白内障超声乳化吸除术治疗不同房角关闭状态的闭角型青光眼的临床疗效观察VIP专享VIP免费

·492·临床眼科杂志2008年第l6卷第6期JournalofClinicalOphthalmology，2008，Vo1．16，No．6·临床研究·白内障超声乳化吸除术治疗不同房角关闭状态的闭角型青光眼的临床疗效观察潘佳鸿张忆谭烨【摘要】目的比较观察单纯白内障超声乳化吸除联合后房型人工晶状体植入术治疗不同房角关闭状态的闭角型青光眼合并白内障患者手术前后房角的改变及对眼压的影响。方法收集2005年1月至2007年12月收治的闭角型青光眼合并白内障31例(36只眼)，患者均接受白内障超声乳化吸除联合后房型人工晶状体植入术。根据术前房角关闭粘连范围分组，A组8只眼，房角关闭粘连≤1／2周；B组l0只眼，1／2周<房角关闭粘连~<3／4周；C组18只眼，房角关闭粘连>3／4周。术前及术后常规行最佳矫正视力、裂隙灯、Goldmann前房角镜及超声生物显微镜检查，中央前房深度和眼压检查。结果三组36只眼术后视力均有不同程度提高，前房深度增加。除A组外，B、c两组术后眼压均明显降低，统计学处理组内手术前后差异有显著性，术后组间眼压差异无显著性。房角镜及UBM检查术后房角均有增宽，房角关闭及周边虹膜前粘连范围明显减小甚至消失，部分患者房角重新开放，其中房角全部开放15只眼，1／4周<房角关闭粘连≤1／2周7只眼(c组)，房角关闭粘连≤1／4周12只眼(A组2眼B组4眼C组6眼)，随访6～24月未见房角关闭粘连扩大及眼压再次升高；房角关闭粘连仍~>3／4周2只眼(c组)，术后早期出现青光眼复发。结论单纯白内障超声乳化吸除联合后房型人工晶状体植入术可以有效治疗房角关闭粘连的范围超过1／2周甚至达3／4周以上的闭角型青光眼。但是对于房角关闭粘连超过3／4周以上甚至全闭，且术前用药后眼压仍较高者，术后可能出现青光眼复发。【关键词】白内障超声乳化吸除术；人工晶状体；闭角型青光眼；治疗[临床眼科杂志。2008。16：492]Clinicalstudyontheefectofphacoemulisificationinthemanagementofangle-closureglaucomaindiferentextentclosureanglePANJia—hong，ZHANGYi。TANYe．DepartmentofOphthalmology．PudongNewAreaGongliHos-p。Shanghai200135，China【Abstract】ObjecfiveToinvestigatethechangesofanteriorchamberangleandlOPafterphaeomulsificationwithfoldableposteriorchamberintraocularlensimplantation(PC—IOL)inmanagementofangle—closureglaucoma(ACG)indifer-entextentclosureanglewithcataract．MethodsPhacomulsificationwithfoldablePC·IOLimplantationwasperformedin31patients(36eyes)withACGinGonglihospita1．Accordingtoangleclosuredegreesandperipheralanteriorsynechiaebe—foreoperation，thepatientsweredividedthreegroups，groupAwas8eyeswithlessthan1／2perimeterclosureangleandperipheralanteriorsyneehiae，groupBwas10eyeswithmorethan1／2perimeterbutlessthan3／4perimeterelosllreangleandperipheralanteriorsynechiae。gloupCwas18eyeswithmorethan3／4perimeterclosureangleandperipheralanteriorsynechiae．Thebestcorrectedvisualacuity(BCV'A)-intraocularpressure(1OP)，anteriorchamberanglewidthandanteriorchamberdepth(ACD)weremeasui~dandrecorded．ResultsVisionofall36eyesimproveddiferentlyanddeepeningofanteriorchamberdepthwerefound．ExceptgroupA。lOPwasfallobviouslyingroupBandgroupCwithoutmedication．Therewassignificantdiferencebetweenpreoperationandpostoperation，buttherewasnosignificantdiferencebetweenthetwogroupspostoperation．TheanglesexaminedbygonioseopyandUBMwerewiderthanthatofpreoperation-theextentofanytouchoradhesionbetweenirisandtrabeculaereduced．Allanglecircumferenceopenedagainin15eyes-therewerestill1／4～1／2perimeterangleclosureorsynechiain7eyes(groupC)，lessthan1／4perimeterin12eyes(2eyesingroupA。4eyesingroupB。6eyesingroupC)。peripheralanteriorsynechiaeformationorelosureangleandIOPelevationdidnotrecurafter6monthspostoperationupto24months：morethan3／4perimeterin2eyes(groupC)...