选择不同术式治疗老年人急性闭角型青光眼89眼疗效分析  

Analysis of the Efficacy of Different Surgical Methods for the Treatment of 89 Eyes of Elderly Patients with Acute Angle-closure Glaucoma

作　　者：周历[1] 盛豫[1] 关娟[1] 司艳芳[1] 王倩[1] 

机构地区：[1]解放军第309医院眼科,北京100091

出　　处：《医学临床研究》2012年第1期39-41,共3页Journal of Clinical Research

摘　　要：[目的]选择不同的手术方法针对老年人闭角型青光眼进行治疗,并对治疗效果及机制进行分析.[方法]选择86例急性闭角型青光眼老年患者的89眼病例,其中男性患者38例38眼,女性患者48例51眼,平均年龄69.8岁.根据患者发病情况及其患眼的解剖特点选择不同术式,手术治疗方法分别为：小梁切除手术（12例）、单纯白内障摘除手术（65例）、青光眼-白内障摘除联合手术（9例）.[结果]急性闭角型青光眼患者有11眼行小梁切除术恢复眼压.66眼通过行超声乳化白内障吸除术＋人工晶体植入术眼压恢复正常,白内障摘除手术后前房深度及房角开放程度较术前有显著改善.9眼首选青光眼-白内障摘除联合手术后眼压均恢复正常,另有2眼为单纯白内障摘除术后眼压仍不能控制的病例又做了小梁切除手术,还有1眼小梁切除术后补充做白内障摘除术.[结论]单纯小梁切除术,容易出现滤过口关闭或过度滤过导致前房不形成.青-白联合手术需要白内障摘除及小梁切除两个手术同时进行,降眼压效果好.与这两者相比,单纯白内障超声乳化手术通过单纯摘除白内障解除了晶状体膨胀造成的瞳孔阻滞和浅前房,使得前房深度恢复,眼内房水行走正常循环通道,达到治疗青光眼的目的.该方法具有手术时间短,切口小,损伤小、术后散光小、不易出现过度滤过等优点,解决了许多其它手术的不足,具有重要的临床意义.[Objective] To choose different surgical methods for the treatment of elderly patients with angle-closure glaucoma and to analyze the efficacy and mechanism. [Methods] Totally 86 elderly patients（89 eyes） with acute angle- closure glaucoma were selected. All patients included 38 males（38 eyes） and 48 females（51 eyes）. The average age was 69.8 years old. According to the onset of the patients and anatomical features of affected eyes, different surgical methods were chosen. Surgical methods included trabeculectomy, simple cataract surgery and the combined surgery of glaucoma and cataract. [Results] Intraocular pressure in il eyes of acute angle-closure glaucoma declined to the normal after trabeculectomy. Intraocular pressure in 66 eyes declined to the normal after phacoemulsification combined with in- traocular lens implantation. Compared with before operation, anterior chamber depth and angle open degree were sig- nificantly improved after cataract surgery. The intraocular pressure of 9 eyes declined to the normal after first option of the combined surgery of glaucoma and cataract. The other 2 eyes underwent trabeculectomy again because intraocular pressure was not controlled by single cataract surgery. One eye additionally underwent cataract surgery after trabecu- lectomy. [Conclusion]The closure of filter outlet or excess filtration inducing the non-formation of anterior chamber easily occurs after single trabeculectomy. The combined surgery of glaucoma and cataract needs the simultaneous cata- ract surgery and trabeculectomy, and has good effect on the decline of intraocular pressure. Compared with trabeculec- tomy or the combined surgery of glaucoma and cataract, simple phacoemulsification can relieve pupillary block and shallow anterior chamber caused by expanded lens, and recover the anterior chamber depth and normal circulation of a- queous humor so as to cure glaucoma. Simple phacoemulsification has advantages such as short operation time, small incision, less injury, small postoperative astig

关 键 词：急性病 青光眼 闭角型/外科学 

分 类 号：R775.2[医药卫生—眼科]