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目的观察超声乳化白内障吸除、加后房型折叠人工晶状体植入联合房角分离术,治疗闭角型青光眼的疗效以及手术适应证的探讨。方法已确诊为闭角型青光眼患者46例(46眼),均合并不同程度晶状体混浊。所有病例行超声乳化白内障吸除及后房型折叠人工晶状体植入联合房角分离术,术后随访9～24个月。观察术前术后眼压、视力、前房深度、房角、房水流畅系数(C)与压畅比(PO/C)和降眼压用药数量等的变化。结果术后随访最终平均眼压明显低于术前平均眼压(配对t检验,P<0.01),术后最佳矫正视力好于术前(配对秩和检验,P<0.01)。前房深度加深(配对t检验,P<0.01)。房角全部开放36眼(78.26%)。术后房水流畅系数(C)与压畅比(PO/C)有明显改善(配对t检验,P<0.01)。术后平均使用降眼压药数量明显减少(配对t检验,P<0.01)。另有7眼(15.21%)术后眼压仍>25mmHg,遂行滤过性手术治疗。结论晶状体摘除、后房型折叠人工晶状体植入联合房角分离术是治疗原发性闭角型青光眼合的一种有效的选择,但对房角关闭粘连超过270°以上,则有必要联合小梁切除术。
Objective To observe the therapeutic effect of phacoemulsification cataract surgery combined with posterior chamber fold-fold intraocular lens implantation combined with posterior chamber intraocular lens implantation for the treatment of angle-closure glaucoma. Methods 46 patients (46 eyes) with angle-closure glaucoma were identified, all with varying degrees of lens opacity. All patients underwent phacoemulsification cataract extraction and posterior chamber fold intraocular lens implantation combined with angle separation, followed up for 9 to 24 months. The changes of intraocular pressure, visual acuity, anterior chamber depth, angle of the anterior chamber, hydrodynamic coefficient (C) and ratio of diastolic pressure (PO / C) and intraocular pressure (IOP) were observed before and after operation. Results The mean postoperative IOP was significantly lower than preoperative mean IOP (paired t test, P <0.01). The best corrected visual acuity after operation was better than preoperative (paired rank sum test, P <0.01). Depth of anterior chamber depth (paired t test, P <0.01). All 36 open eyes (78.26%). Postoperative aqueous fluid flow coefficient (C) and pressure relief ratio (PO / C) were significantly improved (paired t test, P <0.01). The average number of post-ocular hypotensive agents was significantly reduced (paired t-test, P <0.01). Another 7 eyes (15.21%) after intraocular pressure is still> 25mmHg, performed filtering surgery. Conclusion Lens extraction combined with posterior chamber foldable intraocular lens implantation combined with angle separation is an effective method for the treatment of primary angle-closure glaucoma. However, when the angle of closure is more than 270 °, it is necessary to combine the trabeculae cut.