早期原发闭角型青光眼合并白内障的两种手术方式临床观察

【摘要】 目的 分析单纯超声乳化和超声乳化联合虹膜周边切除对早期原发闭角型青光眼合并白内障的临床治疗效果。方法 选择仅局部用药即可控制眼压在正常范围的早期闭角型青光眼合并白内障患者34例（38眼），随机分组，分别施以单纯超声乳化和超声乳化联合虹膜周边切除手术（各19眼）。结果 两种术式都显著改善了视力（经χ2检验，P＜0.01）；视力改善与采用何种术式无关（经χ2检验，P＞0.05）。术前术后眼压差异无显著性，但术前17眼需药物协助控制眼压，术后观察期内无一例眼压升高需使用降眼压药物者。两种术式都显著改善了房角粘连（经χ2检验，P＜0.01）。周边前房深度术前术后差异有非常显著性（经t检验，P＜0.01）；两种术式间差异无显著性（经t检验，P＞0.05）。中央前房深度术前术后差异有非常显著性（经t检验，P＜0.01），两种术式间差异无显著性（经t检验，P＞0.05）。结论 对于早期原发闭角型青光眼合并白内障患者采取单纯超声乳化和超声乳化联合虹膜周边切除手术治疗均可以控制眼压，改善视力，但单纯超声乳化术术后并发症少，而且手术操作简单。

【关键词】 白内障；青光眼，闭角型；晶体超声乳化术；虹膜周边切除术

Clinical investigation of two methods for cataract patients with angle closure glaucoma

【Abstract】 Objective To evaluate the effect of the phacoemulsification single or combined with trabeculectomy for cataract patients with early angle-closure glaucoma.Methods 34 patients（38eyes）with cataract and early angle-closure glaucoma were chosen and divided into two groups randomly whose intraocular pressure could be controlled to normal by remedy.19 eyes were performed with the phacoemulsification single or combined with trabeculectomy separately.Results Both methods improved visual sight significantly（by χ2’s test，P＜0.01），but the improvement had no connection with the methods（by χ2’s test，P＞0.05）.The postoperative intraocular pressures（IOP）of both methods had no difference with the preoperative IOP，but the preoperative IOP of 17 eyes need to be controlled by remedy and the postoperative IOP of all eyes came to normal without using medicine during our investigation.Both methods have improved peripheral anterior synechiae（PAS） significantly（by χ2’s test，P＜0.01）.The peripheral and central anterior chamber depths were improved significantly（by t’s test，P＜0.01），but both methods had no distinction（by t’s test，P＞0.05）.Conclusion Although for cataract patients with angle-closure glaucoma，the phacoemulsification single or combined with trabeculectomy can also lower the IOP and increase the visual acuities，but the phacoemulsification single was simpler and had less complications.

【Key words】 cataract；glaucoma，angle-closure；ultrasonic phacoemulsification；peripheral iridotomy

随着超声乳化这一闭合白内障摘除技术在临床上的迅速推广，越来越多的国内外学者尝试并证明了超声乳化白内障吸除联合人工晶体植入术治疗闭角型青光眼的可能性［1～3］，但术中是否需要同时行虹膜根切各家说法不一［1］。现将我院自2004年1月至今，患有早期原发闭角型青光眼合并白内障的病人34例（38眼）随机分成A、B两组（各19眼），分别施以单纯超声乳化白内障摘除联合人工晶体植入手术和超声乳化白内障摘除人工晶体植入联合虹膜根切手术，观察并比较总结两种术式术后疗效及远期随访的房角及眼压变化，现介绍如下。