上海交通大学学报（医学版）

›› 2010, Vol. 30 ›› Issue (11): 1364-.doi: 10.3969/j.issn.1674-8115.2010.11.011

• 论著（临床研究） • 上一篇    下一篇

白内障超声乳化联合房角粘连分离术治疗急性闭角型青光眼

郑 岩1,2, 汪朝阳2, 祝肇荣2   

  1. 1.温州医学院, 温州 325027； 2.上海交通大学医学院附属新华医院眼科, 上海 200092
  • 出版日期:2010-11-25 发布日期:2010-11-29
  • 通讯作者: 汪朝阳, 电子信箱: zhaokekewzy@hotmail.com。
  • 作者简介:郑 岩（1968—）, 男, 副主任医师；电子信箱: clairvoyant@126.com。
  • 基金资助:

    上海市重点学科建设项目（S30205）

Management of acute angle-closure glaucoma by phacoemulsification combined with goniosynechialysis

ZHENG Yan1,2, WANG Zhao-yang2, ZHU Zhao-rong2   

  1. 1.Wenzhou Medical College, Wenzhou 325027, China；2.Department of Ophthalmology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
  • Online:2010-11-25 Published:2010-11-29
  • Supported by:

    Shanghai Key Discipline Construction Project, The Third Period, S30205

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摘要：

目的 观察白内障超声乳化摘除联合房角粘连分离术对原发性急性闭角型青光眼合并白内障的治疗效果。方法 收集原发性急性闭角型青光眼合并白内障患者的病史资料，以其中经局部和全身降眼压药物治疗后仍不能有效控制眼压而实施白内障超声乳化摘除联合房角粘连分离术的32例患者（32眼）作为研究对象，其中29眼在急性发作72 h内手术，3眼在急性发作120 h后手术。回顾手术过程，记录末次随访前房角镜检查所见；对术前检查和术后末次随访检查结果进行比较分析，包括眼压、视力及中央前房深度、前房容积和前房角宽度等眼前段结构指标。结果 术后末次随访前房角镜检查显示虹膜根部平坦，前房角开放，小梁表面沉着较多色素；32眼中前房角全部开放24眼（均于急性发作72 h内手术）。32眼术前眼压均>50 mmHg(1 mmHg=0.133 kPa)，术后末次随访平均眼压为（15.3±5.0） mmHg，其中眼压<21 mmHg为28眼（均为急性发作72 h内手术），21~27 mmHg为4眼。术后末次随访发现，最佳矫正视力较术前显著提高(急性发作120 h后手术眼最佳矫正视力均<0.1)，眼前段结构指标较术前明显改善，手术前后比较差异均有统计学意义（P＜0.001）。结论 白内障超声乳化摘除联合房角粘连分离术是治疗原发性急性闭角型青光眼合并白内障的有效方法，但应注意手术时机和适应证的选择。

关键词: 超声乳化, 房角分离, 青光眼, 急性闭角型

Abstract:

Objective To investigate the clinical effects of phacoemulsification combined with goniosynechialysis in management of primary acute angle-closure glaucoma complicated with cataract. Methods The clinical data of patients with primary acute angle-closure glaucoma complicated with cataract were collected, and those (32 eyes) who received phacoemulsification combined with goniosynechialysis for uncontrolled intraocular pressure after general and topic medical management were selected. Operations were conducted within 72 h after acute episode for 29 eyes, and the other 3 eyes were operated 120 h after acute episode. The operation procedure was reviewed, and gonioscopic findings of the last follow up were recorded. Parameters of anterior segment structures of eyes including intraocular pressure, visual acuity, central anterior chamber depth, anterior chamber volume and anterior chamber angle width of examinations before operation and in last follow up after operation were analysed. Results Gonioscopy of last follow up revealed that iris root was flat, angle of anterior chamber was open, and there was much pigment on the surface of trabeculum. The angle of anterior chamber in 24 of the 32 eyes was totally open, with operations within 72 h after acute episode. Intraocular pressure was >50 mmHg (1 mmHg=0.133 kPa) in all the 32 eyes before operation, the mean intraocular pressure was (15.3±5.0) mmHg in the last follow up, the intraocular pressure was <21 mmHg in 28 eyes (all were performed operations within 72 h after acute episode), and the intraocular pressure was 21 to 27 mmHg in the 4 eyes. The last follow up after operation revealed that the best corrected visual acuity significantly elevated from that preoperation (the optimal corrected vision was <0.1 in those with operations 120 h after acute episode). Parameters of anterior segment structures of eyes after operation were significantly better than those before operation (P＜0.001). Conclusion Phacoemulsification combined with goniosynechialysis is effective in management of primary acute angle-closure glaucoma complicated with cataract, while the opportunity and indication of surgery should be properly determined.

Key words: phacoemulsification, goniosynechialysis, glaucoma, acute angle-closure