超声乳化白内障吸除术或联合房角分离术治疗原发性闭角型青光眼_论文.docxVIP

超声乳化白内障吸除术或联合房角分离术治疗原发性闭角型青光眼 作者：冯朝晖　孙乃学　张晓辉　任百超 【摘要】 　　目的：观察超声乳化白内障吸除人工晶状体植入术或同时联合房角分离术治疗原发性闭角型青光眼（primary angle closure glaucoma, PACG）的临床疗效，探讨手术适应证。方法：PACG患者 29例（43眼），均合并不同程度晶状体混浊。根据术前房角粘连关闭的范围不同分为3组：A组16眼，术前房角粘连关闭≤180°，行超声乳化白内障吸除人工晶状体植入术。B组15眼，180°＜术前房角粘连关闭≤270°,C组12眼， 术前房角粘连关闭＞270°，B组和C组行超声乳化白内障吸除人工晶状体植入联合房角分离术。术后随访9~24（平均 ±）mo。观察眼压、房角和视力等的变化。 结果：A组16眼(100%)、 B组14眼(93%) 、C组2眼（17%）,术后不用任何降眼压药物眼压正常。B组另1眼（7%）局部用药眼压控制正常。C组其余的10眼中，2眼（17%）局部用药眼压＞21mmHg（ 【关键词】 青光眼　闭角型　超声乳化白内障吸除术　房角分离术　人工晶状体 AbstractAIM: To investigate the clinical effects and indications of phacoemulsification plus intraocular lens(IOL) implantation per se and combined with goniosynechialysis (GSL) in the management of primary angle-closure glaucoma（PACG）.METHODS: Twenty-nine cases (43 eyes) with PACG and cataract were divided into 3 groups according to preoperative degrees of synechial angle closure(SAC):16 eyes of group A with equal to or less than 180 degrees SAC, 15 eyes of group B with more than 180 degrees but equal to or less than 270 degrees SAC, 12 eyes of group C with more than 270 degrees SAC. Group A was treated with phacoemulsification plus IOL implantation. Both group B and C was treated with phacoemulsification and IOL implantation combined with GSL. Intraocular pressure(IOP), anterior chamber angle and visual acuity were monitored during follow-up for 9-24 months in these eyes. RESULTS: The IOPs of 16 eyes (100%) in group A , 14 eyes (93%%) in group B and 2 eyes (17%) in group C were normal without any medications. The IOP of 1 eyes (7%) in group B was normal with a single antiglaucomatous eye drops. The IOPs of 10 eyes in group C were higher than 21mmHg after medications, 8 eyes required trabeculectomy. The chamber angles became wider and SAC were mostly reopened after surgery in all eyes. The postoperative outcome of best corrected visual acuity were ever improved in 38 of 43 eyes (88%).CONCLUSION: Phacoemulsification plus IOL implantation is able to effectively contro