周边虹膜切除术与超声乳化人工晶状体植入术治疗早期原发性闭角型青光眼的疗效比较

目的比较周边虹膜切除术与超声乳化联合人工晶状体植入术治疗早期原发性闭角型青光眼的临床效果。方法选择仅局部用药即可控制眼压在正常范围内的早期闭角型青光眼合并白内障患者48例(54眼),应用周边虹膜切除术对28例(32眼)早期闭角型青光眼进行手术治疗,其结果与同类病人(20例22眼)的超声乳化联合人工晶状体植入术治疗结果进行比较。术前,术后一个月内每周一次,半年内每月一次,半年后三个月一次做眼压、裂隙灯检查直至1年。比较两者在术后眼压控制、视力恢复及前房情况,并作统计学分析。结果应用周边虹膜切除术治疗组术后平均眼内压为15.2±3.1mmHg,而同类病人经超声乳化联合人工晶状体植入术治疗后平均眼内压为14.9±2.6mmHg。分别经周边虹膜切除术和超声乳化联合人工晶状体植入术治疗,两类病人眼内压在术后早期无明显差异(P>0.05)。经超声乳化联合人工晶状体植入术治疗,18眼(81.8%)最佳矫正视力提高,0.4者占63.6%,经周边虹膜切除术治疗术后最佳矫正视力无明显提高,其中8眼视力不增反降,最佳矫正视力0.4者占18.8%,两者差异有显著性(P<0.05)。经周边虹膜切除术治疗术后中央前房深度无明显变化,而经超声乳化联合人工晶状体植入术治疗术后中央前房深度显著加深,两者差异性明显(P<0.05)。结论原发性闭角型青光眼早期患者施行超声乳化联合人工晶状体植入术,术后房角显著加宽,中央前房深度显著加深,矫正视力也不同程度提高,且并发症少。

Comparison of peripheral iridotomy with the phacoemulsification and intraocular lens implantation in treating primary angle-closure glaucoma.

Objetive To compare the effect of the peripheral iridotomy and phacoemulsification and intraocular lens implantation in the treatment of early primary angle-closure glaucoma.Methods 48 patients(54 eyes)with early primary angle-closure glaucoma were chosen and divided into two groups randomly,only those intraocular pressure could be controlled to normal by remedy were enrolled.28 patients(32 eyes)were performed with the peripheral iridotomy.The results were compared with those treated by phacoemulsification and intraocular lens implantation(20 patients,22 eyes).Intraocular pressure(IOP)measurement,slit-lamp examinations were performed before,and after operation for one time per week until 1 month,one time per month until 6 months and one time per 3 months until 12 months.The postoperative control of IOP and visual acuity were compared and analyzed.Results The average IOP was 15.23.ImmHg with the peripheral iridotomy,and 14.92.6 mmHg with the phacoemulsification and intraocular lens implantation.No statistical differences between two surgeries were identified with respect to IOP at early stage after surgery.Bestcorrected visual acuity(BCVA)of 18 eyes(81.8%)increased after phacoemulsification and intraocular lens implantation.Postoperatiive visual acuity were better than 0.4 in 63.6%patients.8 eyes’ visual acuity dropped after the peripheral iridotomy There was significant difference for two methods(P<0.05).The anterior chamber depth in the peripheral iridotomy group did not change significantly, however,the anterior chamber depth increased in phacoemulsification and intraocular lens implantation group.Conclusion The phacoemulsification and intraocular lens implantation had better effect in the anterior chamber angle width,the anterior chamber depth, best—corrected visual acuity and the postoperative complications than the peripheral iridotomy surgery.