超声乳化白内障吸除联合房角分离术治疗闭角型青光眼的临床研究

目的观察超声乳化及后房型折叠人工晶状体植入联合房角分离术,治疗闭角型青光眼的疗效,以及术前术后房角形态的改变。方法连续性选取收治的闭角型青光眼合并有白内障的患者77例96只眼,随机分为超声乳化组(Phaco组)和小梁切除手术组(Trab组)。观察手术前后视力、中央前房深度、角膜内皮细胞密度、视野、房角及眼压的变化情况并进行统计学处理。平均随访11个月。结果 Phaco组术后视力明显提高而Trab组提高不明显;眼压Phaco组手术后6个月时由术前(36.42±5.37)mmHg降低为(15.37±4.29)mmHg,Trab组由术前(38.25±3.39)mmHg降低为(15.55±2.00)mmHg,两组手术前后比较差异均有统计学意义。Phaco组手术后3个月时的前房深度由术前(1.66±0.24)mm加深为(3.31±0.34)mm,房角均较术前有增宽,前后比较差异有非常显著性(P<0.001)。而Trab组则无明显变化。两组患者术后视野均无缩小。结论对于合并闭角型青光眼的白内障患者,超声乳化白内障吸除、人工晶体植入联合房角分离术是一种便捷、安全、有效的方法 ,具有降压、增视及改善房角形态等优点。

Clinical Research on the Efficacy of Phacoemulsification, Intraocular lens Implantation and Goniosynechialysis in Cataract Combined with Acute angle-closure Glaucoma

Objective To investigate the effectiveness ofphacoemulsification, intraocular lens implantation and goniosynechialysis in cataract combined with acute angle-closure glaucoma and to observe morphologic changes of chamber angle after the surgery. Methods 96 eyes of 77 consecutive patients with primary angle-closure glaucoma and cataract were randomized into Phaco gr6up and Trab group; The changes of visual acuity, anterior chamber depth （ACD）, corneal endothelial cell density, visual field, anterior chamber angle and IOP before and after operation were measured.The average follow-up period was 11 months. Results The visual acutity was improved significiantly after phacoemulsication and no significant difference in Trab group; The IOB significiantly decreased from （36.42~5.37）mmHg to （15.37±4.29）mmHg at 6 months after surgery in phaco group. While in Trab group, the lOP decreased from （38.25±3.39）mmHg to （15.55±2.00）mmHg. There were significant differences in two groups before and after surgery;The anterior chamber depth （ACD） was increased from（1.66±0.24）mm before surgery to（3.3 ±0.34）mm at 3 months after surgery and chamber angle is open in the phaco group, but there were no significant differences in the trab group; the visual field of all the eyes had no contraction.Conclusion For patients with angle-closure glaucoma and cataract, phacoemu lsification and goniosynech ialysisis a convenient, safe and effective method, and have the effects of depressurization and improving vision and morphology of chamber angle.