晶状体异位继发急性闭角型青光眼术式选择及疗效观察

目的 回顾性分析晶状体异位继发急性闭角型青光眼手术方式的选择及观察其疗效.方法 取36例(41只眼)晶状体异位继发急性闭角型青光眼患者,采用超声生物显微镜观察晶状体悬韧带离断范围,根据晶状体脱位范围以及房角关闭范围,分别选择小梁切除术,超声乳化白内障吸除联合囊袋张力环及人工晶状体植入手术和(或)小梁切除联合超声乳化白内障吸除术,术后随访1个月,观察手术治疗效果.结果 随访期间,患者术后矫正视力提高,眼压降低:术后1d,17只眼(41.46%)矫正视力＞0.5;30只眼(73.17%)眼压在21mmHg以内;术后7d,24只眼(58.54%)矫正视力＞0.5;35只眼(85.36%)眼压在21mmHg以内;术后30d,27只眼(65.85%)矫正视力＞0.5;所有患者眼压在21mmHg以内.结论 在晶状体异位继发急性闭角型青光眼患者中,晶状体脱位范围在1~2个象限者,超声乳化白内障吸除联合囊袋张力环及人工晶状体植入手术是一种安全有效的术式;脱位范围大于2个象限者,选择白内障囊外摘除手术;房角关闭大于1/2的患者,选择小梁切除联合白内障手术.

Surgical choice and effect in patients with acute angle-closure glaucoma secondary to subluxated lens

Objective To retrospectively evaluate the surgical procedures and results for eyes with acute angle-closure glaucoma secondary to lens subluxation. Methods Thirty-six cases (41 eyes) with acute angle-closure glaucoma secondary to lens subluxation were examined by gonioscopy and/or ultrasound biomicroscopy (UBM). The different surgical procedures such as phacoemulsification with capsular tension ring lens (CTR) and intraocular lens (IOL) implantation, extracapsular cataract extraction (ECCE) and/or antiglaucoma surgery were chosen according to the extent of anterior chamber angle close and lens subluxation. Visual outcome and intraocular pressure (IOP) were examined on postoperative days 1, 7 and 30. Results The best corrected visual acuity (BCVA) was significantly improved and IOP was well controlled in all eyes during the follow-up. The BCVA was better than 0.5 in 17 eyes (41.46%), in 24 eyes (58.54%) and in 27 eyes (65.85%) on postoperative day 1, 7 and 30, respectively. IOP was less than 21 mmHg in 30 eyes (73.17%), in 35 eyes (85.36%) and in all eyes (100%) on postoperative day 1, 7 and 30, respectively. Conclusions It is safe and effective to choose phacoemulsification combined with CTR and IOL implantation for eyes with zonular defect less than 2 quadrants, ECCE and IOL implantation for eyes with zonular defects more than 2 quadrants and lens extraction combined with trabeculectomy for eyes with anterior chamber angle close more than half of the angle.