晶状体超声乳化、折叠人工晶状体植入和小梁切除联合手术治疗闭角型青光眼  

Phacoemusification combined with foldable intraocular lens implantation and trabeculectomy in angle-closure glaucoma

作　　者：王琳[1] 惠延年[1] 韩泉洪[1] 杜宏俊[1] 王英[1] 黄蔚[1] 

机构地区：[1]中国西安第四军医大学西京医院眼科全军眼科研究所,710032

出　　处：《国际眼科杂志》2004年第1期81-84,共4页International Eye Science

摘　　要：目的:报告1组闭角型青光眼( angle-closure glau-coma, ACG)患者在1次手术中完成晶状体超声乳化、折叠人工晶状体(intraocular lens, IOL)植入和小梁切除联合手术的视力和眼压控制效果。方法:对过去1a间为治疗ACG所施行晶状体超声乳化、折叠IOL植入和小梁切除联合手术患者的临床资料进行回顾性分析。本组共49例(56眼),其中52眼晶状体透明,27眼有明显的视野损害。患者随访10月～2a。结果:手术的并发症轻微,包括手术后的浅前房4眼、脉络膜脱离1眼、明显的纤维蛋白渗出2眼,经处理在短期恢复。手术后,各眼的视力保持或好于手术前最好矫正视力,其中41眼≥0.5,16眼≥1.0。手术后1周时眼压为10.1±3.7 (5～20) mmHg并在随访期内一直保持稳定,但有2眼在术后2周时眼压为22～23mmHg,常规点用2.5g/L噻吗洛尔,得到良好控制。所有的眼视野保持不变。结论:晶状体超声乳化、折叠IOL植入、小梁切除联合手术,对ACG,尤其中晚期病例,是一种安全、有效的控制眼压和保持视力的手术。术后浅前房、恶性青光眼等并发症少见。避免了2次手术。这种联合手术不仅促进房水外流,而且可矫正多数患者原有的远视,使其裸眼视力好于术前。AIM: To investigate the visual outcome and intraocular pressure (IOP) control in a series of patients with angle-closure glaucoma (ACG) treated with phacoemusification, foldable intraocualr lens (IOL) implantation and trabeculectomy in one operation.· METHODS: The clinical data of patients with ACG who underwent the combined surgery during the past one year were retrospectively analyzed. The series included 49 patients (56 eyes), among which 52 eyes had a clear lens and 27 eyes had obvious visual field defects. The patients were followed up for 10 months to 2 years.· RESULTS: Surgical complications were mild and there were 4 eyes with a shallow anterior chamber, 1 eye with choroidal detachment, and 2 eyes with remarkable fibrin exudates which were resolved shortly. All eyes had visual acuity equal to or better than the best corrected preoperative vision after surgery, with 0.5 or better in 41 eyes and 1.0 or better in 16 eyes. IOP was 10.1±3.7 (5-20)mmHg one week after operation and was maintained stable during the follow-up period but two eyes had IOP of 22-23mmHg 2 weeks after surgery, which was controlled well with routine administration of 2.5g/L timolol. The visual field remained unchanged in all eyes. · CONCLUSION: Combined surgery of phacoemusification with foldable IOL implantation and trabeculectomy in one operation is a safe, effective procedure to control IOP and maintain visual acuity for treatment of ACG, especially in moderate and advanced cases. Postoperative complications including shallow anterior chamber and malignant glaucoma are rare. Secondary operation can be avoided. The combined surgery can not only facilitate aqueous outflow, but also correct the previous hyperopia in most patients, which provides them with a better naked vision than that before operation.·

关 键 词：晶状体超声乳化 晶状体折叠 人工晶状体植入术 ACG 小梁切除术 手术治疗 闭角型青光眼 眼压 

分 类 号：R779.6[医药卫生—眼科]