不同房角分离术治疗原发性急性闭角型青光眼合并白内障的疗效

Two kinds of goniosynechialysis for primary acute angle-closure glaucoma with cataract

摘要:

目的：探讨白内障超声乳化联合两种不同房角分离术治疗原发性急性闭角型青光眼合并白内障的临床疗效。

方法：原发性急性闭角型青光眼合并白内障的患者60例62眼随机分为两组，A组31眼行白内障超声乳化摘除术联合I/A头牵拉房角分离术，B组31眼行白内障超声乳化摘除联合黏弹剂钝性房角分离术，比较两组患者术前和术后3mo的最佳矫正视力、眼压、中央前房深度、房角开房范围和瞳孔大小。

结果：术后所有患者眼压明显低于术前眼压，差异具有统计学意义(P<0.05)； 62眼视力较术前均有不同程度的改善； 前房深度和房角开放范围均较术前明显增加，差异具有统计学意义(P<0.05)。A组与B组相比，两组患者术后3mo视力、眼压控制和中央前房深度方面差异无统计学意义(P>0.05)，A组在房角开放范围方面优于B组，差异有统计学意义(P<0.05)。术后3mo，A组患者中有8眼瞳孔缩小1mm以上，B组患者中有2眼瞳孔缩小1mm以上。

结论：白内障超声乳化摘除术联合两种不同的房角分离术均能有效治疗原发性急性闭角型青光眼合并白内障，其中I/A头牵拉房角分离术能更有效地增加房角开放范围。

Abstract:

AIM: To study the effect of two kinds of phacoemulsification combined with goniosynechialysis for primary angle-closure glaucoma with cataract.

METHODS: Phacoemulsification combined with goniosynechialysis was performed in 60 patients 62 eyes for primary angle-closure glaucoma with cataract. They were randomly divided into two groups, 31 eyes underwent phacoemulsification with goniosynechialysis combined with I/A catheterization were performed in Group A; in Group B, 31 eyes were performed phacoemulsification with goniosynechialysis combined with viscoelastics. Best corrected visual acuity, the intraocular pressure, anterior chamber depth, anterior chamber angle width and pupil size were measured before the operation, and 3mo after the operation.

RESULTS: Intraocular pressure of all cases were reduced obviously after the operation(P<0.05). Visual acuity of the 62 eyes were improved in different extent; the anterior chamber depth and anterior chamber angle width after 3mo of the operation were deeper and wider than those before the operation(P<0.05). There were no different in the intraocular pressure, best corrected visual acuity and anterior chamber depth between the two groups(P>0.05), but, Group A was superior to Group B in anterior chamber angle width(P<0.05). At 3mo after operation, there were 8 eyes in Group A with more than 1mm lessen pupil size, two eyes in Group B had the same.

CONCLUSION: Two kinds of goniosynechialysis combined with phacoemulsification in the treatment of primary acute angle-closure glaucoma with cataract are effective. Among them, the goniosynechialysis with I/A was more effective to increase the anterior chamber angle width.