超声乳化白内障吸除术或联合房角分离术治疗原发性闭角型青光眼_论文

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1、超声乳化白内障吸除术或联合房角分离术治疗原发性闭角型青光眼作者：冯朝晖　孙乃学　张晓辉　任百超【摘要】　　目的：观察超声乳化白内障吸除人工晶状体植入术或同时联合房角分离术治疗原发性闭角型青光眼（primaryangleclosureglaucoma,PACG）的临床疗效，探讨手术适应证。方法：PACG患者29例（43眼），均合并不同程度晶状体混浊。根据术前房角粘连关闭的范围不同分为3组：A组16眼，术前房角粘连关闭≤180°，行超声乳化白内障吸除人工晶状体植入术。B组15眼，180°＜术前房角粘连关闭

2、≤270°,C组12眼，术前房角粘连关闭＞270°，B组和C组行超声乳化白内障吸除人工晶状体植入联合房角分离术。术后随访9~24（平均±）mo。观察眼压、房角和视力等的变化。结果：A组16眼(100%)、B组14眼(93%)、C组2眼（17%）,术后不用任何降眼压药物眼压正常。B组另1眼（7%）局部用药眼压控制正常。C组其余的10眼中，2眼（17%）局部用药眼压＞21mmHg（【关键词】青光眼　闭角型　超声乳化白内障吸除术　房角分离术　人工晶状体AbstractAIM:Toinvestigatethe

3、clinicaleffectsandindicationsofphacoemulsificationplus12/12intraocularlens(IOL)implantationperseandcombinedwithgoniosynechialysis(GSL)inthemanagementofprimaryangle-closureglaucoma（PACG）.METHODS:Twenty-ninecases(43eyes)withPACGandcataractweredividedinto3

4、groupsaccordingtopreoperativedegreesofsynechialangleclosure(SAC):16eyesofgroupAwithequaltoorlessthan180degreesSAC,15eyesofgroupBwithmorethan180degreesbutequaltoorlessthan270degreesSAC,12eyesofgroupCwithmorethan270degreesSAC.GroupAwastreatedwithphacoemul

5、sificationplusIOLimplantation.BothgroupBandCwastreatedwithphacoemulsificationandIOLimplantationcombinedwithGSL.Intraocularpressure(IOP),anteriorchamberangleandvisualacuityweremonitoredduringfollow-upfor9-24monthsintheseeyes.RESULTS:TheIOPsof16eyes(100%)

6、ingroupA,14eyes(93%%)ingroupBand2eyes(17%)ingroupCwerenormalwithoutanymedications.TheIOPof1eyes(7%)ingroupBwasnormalwithasingleantiglaucomatouseyedrops.TheIOPsof10eyesingroupCwerehigherthan12/1221mmHgaftermedications,8eyesrequiredtrabeculectomy.Thechamb

7、eranglesbecamewiderandSACweremostlyreopenedaftersurgeryinalleyes.Thepostoperativeoutcomeofbestcorrectedvisualacuitywereeverimprovedin38of43eyes(88%).CONCLUSION:PhacoemulsificationplusIOLimplantationisabletoeffectivelycontrolIOPandalsoimprovethevisualacu

8、ityofPACGwithequaltoorlessthan180degreesSACandwithcataract.ForSACrangingfrom180to270degrees,thesimilareffectscanalsobeobtainedviaphacoemulsificationplusGSL.However,trabeculectomymaybenecessaryforcasesofSACmorethan270degrees.·KEYW