白内障超声乳化术治疗原发性闭角型青光眼临床观察

目的:观察白内障超声乳化术治疗闭角型青光眼术后中央前房深度和眼压的变化及手术疗效.方法:前瞻性病例对照研究.入选病例为原发性急、慢性闭角型青光眼37例49眼,对26眼临床前期或房角检查动态下房角关闭粘连范围≤180°的患者采取白内障超声乳化+后房型折叠式人工晶状体植入术;对23眼动态下房角关闭粘连范围≥180°的患者行白内障超声乳化+人工晶状体植入术+小梁切除术;对有青光眼发作史的所有患眼联合行房角粘连分离术.术后观察视力、眼压、前房深度和房角.随访3mo~2a.结果:术后47眼视力提高,2眼无变化,≥0.5者35眼(71%).术后所有患者眼压明显降低(P<0.01)、前房明显加深(P<0.01),房角增宽.47眼眼压得到长期良好控制.2眼术后1mo眼压再次升高,为慢性闭角型青光眼晚期高眼压下手术的患者.结论:白内障超声乳化人工晶状体植入术可有效治疗原发性闭角型青光眼,可使前房加深、眼压降低、房角增宽;但对房角关闭粘连范围≥180°的患者应同时行小梁切除术.

Clinical observation of phacoemulsification in management of primary angle-closure glucoma

AIM:To observe the changes of the intraocular pressure(IOP) and the central anterior chamber depth(ACD) after phacoemulsification in eyes with primary angle-closure glucoma,and to analyze the therapeutic efficacy.METHODS:In this prospective clinical self control study,37 cases(49 eyes) of primary angle-closure glucoma were performed phacoemulsification and IOL implantation,of which 23 eyes underwent combined trabeculectomy.All eyes with an attack history of glaucoma underwent combined goniosychialysis.The visual acuity,IOP,ACD and anterior chamber angle were observed postoperatively.All cases were followed up for 3 months to 2 years.RESULTS:Their visual acuity improved in 47 eyes postoperatively,the best-corrected visual acuity was 0.5 or better in 35 eyes(71%).The mean IOP was significantly decreased(P<0.01),the mean ACD was significantly increased(P<0.01),and the anterior chamber angles were wider postoperatively.In 47 eyes the long-term IOP were controlled.The IOP increased again in 2 eyes postoperative 1 month,They were patients with chronic angle-closure glucome at the late stage who accepted surgory under high IOP.CONCLUSION:Phacoemulsification and folding IOL implantation is effective and safe in patients with primary angle-closure glucoma.It could decrease the IOP,increase ACD and widen anterior chamber angles significantly.However,patients with angle closure and synechia range ≥ 180° should also undergo trabeculectomy.