超声乳化人工晶体置入联合房角分离术治疗慢性闭角型青光眼

 目的 探讨超声乳化白内障吸除人工晶体置入联合房角分离治疗慢性闭角型青光眼的疗效及其影响因素。方法 回顾性分析2008-09至2013-10收治的慢性闭角型青光眼患者80例共92眼经超声乳化白内障吸除人工晶体置入联合房角黏弹剂分离术治疗的效果。所有患者根据术前局部用药眼压控制与房角关闭及粘连情况分4组: G1组(术前用药后眼压≤25.0 mmHg，房角关闭≤270°)42眼、G2组(术前用药后眼压≤25.0 mmHg，房角关闭＞270°)12眼、G3组(术前用药后眼压＞25.0 mmHg，房角关闭≤270°)10眼和G4组(术前用药后眼压＞25.0 mmHg，房角关闭＞270°)28眼。比较分析术前、术后各组视力、眼压以及中央前房深度(anterior chamber depth，ACD)、前房容积(anterior chamber angle，ACV)和前房角宽度(anterior chamber angle，ACA)等眼前节结构变化。术后随访12～60个月，平均33个月。结果 术后各组患者视力显著改善、眼压也显著下降(P<0.01)，术后视力改善情况:G1组、G2组 优于 G3组、G4组(P<0.01)，G3组 也优于 G4组(P<0.01);眼压情况则除G4组[(22.98±4.54)mmHg]仍高于正常外，G1组、G2组和G3组均下降至正常水平，且G1组、G2组眼压下降较G3组(P<0.05)、G4组(P<0.01)明显，G3组也好于G4组(P<0.05)，但G1组与G2组在视力和眼压差异均未显示出有统计学意义(P>0.05)。各组患者均有不同程度的视神经萎缩，并且与病程相关，术后仍有20眼(G3组2眼，G4组18眼)未达到有效眼压控制，需加用药物及手术干预。眼前节结构:术后各组ACD、ACA、ACV均较术前有明显改善(P<0.01);术后各组间，ACD变化最为显著，其中G1组、G2组显著深于G3组、G4组(P<0.01)，G3组也较G4组深(P<0.05)，G1组、G2组则明显差别(P<0.05);ACA则仅G1组宽于G4组(P<0.01)，其他各组差异无统计学意义(P>0.05);各组间ACV均差异无统计学意义(P>0.05)。结论 超声乳化白内障吸除人工晶体置入联合房角分离术是一种治疗慢性闭角型青光眼的安全有效的方法，可有效提高视力，远期眼压控制效果确切，但疗效与术前眼压控制情况、房角关闭和粘连范围以及病程等密切相关。

Clinical efficacy of phacoemulsification and intraocular lens implantation combined with goniosynechialysis for chronic angle-closure glaucoma

Objective To study the clinical efficacy and effective factors for chronic angle-closure glaucoma after phacoemul sification and intraocular lens implantation combined with goniosynechialysis.Methods Eighty patients (92 eyes) with chronic angle-closure glaucoma undergoing phacoemulsification and intraocular lens implantation combined with goniosynechialysis from September 2008 to December 2013 were retrospectively analyzed.Ninety-two eyes were divided into four groups based on IOP control and the range of the anterior angle closure and peripheral anterior synechiae(PAS) before operation. Group 1(G1) 42 eyes (IOP≤25 mmHg and the range of angle closure and PAS≤270 degree). Group 2(G2) 12 eyes (IOP ≤25 mmHg and the range of angle closure and PAS＞270 degree). Group 3(G3) 10 eyes (IOP>25 mmHg and the range ≤270 degree). Group 4(G4) 28 eyes (IOP>25 mmHg and the range＞270 degree). Follow-up lasted 33 months (12-60m onths). Visual acuity, IOP, cental anterior chamber depth(ACD), anterior chamber volume (ACV) and anterior chamber angle(ACA) before and after operation were analyzed.Results Compared with pre-operation, the intraocular pressure(IOP) decreased and the visual acuity, ACD, ACV and ACA improved significantly post-operation (P<0.01). The improvement of visual acuity of G1 and G2 was better than G3 and G4(P<0.01) and G3 better than G4(P<0.01),though no difference was observed between G1 and G2(P>0.05) after surgery. Excepting that the IOP of G4 was higher than normal(22.98±4.54) mmHg, which of other three groups was controlled to normal and which of G1 and G2 was lower than G3(P<0.05) and G4(P<0.01),and G3 was lower than G4(P<0.05) ,while no difference was observed between G1 and G2(P<0.05). The IOP was controlled by additional medication and surgery in 20 eyes (2 of G3 and 18 of G4).Varying severity optic atrophy was observed in all eyes and correlated to the disease course. Similar to the visual acuity, ACD of G1 and G2 was deeper than that of G3 and G4 (P<0.01), and G3 deeper than G4 (P<0.05) while no difference was observed between G1 and G2. There were no differences among all groups of ACA and ACV except that the ACA of G1 was wider than G4 (P<0.01).Conclusions Phacoemulsification and intraocular lens implantation combined with goniosynechialysis for chronic angle-closure glaucoma is a safe and effective measure, which is beneficiat to visual acuity improvement and IOP long-term controll. But the clinical effects are closely related to the controlled condition of IOP, the range of anterior chamber closure and PAS before operation and disease course.