早期白内障超声乳化与虹膜周边切除术治疗闭角型青光眼的对比研究

目的:比较超声乳化和虹膜周边切除术治疗闭角型青光眼合并轻度白内障的临床疗效。方法:急性闭角型青光眼48例48眼临床前期、先兆期或缓解期,以及慢性闭角型青光眼早期合并白内障患者,随机分为A组(24眼):超声乳化白内障吸除人工晶状体植入;B组(24眼):虹膜周边切除术。观察手术前后眼压、前房深度、周边前房深度、前房角及视力情况,术后平均随访时间5.5mo。结果:A组术后1d眼压明显高于B组(P<0.05),但3d以后恢复正常,两组间无明显差异;A组术后中央前房深度3.21±0.11mm,较术前明显加深(P<0.05),而B组为1.89±0.05mm,与术前相比无明显变化;两组术前周边前房深度相似,但术后A组术后周边前房明显加深(P<0.05);A组术后视力比术前视力明显提高(P<0.05),而B组术后视力相比变化不大。结论:急性闭角型青光眼临床前期、先兆期和缓解期,以及慢性闭角型青光眼早期伴有白内障者,行白内障超声乳化吸出联合人工晶状体植入术,是一种安全有效治疗方法,不仅能提高视力,亦能避免青光眼的发作。

Preliminary comparison study of early phacoemulsification and peripheral iridotomy for primary angle-closure glaucomatous patients

AIM:To compare the efficacy of early phacoemulsifi-cation versus peripheral iridotomy for primary angle-closure glaucomatous patients with cataract and better visual acuity .·METHODS: A prospective randomized controlled trial was performed. 48 eyes of 48 cases were categorized into two groups according to the operation method.Group A(24 eyes) were undertaken cataract phacoemulsification;group B(24 eyes) were undertaken peripheral iridotomy . Patients were followed up for 1day,7days,1month,3months and 6months. The postoperative visual acuity (VA) were analyzed and compared between the two groups,as well as intraocular pressure (IOP) ,central anterior chamber depth(CACD) and peripheral anterior chamber (PACD). ·RESULTS: The IOP one day after the operation was significantly higher in group A than that in group B,and three days latter the IOP of group A reduced to normal level. There was no statistically significant difference between the two groups. In group A,the CACD varied from 2.25±0.09mm(preoperative) to 3.21±0.11mm(postoperative) ,and the difference was significant(P<0.05),There was no statistically significant difference before and after the operation in group B.The PACD in all eyes in group A deepened significantly(P<0.05),while in group B it did not. In group A,the postoperative VA (0.52±0.15) of all patients improved in different degrees,while in group B the VA after peripheral iridoto-my was as poor as the preoperative VA .There was statistically significant difference between the two groups (P<0.05). ·CONCLUSION: Early phacoemulsification appeared to be more effective in preventing IOP rise than peripheral iridotomy in patients with acute primary angle-closure glaucoma and primary angle-closure glaucomatous with cataract. And it can be considered as a definitive treat-ment to prevent IOP rising.