多联手术治疗晶状体悬韧带松弛继发急性闭角型青光眼

目的　探讨多联手术治疗晶状体悬韧带松弛继发急性闭角型青光眼的临床疗效。方法　回顾性病例研究。２０１２年３月至２０１４年５月在河北省眼科医院白内障科就诊的晶状体悬韧带松弛继发急性闭角型青光眼患者２３例（２３眼），采用微切口囊袋内预劈核超声乳化联合张力环植入、前部玻璃体切割和房角分离术进行治疗。术后随访观察最佳矫正视力、眼压、前房深度以及前囊收缩情况、后囊膜混浊程度、人工晶状体的居中性。结果　术后３个月最佳矫正视力＞０．６～１．０者８眼，＞０．３～０．６者１２眼，０．１～０．３者３眼。术后３个月最佳矫正视力较术前增加，差异有统计学意义（ｔ＝３６．２２５，Ｐ＜０．０１）。所有患者术后１ｄ眼压均下降至正常，为１０．３～１６．５（１４．２±１．９）ｍｍＨｇ（１ｋＰａ＝７．５ｍｍＨｇ），与术前相比差异有统计学意义（ｔ＝２７．９０２，Ｐ＜０．０１）。术后随访３个月，未见眼压明显波动。术中未出现灌注液迷流综合征，术后未发生恶性青光眼。术后３个月所有患者人工晶状体居中性良好，未出现囊袋收缩、后发性白内障等并发症。结论　采用多联手术治疗晶状体悬韧带松弛继发急性闭角型青光眼可以取得满意的疗效。

Multi-surgery treatment for secondary acute angle-closure glaucoma due to zonular laxity of lens

Objective To explore the clinical efficacy of the multi-surgery treatment for secondary acute angle-closure glaucoma due to zonular laxity of the lens. Methods Retrospective case study. This study was comprised of 23 cases (23 eyes) with secondary acute angle-closure glaucoma due to zonular laxity of the lens from March 2012 to May 2014 in our hospital. All patients underwent micro-rncision and prechop phacoemulsification with the capsular tension ring implantation, combined with anterior vitrectomy and lysis of goruosynechiae. The postoperative best corrected visual acuity,intraocular pressure (IOP) and anterior chamber depth were observed, and the capsular contraction syndrome ,posterior capsule opacification and intraocular lens dislocation were also observed. Results The postoperative best corrected visual acuity in 8 eyes was?»0.6 - 1. 0,12 eyes was¡Ý0. 3 -0. 6.and 3 eyes was?»0. I -0. 3. All the postoperative best corrected visual acuities were improved at 3 months after surgery, there was statistical difference compared with pre-operation ( t = 36. 225 .P < 0. 01 ) . All of the IOP were down to normal on the lst day after surgery,which was 10. 3 - 16. 5 ( 14. 2 + 1. 9 ) mmHg ( I kPa = 7. 5 mmHg) , there was statistical difference compared with pre-operation ( t = 27. 902 .P < 0. 01) . No IOP was increased within 3 months after surgery. The complications such as the infusion misdirection syndrome , malignant glaucoma .intraocular lens dislocation , capsular contraction syndrome , posterior capsule opacification were not appeared. Conclusion The multi-surgery for secondary acute angle-closure glaucoma due to zonular laxity of lens can get good treatment effects.