白内障囊外摘除联合房角分离术治疗急性闭角型青光眼
发布时间：2018-10-16 13:02
【摘要】： 青光眼是全世界不可逆盲的最常见的原因。近年来国内学者依据其发病机制将原发性闭角型青光眼分为以下三种类型：单纯性瞳孔阻滞型、单纯性非瞳孔阻滞型及混合机制型。单纯性非瞳孔阻滞型也有虹膜高褶型之称,在我国很少见,仅7.1%的原发性闭角型青光眼属于此型,混合机制型占原发性闭角型青光眼的54.8%。 闭角型青光眼患者具有浅前房、窄房角和眼轴短等特点,随着年龄增加,睫状体带松弛,晶状体增厚6造成相对瞳孔阻滞。在白内障的病程中,随着年龄的增加,晶状体膨胀,前后径增大,位置前移,使晶状体与虹膜的接触面积增大,后房的房水从瞳孔排向前房的阻力逐渐增大,形成瞳孔阻滞。当后房压力不能克服瞳孔阻滞时,周边虹膜膨隆明显,导致房角狭窄、甚至关闭。因此,临床上白内障合并闭角型青光眼的病人较常见。 以往治疗白内障合并闭角型青光眼的手术通常采用白内障囊外摘除人工晶体植入联合青光眼小梁切除术。但近年来关于白内障合并闭角型青光眼的手术方式,成为眼科界争论的问题之一。国内外眼科学者在白内障摘除术与抗青光眼手术分阶段治疗中,发现单纯白内障手术由于晶体摘除可加深前房,开放尚未粘连的房角,对部分闭角型青光眼具有控制眼压的作用,于是提出了单纯白内障手术治疗闭角型青光眼的治疗方法,从而扩大了晶状体摘除术的应用范围。该方法不但可简化手术程序,而且能改善患者视力状况。但仍有部分房角粘连牢固的病人未得到改善,眼压仍然高于正常水平。 据最近报道：晶状体摘出联合人工晶状体(10L)植入术,房角粘连分离术,超声乳化白内障吸出术联合房角粘连分离术(phacoemulsification with goniosynechialysis,简称PEGS),都能成功地降低闭角型青光眼患者的眼压。 目的 观察白内障囊外摘除人工晶体植入联合房角分离术治疗合并有白内障的急性闭角型青光眼的疗效以及术后房角形态的改变。 方法 我们选择2003年1月至2009年6月确诊为急性闭角型青光眼合并白内障患者84例(88只眼),行白内障囊外摘除联合房角分离术,进行回顾性分析,对其手术前后的视力、眼压、视野、中央前房深度、房角形态进行对照观察。 结果 术后随访3-6个月,84例(88只眼)有69例(71只眼)视力较术前明显提高。88只眼术后中央前房深度均加深,术前前房深度1.673±0.476mm,术后前房深度3.414±0.167mm。84只眼术后眼压明显降低,术前眼压28.437±3.321 mmHg，术后眼压13.981±5.173 mmHg。术后3月房角镜检查84例(88只眼)房角均较术前有不同程度的开放。60例(62只眼)术后6月复查视野无缩小。 结论 白内障囊外摘除联合房角分离术是治疗合并有白内障的急性闭角型青光眼的有效方法。能使此类患者降低眼压、加深前房、开放房角和提高视力。
[Abstract]:Glaucoma is the most common cause of irreversible blindness worldwide. In recent years, according to its pathogenesis, primary angle-closure glaucoma has been classified into three types: simple pupillary block, simple non-pupillary block and mixed mechanism. Simple non-pupillary block type is also known as high iris fold type. It is rare in China. Only 7.1% of primary angle-closure glaucoma belongs to this type, and mixed mechanism type accounts for 54.8% of primary angle-closure glaucoma. The patients with angle-closure glaucoma have the characteristics of shallow anterior chamber, narrow angle of atrium and short eye axis. With the age, the ciliary zone is relaxed and the lens thickens, which results in the relative pupil block. In the course of cataract, with the increase of age, the lens dilates, the anteroposterior diameter increases, the position moves forward, the contact area between the lens and the iris increases, and the resistance of the aqueous humor in the posterior chamber from the pupil to the anterior chamber increases gradually, resulting in pupil block. When posterior chamber pressure can not overcome pupillary block, peripheral iris bulges obviously, leading to angular stenosis or even closure. Therefore, cataract with angle closure glaucoma is more common in clinical patients. Extracapsular cataract extraction (Ecce) and intraocular lens implantation (IOL) combined with trabeculectomy are usually used in the treatment of cataract with angle closure glaucoma. However, the surgical methods of cataract combined with angle closure glaucoma have become one of the controversial issues in ophthalmology in recent years. In the phased treatment of cataract extraction and anti-glaucoma surgery, domestic and foreign ophthalmologists found that simple cataract surgery can deepen the anterior chamber and open the unadherent angle because of lens extraction. Partial angle-closure glaucoma has the function of controlling intraocular pressure, so a simple cataract surgery is put forward to treat angle closure glaucoma, thus expanding the scope of application of lens extraction. This method not only simplifies the procedure, but also improves the visual acuity of patients. However, some patients with solid adhesion of the angle of atrium were not improved, and IOP was still above normal level. It has been reported recently that lens extraction combined with intraocular lens (10L) implantation, atrial angle adhesion separation, phacoemulsification cataract extraction combined with atrial angle adhesion separation (phacoemulsification with goniosynechialysis,) can successfully reduce the intraocular pressure in patients with angle closure glaucoma. Objective to observe the effect of extracapsular cataract extraction and intraocular lens implantation combined with angle separation in the treatment of acute angle closure glaucoma with cataract. Methods from January 2003 to June 2009, 84 patients (88 eyes) with acute angle-closure glaucoma and cataract were treated with extracapsular cataract extraction and angle separation. Visual acuity, intraocular pressure, visual field, depth of central anterior chamber and angle of atrium were observed before and after operation. Results after 3 to 6 months follow-up, 69 eyes (71 eyes) of 84 eyes (88 eyes) improved their visual acuity, and the depth of central anterior chamber deepened in 88 eyes after operation. The preoperative depth of anterior chamber was 1.673 卤0.476 mm, the postoperative depth of anterior chamber was 3.414 卤0.167mm.84, and the intraocular pressure was significantly decreased. The preoperative intraocular pressure was 28.437 卤3.321 mmHg, and the postoperative IOP was 13.981 卤5.173 mmHg.. The angle of atrial angle of 84 cases (88 eyes) was open to different degree after 3 months of operation, and the visual field of 60 cases (62 eyes) was not reduced in 6 months after operation. Conclusion extracapsular cataract extraction combined with angle separation is an effective method for the treatment of acute angle-closure glaucoma with cataract. These patients can reduce intraocular pressure, deepen anterior chamber, open room angle and improve visual acuity.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R779.6
本文编号：2274444
[Abstract]:Glaucoma is the most common cause of irreversible blindness worldwide. In recent years, according to its pathogenesis, primary angle-closure glaucoma has been classified into three types: simple pupillary block, simple non-pupillary block and mixed mechanism. Simple non-pupillary block type is also known as high iris fold type. It is rare in China. Only 7.1% of primary angle-closure glaucoma belongs to this type, and mixed mechanism type accounts for 54.8% of primary angle-closure glaucoma. The patients with angle-closure glaucoma have the characteristics of shallow anterior chamber, narrow angle of atrium and short eye axis. With the age, the ciliary zone is relaxed and the lens thickens, which results in the relative pupil block. In the course of cataract, with the increase of age, the lens dilates, the anteroposterior diameter increases, the position moves forward, the contact area between the lens and the iris increases, and the resistance of the aqueous humor in the posterior chamber from the pupil to the anterior chamber increases gradually, resulting in pupil block. When posterior chamber pressure can not overcome pupillary block, peripheral iris bulges obviously, leading to angular stenosis or even closure. Therefore, cataract with angle closure glaucoma is more common in clinical patients. Extracapsular cataract extraction (Ecce) and intraocular lens implantation (IOL) combined with trabeculectomy are usually used in the treatment of cataract with angle closure glaucoma. However, the surgical methods of cataract combined with angle closure glaucoma have become one of the controversial issues in ophthalmology in recent years. In the phased treatment of cataract extraction and anti-glaucoma surgery, domestic and foreign ophthalmologists found that simple cataract surgery can deepen the anterior chamber and open the unadherent angle because of lens extraction. Partial angle-closure glaucoma has the function of controlling intraocular pressure, so a simple cataract surgery is put forward to treat angle closure glaucoma, thus expanding the scope of application of lens extraction. This method not only simplifies the procedure, but also improves the visual acuity of patients. However, some patients with solid adhesion of the angle of atrium were not improved, and IOP was still above normal level. It has been reported recently that lens extraction combined with intraocular lens (10L) implantation, atrial angle adhesion separation, phacoemulsification cataract extraction combined with atrial angle adhesion separation (phacoemulsification with goniosynechialysis,) can successfully reduce the intraocular pressure in patients with angle closure glaucoma. Objective to observe the effect of extracapsular cataract extraction and intraocular lens implantation combined with angle separation in the treatment of acute angle closure glaucoma with cataract. Methods from January 2003 to June 2009, 84 patients (88 eyes) with acute angle-closure glaucoma and cataract were treated with extracapsular cataract extraction and angle separation. Visual acuity, intraocular pressure, visual field, depth of central anterior chamber and angle of atrium were observed before and after operation. Results after 3 to 6 months follow-up, 69 eyes (71 eyes) of 84 eyes (88 eyes) improved their visual acuity, and the depth of central anterior chamber deepened in 88 eyes after operation. The preoperative depth of anterior chamber was 1.673 卤0.476 mm, the postoperative depth of anterior chamber was 3.414 卤0.167mm.84, and the intraocular pressure was significantly decreased. The preoperative intraocular pressure was 28.437 卤3.321 mmHg, and the postoperative IOP was 13.981 卤5.173 mmHg.. The angle of atrial angle of 84 cases (88 eyes) was open to different degree after 3 months of operation, and the visual field of 60 cases (62 eyes) was not reduced in 6 months after operation. Conclusion extracapsular cataract extraction combined with angle separation is an effective method for the treatment of acute angle-closure glaucoma with cataract. These patients can reduce intraocular pressure, deepen anterior chamber, open room angle and improve visual acuity.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R779.6
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