小切口白内障囊外摘除人工晶状体植入联合房角分离治疗原发性闭角型青光眼合并白内障的临床观察

发布时间：2018-10-31 11:29

【摘要】：目的观察小切口白内障囊外摘除人工晶状体(IOL)植入联合房角分离术治疗原发性闭角型青光眼(PACG)合并白内障的患者临床疗效及手术适应证的探讨。方法已确诊为PACG患者92例(92眼),均合并有程度不同的晶状体混浊。所有患者行小切口白内障囊外摘除IOL植入联合房角分离术,术后随访9~24个月。随访观察手术前后眼压、视力、中央前房深度、房角形态、房水流畅系数与压畅比和降眼压用药数量等的变化情况。结果术后随访最终平均眼压明显低于术前平均眼压(P0.01),术后最佳矫正视力好于术前(P0.01)。前房深度加深(P0.01)。房角全部开放72眼(78.26%)。术后房水流畅系数与压畅比有明显改善(P0.01)。术后平均使用降眼压药数量明显减少(P0.01)。另14眼(15.22%)虽经联合降眼压,术后眼压仍大于25 mm Hg(1 mm Hg=0.133 k Pa),遂加行小梁切除术。结论小切口白内障摘除IOL植入联合房角分离术,能有效降低眼压、加深前房、开放房角、改善视功能,对合并白内障的闭角型青光眼,是安全经济有效的手术方法,对于无超声乳化设备的基层医院值得推广应用。但对于术前房角粘连关闭大于270°的患者,联合采用小梁切除术,对于挽救患者的视功能,是必要和稳妥的。
[Abstract]:Objective to observe the clinical effect and operative indication of small incision extracapsular cataract extraction (Ecce) with intraocular lens (IOL) implantation combined with angle separation for primary angle closure glaucoma (PACG) patients with cataract. Methods 92 cases (92 eyes) of PACG were diagnosed. All patients were treated with small incision extracapsular cataract extraction (IOL) implantation and angle separation. The follow-up was 9 ~ 24 months. The changes of intraocular pressure (IOP), visual acuity, depth of central anterior chamber, angle of atrium, the coefficient of aqueous humor fluency and the ratio of intraocular pressure to unobstructed and the amount of drugs used to reduce intraocular pressure were observed. Results the final mean IOP was significantly lower than the preoperative mean IOP (P0.01), and the best corrected visual acuity (BCVA) was better than that before the operation (P0.01). The depth of anterior chamber deepened (P0.01). All the angles were open in 72 eyes (78.26%). After operation, the flow coefficient of aqueous humor and the ratio of pressure unobstructed were significantly improved (P 0.01). The number of intraocular pressure lowering drugs was significantly decreased after operation (P 0.01). 14 eyes (15.22%) were treated with trabeculectomy after intraocular pressure reduction (IOP) > 25 mm Hg (1 mm Hg=0.133 k Pa),. Conclusion small incision cataract extraction with IOL implantation combined with angle separation can effectively reduce intraocular pressure, deepen anterior chamber, open angle and improve visual function. It is a safe, economical and effective surgical method for angle-closure glaucoma with cataract. It is worth popularizing and applying to the basic hospital without phacoemulsification equipment. However, trabeculectomy combined with trabeculectomy is necessary and safe to save the visual function of the patients whose atrial angle adhesions are closed more than 270 掳before operation.
【作者单位】：梁平县人民医院眼科;
【分类号】：R779.66

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