急性闭角型青光眼不同眼压下前房角的改变与手术方式的选择

目的：评估急性闭角型青光眼在不同眼压状态下前房角的形态改变以及采取不同手术方式的治疗效果。方法：对2005年4月～2008年6月于我院就诊的急性闭角型青光眼急性发作期和前驱期患者105例135眼，应用前房角镜和超声生物显微镜（UBM）观察在不同眼压下发病眼的前房角的改变，根据其形态的变化采取不同的手术方式，包括超声乳化联合折叠人工晶体植入手术及双切口青光眼白内障联合手术等手术方式。术后常规应用激素和抗生素药物治疗。观察6～24个月。结果：本组患者术前前房角为关闭状态，周边虹膜形态为S，虹膜根部附着位置为AC（Spaeth房角分级法）。药物治疗后部分病例前房角开放。术后本组所有患者的视力均有提高，眼压控制稳定为20 mm Hg（1 mm Hg=0.133 kPa）。术后前房角宽度大于术前。术中和术后无严重并发症发生。观察6～24个月，眼压持续稳定，术后1周的前房角形态与术后6个月的前房角形态无明显改变。结论：根据不同眼压状态下前房角的形态变化，采取不同手术方式治疗急性闭角型青光眼，可取得稳定的术后效果。

The changes of anterior chamber angle and the choice of surgical procedure in different intraocular pressure of acute angle-closure glaucoma

Objective： To evaluate the efficacy and safety of phacoemulsification and phacotrabeculectomy for acute primary angle-closure glaucoma with the change of anterior chamber angle with different intraocular pressure （lOP）. Methods： Retrospectively analyzed 135 eyes （105 cases） with acute primary angle-closure glaucoma were retrospectively analyzed from April 2005 to June 2008. Each eye was examined by gonioscopy and ultrasound biomicroseopy （UBM） with different lOP. Different methods of surgery including phacoemulsification and phacotrabeculectomy bind with foldable intraocular IOLs implantation were performed for every eye based on the changes of anterior chamber angle with different lOP. Antibiotic and glucocorticoid medicine was used in each case. All eyes were examined after 6 to 24 months. Results： The anterior chamber angle of each eye with high lOP was closed, Configuration of peripheral iris was S, site of iris insertion was AC （Spaeth classification）. The anterior chamber angle was reopened in some eyes with medicine treatment. The visual acuity （VA） was improved and post operatively lOP was controlled within 20 mm Hg （1 mm Hg=0.133 kPa）. Gonioseopy and UBM showed that anterior angle was widen than that before operation in two groups. No sever intraoperative and postoperative complications happened in two groups. No changes of anterior angle were observed after 6 months with that after 1 week postoperatively after 6 to 24 months. Conclusion： According to different ocular hypertension morphological changes of anterior chamber angle, take a different surgical procedures for acute angle-closure glaucoma, the postoperative results and stability can be achieved.