原发性闭角型青光眼白内障联合房角分离术房角形态变化及疗.pdf

·临床研究·原发性闭角型青光眼白内障联合房角分离术房角形态变 化及疗效分析孙摇 重,吴作红基金项目:2012 年度武汉市卫生局临床医学科研项目 (No. WX12B21)作者单位:(430064)中国湖北省武汉市,武汉爱尔眼科医院作者简介:孙重,硕士研究生,主治医师,研究方向:青光眼、白内障通讯作者:吴作红,硕士研究生,副主任医师,研究方向:青光眼、 白内障. wzh2757@ sina. com收稿日期: 2015-07-02 摇 摇 修回日期: 2015-10-24Morphologic change and the clinical effects ofphacoemulsificationcombinedwith goniosynechialysisinprimaryangle - closure glaucomaZhong Sun, Zuo-Hong WuFoundation item:Clinical Scientific Research Foundation of HealthBureau of Wuhan City in 2012 year (No. WX12B21)Wuhan Aier Eye Hospital, Wuhan 430064, Hubei Province, ChinaCorrespondence to:Zuo -Hong Wu. Wuhan Aier Eye Hospital,Wuhan 430064, Hubei Province, China. wzh2757@ sina. com Received:2015-07-02摇 摇 Accepted:2015-10-24Abstract誗AIM: To study themorphological changes of anterior chamber angle in patients with primary angle - closureglaucoma ( PACG)and in whom the closed anterior chamber angle was 逸 180毅 ( determined by gonioscopydynamicly )beforeandafterphacoemulsificationcombined with goniosynechialysis and to evaluate theclinical efficacy of this surgry.誗METHODS:A prospective case series study. Seventy- nine cases (79 eyes) with cataract were enrolled. They went to our hospital for phacoemulsification and werediagnosedasPACG,inwhomtheclosedanteriorchamber angle was 逸 180毅 ( determined by gonioscopydynamicly).They were observed for the changes ofanterior chamber angle, intraocular pressure (IOP) andthe best-corrected visual acuity (BCVA) pre- and post- operative from January to December in 2013. The angleopening distance 500(AOD500) and trabecular-iris angle500 ( TIA500) before and after surgeries were analyzedusing paired student t-test. The range of goniosynechiaand BCVA before and after surgeries were analyzed using Kruskal-Wallis H test.誗RESULTS: TheIOPsof 58eyeswerenormal ( 臆 21mmHg )withoutanymedicationsat1moafter operation, and 56 eyes at 6mo after operation. The rangeof goniosynechia, AOD500, TIA500and BCVA before operation had significant difference compared with thoseat 1 and 6mo after operation(P0. 5术前42370术后 1mo65716术后 6mo65716摇 摇 对于房角关闭270毅,术后原粘连部位房角增宽,但房角粘连关闭仍>180毅,且房角开放处可见小梁色素沉着浓厚,考虑该 9 眼病程时间长,周边虹膜前粘连紧密,虽然房角能部分开放,但仍有大量色素堵塞小梁网,造成小梁网功能的失代偿,房水外流阻力增加,致术后眼压仍高。

同时我们也发现,对于睫状体前位的 3 眼,房角虽有所增宽,但虹膜仍骑跨于睫状体上,大部分房间仍粘连关闭,所以术后眼压仍需用药物控制 在术后 1 ~6mo 期间,有 7 眼房角粘连关闭度增加,有 3 眼又加用 1 种或 2 种局部用药, 分析术后晚期眼压缓慢上升的原因,可能为术后早期房角开放及超声波本身引起的睫状体分泌功能下降[14-15],起到降眼压的作用,但随时间延长,房角粘连继续发展,睫状体房水分泌功能恢复正常,小梁网功能失代偿未能发挥足够的眼内引流作用,导致眼压上升 除 8 眼术前明显视神经萎缩病例术后视力无提高,其余病例术后视力均有提高,可见只要视神经未明显萎缩,白内障手术对青光眼患者的视力还是有一定的改善的摇 摇 综上所述,房角关闭逸180毅的原发闭角型青光眼,超声乳化白内障吸除联合 IOL 植入联合房角分离术均能改善其房角粘连情况,增宽房角,对于单纯性瞳孔阻滞性闭角型青光眼合并白内障患者行此手术,术后效果理想,眼压及视力均能改善;对于非瞳孔阻滞性及多种机制共存型闭角型合并白内障患者,病史较长、虹膜附着位置靠前者房角功能并未能发挥足够的眼内引流作用则术后可能需要联合药物治疗控制眼压。

此手术对于除视神经明显萎缩者外,都在一定程度上能提高患者的视力参考文献1 王宁利,欧阳洁,周文炳,等. 中国人闭角型青光眼的临床研究. 中2391国际眼科杂志摇2015 年 11 月摇 第 15 卷摇 第 11 期摇 摇 http:/ / ies. ijo. cn:029鄄82245172摇 摇 82210956摇 摇 摇电子信箱:IJO.2000@163. com华眼科杂志 2000;36(1):46-512 Hayashi K,Hayashi H,Nakao F,et al . Changes in anterior chamberangle width and depth after intraocular lens implantation in eyes withglaucoma. Ophthalmology 2000;107(4):698-7033 Vizzeri G, Weinreb RN. Cataract surgery and glaucoma. Curr OpinOphthalmol 2010;21(1):20-244 Shrivastava A, Singh K. The effect of cataract extraction on intraocularpressure. Curr Opin Ophthalmol 2010;21(2):118-1225 Tsai HY, Liu CJ, Cheng CY. Combined trabeculectomy and cataractextraction versustrabeculectomyaloneinprimaryangle - closureglaucoma. Br J Ophthalmol 2009;93(7):943-9486 Ehrnrooth P, Lehto I, Puska P, et al .Phacoemulsification intrabeculectomized eyes. Acta Ophthalmol Scand 2005;83(5):561-5667 Inal A, Bayraktar S, Inal B, et al . Intraocular pressure control afterclear corneal phacoemulsification in eyes with previoustrabeculectomy: acontrolled study. Acta Ophthalmol Scand 2005;83(5):554-5608ThamCC,LeungDY,KwongYY,etal.Effectsofphacoemulsification versus combined phaco-trabeculectomy on drainageangle status in primary angle closure glaucoma (PACG). J Glaucom2010;19(2):119-1239 Tham CC, Kwong YY, Leung DY, et al . Phacoemulsification versuscombined phacotrabeculectomy in medically controlled chronic angleclosure glaucoma with cataract. Ophthalmology 2008;115(12):2167-217310 MatlachJ,FreibergFJ,LeippiS,etal.Comparisonofphacotrabeculectomy versus phacocanaloplasty in the treatment of patientswith concomitant cataract and glaucoma.BMC Ophthalmol 2013; 29(13):1-1311 TangY,QianS,WangJ,etal.Effectsofcombinedphacoemulsification and viscogoniosynechialysis versus trabeculectomy inpatients with primary angle-closure glaucoma and coexisting cataract.Ophthalmologica 2012;228(3):167-17312 Lai JS, Tham CC, Lam DS. The efficacy and safety of combinedphacoemulsification,intraocularlensimplantation,andlimitedgoniosynechialysis, followed by diode laser peripheral iridoplasty, in thetreatment of cataract and chronic angle -closure glaucoma. J Glaucoma2001;10(4):309-31513 刘少章,于纯智.363 例原发性慢性闭角型青光眼的小梁组织学改变和临床病理分析. 中国实用眼科杂志 2003;21(5):344-34614Wang N, Chintala SK, Fini ME, et al . Ultras。