目的：探讨360°“最大程度”房角关闭的重症急性闭角型青光眼，通过“双穿刺”、联合超声乳化加房角分离手术，能否重新开放房角，开放的范围和眼压变化。

方法：回顾性系列病例研究。2008-11/2015-11收住我院病例完整的重症急性闭角型青光眼患者33眼，均为最大量药物治疗无效的患者。入院后行“双穿刺”手术短时间降低眼内压(术前和术后7d查房角)，7～14d后行超声乳化联合房角分离手术治疗(术中检查房角)，比较两次手术前后患者眼压、房角变化，观察手术并发症。随访时间为6～24mo。

结果：“双穿刺”术前眼压为53.4±10.7mmHg(1mmHg=0.133kPa)，“双穿刺”手术后32眼眼压正常(其中2眼激光打孔后眼压正常)，平均眼压为16.9±13.2mmHg。1眼眼压仍高。双穿刺术前、术后眼压比较差异有统计学意义(t=9.21，P<0.001)。超声乳化术后1wk眼压为16.7±4.8mmHg。双穿刺术后与超声乳化术后眼压比较差异无统计学意义(t=0.38， P>0.05)。1眼术后眼压异常，术后30d后正常。双穿刺术后房角的检查结果为：房角开放均值(131.8±111.3)°。术后7～14d 32眼行超声乳化联合房角分离术，1眼行超乳联合小梁切除手术，房角开放手术治疗有效率为32/33(97%)。术中房角开放均值(228.6±108.3)°，术后3mo房角开放均值(234.6±107.2)°。双穿刺术后与超声乳化术中房角开放度数比较差异有统计学意义(t=4.52，P<0.001)，超声乳化术后3mo房角均值大于术中房角，差异无统计学意义(t=0.46， P>0.05)。没有严重并发症发生。

结论：“最大程度”房角关闭的重症急性闭角型青光眼，可以通过“双穿刺”联合晶状体摘除手术逐步开放房角、降低眼压。开放房角可以作为重症急性闭角型青光眼的选择。

METHODS: Retrospective observational case series. From November 2008, to November 2015, there were 33 patients with severe acute angle-closure glaucoma and 360° angle closure. Drug treatment showed no effect on them, so initial double-paracentesis(anterior chamber paracentesis combined with vitreous paracentesis)was applied. Then, either phacoemulsification combined with goniosychialysis or trabeculectomy surgery was performed after 7-14d, which was chosen based on the result of gonioscope during the surgery. The intraocular pressure, angle changes, and complications were observed. The follow-up period was 6mo to 3a.

RESULTS: Of 33 participants enrolled, 32 had normal intraocular pressure after “double-paracentesis”(2 had normal intraocular pressure after laser peripheral iridotomy). The mean intraocular pressure was significantly reduced from 53.4±10.7mmHg to 16.9±13.2mmHg(t=9.21,P<0.001)by applying “double-paracentesis”, and 1 still had higher intraocular pressure. The mean intraocular pressure(16.7±4.8mmHg)was 0.2mmHg lower after phacoemulsification than after “double-paracentesis” while there was no significant difference(t=0.38,P>0.05). One patient had abnormal intraocular pressure until 30d after phacoemulsification. Every participant had 360° angle closed before “double-paracentesis”, 32 patients had opened angle(mean 131.8°±111.3°)after “double-paracentesis” and mean(228.6°±108.3°)during phacoemulsification, and mean(234.6°±107.2°)at 3mo after phacoemulsification. There was a significant difference between the post-paracentesis and intraoperative values(t=4.52, P<0.001). There was no difference between the intraoperative and postoperative values(t=0.46, P>0.05). No patients had serious adverse events.

CONCLUSION: For the “maximum degree” angle closure of severe acute angle-closure glaucoma, “double-paracentesis” combined with phacoemulsification can be chosen to open the angle gradually, and reduce intraocular pressure in vast majority of patients.