闭角型青光眼伴白内障的手术处理效果探讨  

Surgical treatment of angle closure glaucoma with cataract

作　　者：李俊宁[1] 邓之华 林陈娟 LI Jun-ning;DENG Zhi-hua;LIN Chen-juan(The Second People's Hospi-tai of Beihai,Beihai,536000)

机构地区：[1]北海市第二人民医院眼科,广西北海536000

出　　处：《实用防盲技术》2021年第4期140-143,166,共5页Journal of Practical Preventing Blind

基　　金：北海市科技攻关项目(北科合201884033)。

摘　　要：目的探讨闭角型青光眼伴白内障的手术处理策略与临床效果。方法观察闭角型青光眼伴发白内障56例(56眼),根据点1%毛果云香碱眼液(1日4次)联合0.5%马来酸噻吗洛尔眼液(1日2次)控制眼压观察3天和前房角粘连情况,选择手术方式分为两组,A组:眼压≤30 mmHg(l mmHg=0.133 kPa),前房角粘连≤270°者30例(30眼),行白内障超声乳化人工晶状体植入联合前房角分离术。B组:眼压> 30 mmHg,前房角粘连>180°26例(26眼),行白内障超声乳化人工晶状体植入联合Express引流器植入术。术后随访12个月,观察患者术前术后视力、眼压,中央前房深度(central anterior chamber depth,CACD)、房角开放距离(angle opening distance,AOD),分析术中术后并发症情况。结果 A、B两组术后平均矫正视力均较术前有显著性提高(A组:t=-14.28, P﹤0.001,B组:t=-14.18,P﹤0.001)。术后平均眼压(mmHg)显著下降(A组:28.78,P﹤0.001,B组t=20.89,P﹤0.001)。术后平均前房深度显著增加(A组:t=-20.27,P﹤0.001,B组t=-15.77,P﹤0.001)。术眼"3点"、"6点"、"9点"和"12点"方位的AOD500均较术前显著增加(P﹤0.001)。A组术中出现虹膜根部离断1例,前房角出血3例,虹膜色素脱落3例。术后予散瞳、激素眼水等对症处理后好转,B组术后有1例发生引流器的引流口堵塞导致眼压增高经用Nd:YAG激光治疗眼压控制正常,有2例仍需1种局部降眼压药控制眼压。结论闭角型青光眼伴发白内障应用1%毛果云香碱眼液联合0.5%马来酸噻吗洛尔眼液控制眼压在≤30mmHg,前房角粘连≤270°者行白内障超声乳化人工晶状体植入联合前房角分离术是安全有效的;眼压> 30 mmHg,前房角粘连>180°者则可考虑联合Express引流器植入术。Objetive To investigate the surgical treatment strategy and clinical effect of angle closure glaucoma with cataract.Methods Fifty six cases(56 eyes) with angle closure glaucoma complicated with cataract were observed.According to the control of intraocular pressure and anterior chamber angle adhesion with 1% pilocarpine and 0.5% timolol,the patients were divided into two groups:group A:intraocular pressure ≤30 mmHg(L mmHg = 0.133 kPa),30 cases(30 eyes) with anterior chamber angle adhesion ≤270° underwent phacoemulsification and intraocular lens implantation combined with anterior chamber angle separation.Group B:26 cases(26 eyes) with intraocular pressure> 30 mmHg and anterior chamber angle adhesion> 1800 underwent phacoemulsification and intraocular lens implantation combined with express drainage device implantation.The patients were followed up for 12 months.Preoperative and postoperative visual acuity,intraocular pressure,central anterior chamber depth(CACD),angle opening distance(AOD) were observed,and the intraoperative and postoperative complications were analyzed.Result The average corrected visual acuity of Group A and Group B was significantly higher than that of Group B(group A:t=-14.28,P <0.001;group B:t=-14.18,P <0.001).The mean intraocular pressure decreased significantly(group A:28.78,P <0.001,group B,t=20.89,P <0.001).The mean anterior chamber depth was significantly increased(group A:T=-20.27,P <0.001;group B,t=-15.77,P <0.001).The aod500 of "3 o’clock", "6 o’clock", "9 o’clock" and "12 o’clock" directions were significantly increased(P<0.001).In group A,there were 1 case of iridodialysis,3 cases of anterior chamber angle hemorrhage and 3 cases of iris pigment shedding.After operation,mydriasis,hormone eye drops and other symptomatic treatment improved.In group B,there was 1 case of intraocular pressure increase caused by blockage of drainage device.After treatment with Nd:YAG laser,the intraocular pressure was controlled normally,and 2 cases still needed a local IOP drug to control

关 键 词：闭角型青光眼 白内障 超声乳化 前房角分离 Express引流器植入术 

分 类 号：R779.6[医药卫生—眼科]