闭角型青光眼18例，慢性闭角型青光眼4例，所有手术由同一医师完成，均采取超声乳化人工晶状体植入联合房角分离术，观察手术前、后眼压，视力，周边前房深度及房角的变化情况，随访3～12个月。结果患眼术前眼压范围7．8～30．013]mHg，平均（18．91±5．48）mmHg，术后平均（11．81±2．90）mmHg，t值4．77（P〈0．05），差异有统计学意义，术后眼压较术前显著性降低。术前BCVA≤0．1者7眼，占31．80％，术后BCVA≤0．5者12眼，占54．5％，术后视力明显提高。术前周边前房深度〈1／2CT者18眼，术后22眼周边前房深度≥1CT，虹膜平坦，周边膨隆消失。术后房角关闭所在象限可见不同程度的开放，周边虹膜粘连范围缩小。2眼出现前房渗出．虹膜部分后粘连，1眼发生后囊破裂，未发生角膜失代偿等并发症。结论采用超声乳化吸出联合房角分离术治疗闭角型青光眼合并白内障是安全、有效的。

Clinical study on the treatment of primary angle-closure glaucoma with cataract by phacoemulsification combined with goniosynechialysis

Objective To investigate the clinical effect of phacoemulsification combined with goniosynechialysis on primary angle-closure glaucoma with cataract. Methods It was a retrospective study.There were 20 cases (22 eyes) diagnosed primary angle-closure glaucoma (PACG) with cataract in our hospital from 2007 to 2009. Male, 12 cases (14 eyes) and female, 8 cases (8 eyes). Their age were from 64to 85 years old, mean age is 76.8 gears old. 22 eyes:18 with PACG, 4 with CPACG, were undergone phacoemulsification and IOL implantation, combined with goniosynechialysis. The intraocular pressure (IOP)before and after operation, best corrected visual acuity ( BCVA), peripheral anterior chamber (PAC) and the change of anterior chamber angle were all observed and reported. The time of following up was 3 to 12months. Results preoperative IOP were from 7.8 mmHg to 30 mmHg and mean IOP is 18. 91 + 5.48mmHg. Meanwhile the postoperative IOP were 11.81+2.9 mmHg. The IOP were obviously decreased after operation. The IOP were obviously decreased after operation. There were 7 eyes (31.8%) whose preoperational BCVA were less than 0.1. There were 12 eyes (54.5%) whose postoperative BCVA were more than 0. 5, There were 18 eyes whose preoperative PAC depth were less than 1/2 CT. There were 22 eyes whose postoperative PAC depth were more than one CT. They have smooth iris and disappeared peripheral bulges.The angle-closure can be partly opened and the range of goniosynechia can be decreased after operation. Two cases had anterior chameber angle exudative and iris adhesion. Only one case had posterior capsular rupture.No case had corneal decompensation. Conclusion The treatment of primary angle-closure glaucoma with cataract by phacoemulsification combined with goniosynechialysis phacoemulsification combined with goniosynechialysis is safe and effective.