超声乳化联合人工晶状体植入治疗急性闭角型青光眼

目的：探讨术前或术中辅助降压后超声乳化白内障吸除人工晶状体植入术治疗急性闭角型青光眼急性发作期的效果。

方法：收治87例92眼急性闭角型青光眼患者，入院时眼压均在45.0mmHg以上，术前通过全身及局部使用最大剂量降眼压药物处理，眼压能降至25.0mmHg以下者于降压后2～3d内行白内障超声乳化吸除人工晶状体植入手术(60眼)，如眼压依然高于30.0mmHg且前房深度尚可者，术前先行前房穿刺降压并于降压后1～2d内行白内障超声乳化白内障摘除联合人工晶状体植入并前房角分离术(25眼)，如药物降压后眼压仍高于35.0mmHg且前房较浅，则手术时行玻璃体腔穿刺抽取部分玻璃体腔液后再前房穿刺实现降眼压后行白内障超声乳化白内障摘除联合人工晶状体植入并前房角分离术(7眼)。对术前检查和术后6mo随访检查结果进行比较分析，包括眼压、视力、手术并发症及中央前房深度和前房角宽度等。

结果：随访6mo～2a，全部病例在随访期间眼压均可控制在20.0mmHg以下，其中有2眼在6mo时需20g/L卡替洛尔滴眼液点眼。术前视力均低于0.3，术后视力：<0.1者5眼，0.1～0.3者22眼，<0.3～0.5者50眼，>0.5者15眼。前房及房角：术后前房均明显加深，房角全部开放者8眼，开放大于270度者23眼，开放≥180度者56眼，开放<180度者5眼。术后并发症：60眼出现较明显的前房反应，其中有16眼出现前房纤维素性渗出。

结论：超声乳化白内障吸除人工晶状体植入术对于急性发作的急性闭角型青光眼有良好的疗效，能及时控制眼压并挽救患者的视功能。前房穿刺或玻璃体穿刺是术前眼压控制不良者有效降眼压手段，有利于提高手术的安全性。

Clinical study on phacoemulsification combined with post chamber intraocular lens implantations for acute angle-closure glaucoma

AIM: To investigate the clinical effects of phacoemulsification combined with post chamber intraocular lens(PC-IOL)implantations for primary acute angle-closure glaucoma.

METHODS: The clinical data of 87 cases(92 eyes)with primary acute angle-closure glaucoma complicated with cataract of which intraocular pressure(IOP)over 45.0mmHg were collected. Phacoemulsification and PC-IOL implantations were performed for 60 eyes which IOP was controlled to 25.0mmHg below by general and topic medical management. IOP of 25 eyes was over 30.0mmHg and the depth of anterior chamber was well, puncture of anterior chamber was performed to decrease the IOP. Then 1 day to 2 days later, phacoemulsification, PC-IOL implantations and goniosynechialysis were performed. IOP of 7 eyes were still over 35.0mmHg with shallow of anterior chamber, phacoemulsification and PC-IOL implantation combined with goniosynechialysis and paracentesis anterior chamber were performed after vitreous aspiration and puncture of anterior chamber. IOP, visual acuity, surgery complications, central anterior chamber depth and gonioscopie findings before and post operation were recorded and analyzed.

RESULTS: The IOP of all cases was controlled under 20.0mmHg during the follow-up 6 months to 2 years. 2% carteolol hydrochloride only need for two cases after 6 months. The visual acuity were improved for most cases, the visual acuity were better than 0.3 of 65 eyes post-operation while all were lower than 0.3 pre-operation. The depth of anterior chamber was deeper in all cases and the anterior chamber angle opening range was more than 180 degree in 87 eyes. More than 60 cases suffered the complications of anterior chamber inflammation and 16 cases anterior fibrinous exudates.

CONCLUSION: Phacoemulsification is safe and effective in management of primary acute angle-closure glaucoma complicated with cataract. Goniosynechialysis, paracentesis anterior chamber and vitreous aspirations were benefit for the patient whose IOP was uncontrolled before surgery.