Phacoemulsification ，separation angle  and  peripheral iris resection for the treatment of angle-closure glaucoma complicated with cataract

    LIANG Jun-rong,HUANG Li.Luhua Hospital of Luzhou City,Luzhou 646003,China

    ［Abstract］  Objective  To investigate the effect of phacoemulsification, foldable intraocular lens implantation, separation angle, iris periphery resection for the treatment of acute and chronic angle closure glaucoma complicated with  cataract.Methods  38 cases of acute and chronic angle-closure glaucoma hospitalized between 2001 March and 2006 June were investigated retrospectively.All of them complicated by lens opacification, visual acuity <0.6 and without glaucoma surgery history. Phacoemulsification ,intraocular lens implantation , separation of the angle and iris periphery resection were performed, followed-up for 3 to 5 years. Visual acuity, intraocular pressure （IOP）, anterior chamber depth and the anterior angle changes were compared before and after operation.Results  IOP of 22 eyes with acute angle-closure glaucoma and 12 chronic angle-closure glaucoma were controlled in the normal range after surgery, and got good eyesight restoration. Four chronic angle-closure glaucoma with angle adhesion> 2 / 3 got effective IOP control, but  1.5 to 2 years after operation, intraocular pressure increased again, drug treatment ineffective. Trabeculectomy was performed to get intraocular pressure controllled in the normal range.Conclusion  Phacoemulsification, foldable intraocular lens implantation, separation angle, iris periphery resection is effective in the treatment of acute and chronic angle-closure glaucoma （angle closure adhesion <2/3） complicated with cataract. But long-term follow-up should be done.

    ［Key words］  phacoemulsification; intraocular lens angle separation; iris peripheral resection; acute and chronic angle-closure glaucoma; cataract

    我院自2001年3月～2006年6月收治急慢性闭角型青光眼合并白内障患者38例，行颞侧透明角膜切口超声乳化白内障吸除人工晶体植入房角分离虹膜周边切除术，观察术前、术后患者的眼压、中央前房深度、周边前房深度、房角变化，现报告如下。

    1  资料与方法

    1.1  一般资料  收集2001年3月～2006年6月在我院治疗的原发性急慢性青光眼合并白内障患者38例38眼，年龄48～82岁，平均60.5岁，其中男14例，女24例。急性闭角型青光眼22例，慢性闭角型青光眼16例，所有患者均无抗青光眼手术史，晶状体有不同程度的浑浊，核呈Ⅱ～Ⅳ级 ，视力光感 ～0.6，眼压药物控制后，34眼＜21 mm Hg，4眼28～35 mm Hg，随访时间3个月～5年。

    1.2  术前准备  常规用0.5%噻吗心安、1%毛果芸香碱、派立明等治疗将眼压尽量降至正常或接近正常，术前3天停用缩瞳药，术前1 h静滴20%甘露醇250 ml，术前30 min美多丽散瞳。

    1.3  手术方法  0.4%倍诺喜表麻，眼压高于正常者加用球周麻醉，压迫眼球降低眼压，做颞侧透明角膜隧道切口入前房，前房内注入黏弹剂，特别是周边房角处，边注射黏弹剂边分离前粘连，使房角开放，鼻侧2点做辅助切口，连续环行撕囊直径约5～5.5 mm，水分离和水分层，用超声乳化仪在囊袋内行原位碎核分块吸除，清除残留杂质，囊袋内注入黏弹剂，植入眼力健折叠型人工晶体于囊袋内，吸除黏弹剂，卡米可林缩瞳，在辅助切口处做虹膜周边切除，用BSS冲洗前房，切口呈水密闭合状态，庆大霉素2万u，地塞米松2.5 mg，球结膜下注射，典必殊眼膏包贴术眼。

    2  结果

    2.1  术后眼压  随访3个月～5年，患者34眼眼压11～21 mm Hg，平均15.5 mm Hg；4眼术后1年内眼压18～24 mm Hg，1.5～2年眼压28～35 mm Hg，药物效果差，再次行青光眼小梁切除术后眼压12～18 mm Hg，这4眼术前均为慢性闭角型青光眼，房角粘连闭合＞2/3。

    2.2  前房深度和前房角、中央前房深度  由术前的（1.58±0.25）mm，术后增加到（2.92±0.20）mm，术后房角有不同程度的加宽，粘连范围缩小或消失，全部周边前房深度≥1 CT。

    2.3  术后视力  视力＜0.1者6眼，眼底检查发现视乳头苍白色，0.1～0.5者10眼，＞0.5者22眼，32例患者术后视力都有明显提高。

    2.4  术后并发症  全部患者人工晶体均在囊袋内，术后8眼发生轻度角膜内皮等水肿，保守治疗3～6天后角膜透明，无一例脉络膜脱离和恶性青光眼、前房形成迟缓等并发症，有2例发生前囊膜收缩综合征。

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