【摘要】目的：观察前房角分离白内障囊外摘除后房型人工晶状体植入联合青光眼小梁切除治疗原发性急性闭角型青光眼合并白内障的临床效果。 方法：对29例（29眼）急性闭角型青光眼合并白内障行白内障囊外摘除后房型人工晶状体植入联合小梁切除术。结果：29例（29眼）术后前房深度增加，视力较前提高，术后无严重并发症。结论：前房角分离、白内障囊外摘除后房型人工晶状体植入联合小梁切除术可有效降低眼压，开放房角，提高视力，取得了良好的治疗效果。
【关键词】 青光眼 白内障 房角分离 白内障摘除人工晶状体植入联合小梁切除
Clinical observation of operation therapeutic on acute angleclosure glaucoma combined with cataract
MeiRui Gao, Lei Gao, ShengLi Ge
Department of Ophthalmology, the Affiliated Hospital of Yanan University, Yanan 716000, Shaanxi Province, China
Abstract
AIM: To observe the clinical effect of separation of angle of anterior chamber combined with exrtacapsular cataract with intraocular posterior chamber lens implantation and trabeculectomy on acute angleclosure glaucoma complicated with cataract.
METHODS: Twentynine cases (29 eyes) with acute angleclosure glaucoma complicated with cataract were operated by separation of angle of anterior chamber combined with exrtacapsular cataract with intraocular posterior chamber lens implantation and trabeculectomy.
RESULTS: Postoperatively, intraocular pressure was decreased, the chamber depth was increased, visual acuity was raised after operation in 29 eyes, and no severe complication occurred．
CONCLUSION: Characterized by decreasing intraocular pressure, opening anterior chamber, and raising visual acuity, separation of angle of anterior chamber combined with exrtacapsular cataract with intraocular posterior chamber lens implantation is a good operative therapy for acute angleclosure glaucoma complicated with cataract.
KEYWORDS: glaucoma; cataract; separation of angle of anterior chamber; exrtacapsular cataract with intraocular posterior chamber lens implantation
0引言
青光眼是一种严重的不可逆疾病，它是一种主要致盲眼病，在我国主要以原发性闭角型青光眼为主，随着年龄的增长，原发性闭角型青光眼的发生，往往与同时存在的白内障有关，晶状体膨胀是原发性闭角型青光眼发病的主要诱因，往往两种因素并存加重了病情发展，严重影响患者的长期生存质量。我院采用白内障囊外摘除、晶状体植入联合房角成形，小梁切除术治疗急性闭角型青光眼合并白内障，取得了良好效果，现报告如下。
1对象和方法
1.1对象 200601/200706，我院对急性闭角型青光眼合并白内障行白内障囊外摘除后房型人工晶状体植入联合小梁切除术29例（29眼），女16例，男13例，术前视力0.1～光感,年龄51～73（平均62）岁。原发性闭角型青光眼急性发作期，按scheie前房角分类法：房角均为窄II～窄IV，白内障膨胀期或成熟期前房按Spaeth分类法分为3级浅前房,所选病例均为1～2级浅前房。术前降眼压至眼压控制平稳后1wk，角膜透明，瞳孔约3～7mm部分虹膜有后粘，虹膜萎缩。
1.2方法 上方角巩膜缘后2mm做3.5mm的巩膜隧道切口。穿刺入前房，黏弹剂入前房，沿前房角360°推注分离房角粘连，行环行连续撕囊，充分的水分离，扩大切口至5～6mm，娩出晶状体核，植入后房型人工晶状体，吸出黏弹剂，上方巩膜做1mm×3mm小梁切除，观察前房形成良好，无伤口渗漏，关闭结膜切口，前房形成不良者切口缝合1针，四环素可的松眼膏涂眼包扎。
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