两种房角分离术联合白内障超声乳化治疗慢性闭角型青光眼的疗效比较  

Comparison of the clinical effect between two goniosynechialysises combining phacoemulsification for chronic angle-closure glaucoma

作　　者：谭吉林 龚力力[2] 贺翔鸽[3] 李红梅 邓小红 

机构地区：[1]重庆市第六人民医院麦格眼科,重庆400060 [2]贵阳市第一人民医院麦格眼科,贵阳 [3]第三军医大学大坪医院眼科,重庆

出　　处：《中国实用眼科杂志》2008年第12期1337-1340,共4页Chinese Journal of Practical Ophthalmology

摘　　要：目的比较两种房角粘连分离术联合白内障超声乳化治疗慢性闭角型青光眼的临床疗效，以寻求一种更可靠、更简单的操作方式。方法将26例（31只眼）伴有白内障的闭角型青光眼分为A、B两组，在完成白内障超声乳化并缩瞳后，用两种不同的手术方式分离房角粘连，A组（16只眼）是通过反复利用I／A头对周边虹膜组织的吸引来牵拉虹膜根部，以分离虹膜与小梁组织的粘连；B组（15只眼）凭借黏弹剂的钝性压力和抛光针对虹膜根部的牵拉来达到分离前房角粘连目的。随访观察3月到2年，对照观察两组术后眼压下降幅度、房角的形态变化及视力等情况。结果用房角镜检查发现所有术眼术后房角均较术前增宽，其中A组16只眼中有15只眼前房角全周重新开放，占93．75％，而B组15只眼中只有7只眼全周重新开放，占46．67％（P〈0．01）；术后眼压均得到控制，但A组眼压下降幅度更大，且两组下降幅度的差异性具有统计学意义（P〈0．05）。两组视力均有明显提高。结论A、B两组方法均能有效治疗闭角性青光眼，但A组的方法更可靠、更有效而且操作更简单。Objective To compare the clinical effects between the two goniosynechialysises combined with phacoemulsification and to seek a more reliable and effective way to treat the chronic angle-closure glaucoma with cataract.Methods 26 cases （31 eyes）with chronic angle-closure glaucoma and cataract were divided into Group A and Group B.After phacoemulsification and narrowing the pupil, in Group A（ 16 eyes）we pulled the root of the iris by using repeatedly the I / A to suck the periphery of iris tissue in order to separate the adhesion of the iris and trabeeular organizations, in Group B （ 15 eyes）we used the, blunt pressure of the viscoelastic and the polishing needle against the root of the iris to achieve the purpose to make anterior chamber angle open again.Intraocular pressure （IOP）,anterior chamber angle and visual acuity were monitored in pre-operation and post-operation.All patients were follow-up 3-24 months.Result The postoperative gonioscoppy examination showed that anterior chamber angles became wider in all eyes.The ratio of reopened anterior chamber angle completely after the surgery in Group A was 93.75%（15/16） ,while the ratio in Group B was only 46.67%（7/15）, （P 〈0.01 ）.The IOP were controlled within normal at all patients in two groups after the surgery, but there were more IOP reduced in Group A, statistical differences were observed by comparing two groups （P 〈0.05 ）.The vision of all patients was significantly improved in the both groups.Conclusions Both methods for goniosynechialysis could effectively treat chronic angle-closure glaucoma,but the method used in group A was more reliable and effective, and the operation was simple.

关 键 词：白内障超声乳化 房角粘连分离术 闭角型 青光眼 

分 类 号：R775.2[医药卫生—眼科] R779.66[医药卫生—临床医学]