超声乳化联合房角分离术治疗急性闭角型青光眼合并白内障的疗效观察

目的：观察超声乳化术治疗原发性急性闭角型青光眼（ acute primary angle closure glaucoma，APACG）合并白内障的疗效及并探讨相关技巧。方法：收集2012－07／2014－07于中山市人民医院眼科就诊的APACG患者67例67眼，术前充分降低眼压，减轻角膜水肿，常规行超声乳化白内障吸出术，并分离房角。记录患者术前青光眼发作时和术后3 mo的视力、眼压、降压药物数量、房角开放范围以及并发症等。并使用Pentacam和眼前段光学相干断层扫描测量仪（ anterior segment ocular coherence tomography，AS－OCT）测量眼前段参数，包括中央前房深度、前房容积和瞳孔直径等。结果：术前与术后3mo相比，LogMAR视力由术前0．87±0．09增至术后0．23±0．08（t＝4．086，P＜0．01）。眼压由术前32．31±4．70降至17．57±4．13mmHg（t＝20．266，P＜0．01），中央前房深度由1．89±0．22增至3．43±0．39mm（t＝24．266，P＜0．01），前房容积自78．24±8．96增加至148．65± ；17．85mm3（t＝51．583，P＜0．01），房角开放范围由105．9°±10．81°增加至320．7°±35．77°（t＝46．677，P＜0．01），降压药物使用数量由术前3．05±0．40降至0．47±0．13种（ t＝10．166，P＜0．01），差异均有统计学意义（P＜0．05）。瞳孔直径由术前3．14±1．28减至术后的3．07±1．18mm （ t＝1．157，P＝0．247），差异无统计学意义。术中发生后囊膜破裂1例，术后人工晶状体前膜形成2例。结论：超声乳化术联合房角分离等技术治疗急性闭角型青光眼合并白内障可以取得较好的手术疗效，可以有效降低眼压和改善眼前段狭窄。

Outcome and surgical techniques of phacoemulsification combined with goniosynechialysis in eyes with acute primary angle closure glaucoma and cataract

AIM:To investigate the outcome and surgical techniques of phacoemulsification combined with goniosynechialysis in eyes with acute primary angle closure glaucoma(APACG)and cataract.

METHODS: Sixty-seven patients(67 eyes)with APACG accompanied with cataract were treated with phacoemulsification from July 2012 to July 2014 in Zhongshan People's Hospital. Before operations, reducing intraocular press(IOP)sufficiently and relieving corneal edema were given to all patients. During the operations, goniosynechialysis were performed sufficiently. All patients were examined for visual acuity, IOP, number of anti-glaucoma drugs and range of opened anterior chamber preoperatively and at 3mo postoperatively. Data of anterior segment included central anterior chamber depth(CACD), anterior chamber volume(ACV), pupil diameter(PD)and others were detected by Pentacam and anterior segment ocular coherence tomography(AS-OCT).

RESULTS: The visual acuity improved from 0.87±0.09 preoperatively to 0.23±0.08 postoperatively and the difference was statistically significant(t=4.086, P<0.01).Mean IOP decreased from 32.31±4.70mmHg preoperatively to 17.57±4.13mmHg postoperatively(t=20.266, P<0.01). CACD measurements increased from 1.89±0.22mm preoperatively to 3.43±0.39mm postoperatively(t=24.266, P<0.01). ACV increased from 78.24±8.96mm³ preoperatively to 148.65±17.85mm³ postoperatively(t=51.583, P<0.01). The range of opened anterior chamber increased from 105.9°±10.81°preoperatively to 320.7°±35.77°postoperatively(t=46.677,P<0.01). The number of anti-glaucoma drugs decreased from 3.05±0.40 preoperatively to 0.47±0.13 postoperatively(t=10.166, P<0.01). PD before and after phacoemulsification were 3.14±1.28mm and 3.07±1.18mm respectively, which showed no statistical difference(t=1.157, P=0.247). Posterior capsule rupture occurred in 1 eye. Anterior fibrinous membrane of intraocular lens occurred in 2 eyes.

CONCLUSION: Phacoemulsification combined with goniosynechialysis can reduce IOP effectively and improve the stenosis of anterior segment, which is an useful treatment for patients with APACG and cataract.