重新开放房角在重症急性闭角型青光眼治疗中的临床意义  

Clinical significance of reopening anterior chamber angle for severe acute angle-closure glaucoma

作　　者：赵俊宏[1] 郭建强[1] 田华[1] 苟琦 王小东[1] 吕沛霖[1] Jun-Hong Zhao;Jian-Qiang Guo;Hua Tian;QiGou;Xiao-Dong Wang;Pei-Lin Lyv(Xi＇an No.1 Hospital;Xi＇an Ophthalmic Hospita;OphthalmicDisease Clinical Research Center of Shaanxi Province,Xi＇an710002,Shaanxi Province,China)

机构地区：[1]中国陕西省西安市第一医院西安市眼科医院陕西省眼科疾病临床研究中心,710002

出　　处：《国际眼科杂志》2018年第7期1290-1294,共5页International Eye Science

基　　金：陕西省科学技术研究发展计划项目(No.2014k11-03-07-02)

摘　　要：目的:探讨360°"最大程度"房角关闭的重症急性闭角型青光眼,通过"双穿刺"、联合超声乳化加房角分离手术,能否重新开放房角,开放的范围和眼压变化。方法:回顾性系列病例研究。2008-11/2015-11收住我院病例完整的重症急性闭角型青光眼患者33眼,均为最大量药物治疗无效的患者。入院后行"双穿刺"手术短时间降低眼内压(术前和术后7d查房角),7～14d后行超声乳化联合房角分离手术治疗(术中检查房角),比较两次手术前后患者眼压、房角变化,观察手术并发症。随访时间为6～24mo。结果:"双穿刺"术前眼压为53.4±10.7mm Hg(1mm Hg=0.133k Pa),"双穿刺"手术后32眼眼压正常(其中2眼激光打孔后眼压正常),平均眼压为16.9±13.2mm Hg。1眼眼压仍高。双穿刺术前、术后眼压比较差异有统计学意义(t=9.21,P<0.001)。超声乳化术后1wk眼压为16.7±4.8mm Hg。双穿刺术后与超声乳化术后眼压比较差异无统计学意义(t=0.38,P>0.05)。1眼术后眼压异常,术后30d后正常。双穿刺术后房角的检查结果为:房角开放均值(131.8±111.3)°。术后7～14d 32眼行超声乳化联合房角分离术,1眼行超乳联合小梁切除手术,房角开放手术治疗有效率为32/33(97%)。术中房角开放均值(228.6±108.3)°,术后3mo房角开放均值(234.6±107.2)°。双穿刺术后与超声乳化术中房角开放度数比较差异有统计学意义(t=4.52,P<0.001),超声乳化术后3mo房角均值大于术中房角,差异无统计学意义(t=0.46,P>0.05)。没有严重并发症发生。结论:"最大程度"房角关闭的重症急性闭角型青光眼,可以通过"双穿刺"联合晶状体摘除手术逐步开放房角、降低眼压。开放房角可以作为重症急性闭角型青光眼的选择。AIM： To explore whether the drainage angle could be reopened by surgery in patients with severe acute angle-closure glaucoma at “the greatest degree” of angle closure, and to study the treatment methods, such as double-paracentesis, phacoemulsification combined with goniosychialysis, and the effectiveness. METHODS： Retrospective observational case series. From November 2008, to November 2015, there were 33 patients with severe acute angle-closure glaucoma and 360° angle closure. Drug treatment showed no effect on them, so initial double-paracentesis（anterior chamber paracentesis combined with vitreous paracentesis）was applied. Then, either phacoemulsification combined with goniosychialysis or trabeculectomy surgery was performed after 7-14d, which was chosen based on the result of gonioscope during the surgery. The intraocular pressure, angle changes, and complications were observed. The follow-up period was 6mo to 3a. RESULTS： Of 33 participants enrolled, 32 had normal intraocular pressure after “double-paracentesis”（2 had normal intraocular pressure after laser peripheral iridotomy）. The mean intraocular pressure was significantly reduced from 53.4±10.7mmHg to 16.9±13.2mmHg（t=9.21,P〈0.001）by applying “double-paracentesis”, and 1 still had higher intraocular pressure. The mean intraocular pressure（16.7±4.8mmHg）was 0.2mmHg lower after phacoemulsification than after “double-paracentesis” while there was no significant difference（t=0.38,P〉0.05）. One patient had abnormal intraocular pressure until 30d after phacoemulsification. Every participant had 360° angle closed before “double-paracentesis”, 32 patients had opened angle（mean 131.8°±111.3°）after “double-paracentesis” and mean（228.6°±108.3°）during phacoemulsification, and mean（234.6°±107.2°）at 3mo after phacoemulsification. There was a significant difference between the post-paracentesis and intraoperative values（t=4.52, P〈0.001）. There was no difference betw

关 键 词：重症急性闭角型青光眼 前房穿刺 玻璃体穿刺 房角分离 超声乳化 

分 类 号：R779.6[医药卫生—眼科]