【摘要】 目的:探讨超声乳化晶状体摘除术治疗闭角型青光眼临床前期、先兆期的疗效。方法:原发性闭角型青光眼临床前期或先兆期患者32例(36眼)行超声乳化晶状体摘除术,对治疗前后的眼压、前房深度、房角形态、视力进行观察对比。随访时间为12mo。结果:在随访期内术后视力较术前有显著提高(P<0.01),房角镜检查术后4个象限房角较术前均显著变宽(P<0.01),术后眼压较术前无显著变化(P>0.05),中央PAC较术前有显著加深(P<0.05)。结论:超声乳化晶状体摘除术对于闭角型青光眼临床前期、先兆期的治疗有较好的效果,并且安全可靠。
【关键词】 超声乳化晶状体摘除术;闭角型青光眼;临床前期;先兆期
Clinical effect of phacoemulsification in the management of angle closure glaucoma in both preclinical and presymptom phases
KeFeng Liu, GuoPing Kuang, Sha Yu, ShaoYing Feng
Foundation item: Science Research Fund of the First People's Hospital of Chenzhou City Hunan Province, China (No.N2008043)
1Postqraduatute Research Institute, Nanhua University, Hengyang 421001, Hunan Province, China;
2Department of Ophthalmology, the First Peoples Hospital of Chenzhou City, Chenzhou 423000, Hunan Province, China
Abstract AIM: To probe into the clinical effect of phacoemulsification in the management of angle closure glaucoma in both preclinical and presymptom phases.METHODS: Thirtytwo patients (36 eyes) suffered from primary angle closure glaucoma in the preclinical or presymptom phases were treated with phacoemulsification. The intraocular pressure, anterior chamber depth, configuration of chamber angle and visual acuity were observed and compared. The follow up was 12 months.RESULTS: During the postoperative follow up, the visual acuity was improved apparently (P<0.01). The postoperative gonioscopy examination showed that the four quadrant chamber angles all broadened markedly (P<0.01). The intraocular pressure changed little (P>0.05). The anterior chamber depth deepened obviously (P<0.05).CONCLUSION: The management of angle closure glaucoma treated by phacoemulsification is effective, safe and credible. KEYWORDS: phacoemulsification; primary angle closure glaucoma; preclinical phase; presymptom phase
0引言
随着对青光眼研究的日益深入,人们越来越重视急性闭角型青光眼的对侧眼(临床前期或先兆期)的预防性治疗。目前公认有效的原发性闭角型青光眼预防性治疗是激光周边虹膜切除术(laser peripheral iridoctomy,LPI),但临床发现,周边虹膜切除术中,由于手术操作的原因或年龄的增加,白内障可进一步发展,导致视力逐渐下降,而必须进行白内障摘除术以提高视力。本文对闭角型青光眼临床前期、先兆期的病例行超声乳化晶状体摘除术及人工晶状体植入。
1对象和方法
1.1对象 观察200609/200707确诊为原发性闭角型青光眼临床前期或先兆期32例(36眼),男11例(13 眼),女21例(23眼),年龄42~70岁,其中右眼20例,左眼16 例。术前检查中央前房深度、晶状体厚度、眼轴长度、眼压、视力、房角镜,角膜曲率测量应用Topcon KR8100P,前房深度、晶状体厚度和眼轴长度应用法国光肽公司CompactII B超机测量, 均连续测量5次, 取其平均值;前房角用苏州六六视觉公司Goldmann房角镜检查。(1)诊断标准:青光眼临床前期和先兆期的诊断标准。临床前期:明确的一眼急性闭角型青光眼发作病史,而另一眼具有闭角型青光眼的解剖结构特征浅前房、窄房角等,而该眼却从来未发作过;先兆期:患者劳累或长时间在黑暗环境中工作或近距离阅读后,出现眼胀痛,一过性黑朦,眼压中度升高,休息后缓解。(2)纳入标准:符合诊断标准;晶状体轻度以上混浊视力为0.1~0.5,晶状体厚度≥4.8mm。(3)排除标准:晶状体核硬度达到IV度以上者;白内障过熟期、有外伤史者;各种原因引起的继发性青光眼。
1.2方法
采用表面麻醉,取上方巩膜隧道切口或透明角膜切口,另做辅助穿刺切口,前房内注入粘弹剂,用撕囊针作直径约5mm左右的连续环形撕囊,水分离和水分层,乳化晶状体核并吸出,I/A注吸系统清除晶状体皮质、囊袋,前房内再次注入粘弹剂,囊袋内植入后房型5.5mm直径的PMMA人工晶状体或6.0mm Acrysof 折叠人工后房型人工晶状体,吸出粘弹剂,前房成型。手术均顺利, 术中无后囊破裂。术后前3d口服地塞米松和醋氮酰胺, 点碘必殊眼液20d。随访时间为12mo。 统计学分析:配对t 检验和符号秩和检验。
2结果
在12mo后观察患者情况。(1)术前视力:0.1~0.5;术后最佳矫正视力0.1~1.0。术后视力较术前有明显提高34眼,术前、后视力均为0.1者2眼,检查眼底1眼为视神经萎缩,另1眼为黄斑变性。术前术后视力比较, 差异有显著性,符号秩和检验(P<0.01,表1)。(2)眼压,IOP平均为16.10±2.58mmHg,较术前IOP平均为14.97±2.59mmHg无显著变化(P>0.05)。(3)房角镜检查:Scheie前房角分级法把房角分为宽(W)、窄(N)两型,把窄型又分为4级:窄I(NI),窄II(NII),窄III(NIII),窄IV(NIV),在记录时为统计方便,将W,NI,NII,NIII,NIV记录为0,1,2,3,4级。术前术后前房角分级比较,差异有显著性(P<0.01,表2)。(4)中央前房深度:术后中央PAC平均为(3.30±0.32)mm,较术前的(1.58±0.24)mm显著增加(P<0.05)。(5)术后并发症:术后主要并发症是角膜水肿,经抗炎对症治疗后7d内全部消失, 未发生黄斑囊样水肿、驱逐性大出血等并发症。表1 手术前后视力的比较(略)表2眼Phaco+IOL术前后各象限房角镜Scheie分级统计结果(略)
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