【摘要】 目的 观察超声乳化白内障吸除人工晶状体植入治疗合并白内障的原发性闭角型青光眼的临床疗效。 方法 25例(28眼)原发性闭角型青光眼患者伴有不同程度晶状体混浊，其中Ⅰ～Ⅱ级核12眼，Ⅲ～Ⅳ级核16眼;矫正视力，光感～0.2;裂隙灯检查，周边前房均≤14CT，伴周边虹膜膨隆;房角检查，粘连关闭范围均≤23圆周。行超声乳化白内障吸除人工晶状体植入术，观察患者术后眼压、视力、周边前房深度及主要并发症等情况。术后随访时间为6～12个月。 结果 眼压控制在21mmHg以下者26眼(92.86%);仅2眼(7.14%)眼压高于21mmHg，但低于30mmHg，经局部应用噻吗心安后可控制在正常范围内。术后所有患者的矫正视力均有不同程度的提高，矫正视力<0.1者2眼，眼底检查视乳头色淡，C/D=0.8～0.9。术后全部患者周边前房深度均≥1CT。 结论 超声乳化白内障吸除术既可提高视力，又可控制眼压，可有效治疗合并白内障的原发性闭角型青光眼。
关键词 超声乳化 白内障 青光眼 闭角型
Observation of curative effect on treating primary angle-closure glaucoma with phacoemulsification
Liu Kaibo，Yang Mingming
Department of Ophthalmology，The First People's Hospital of Gong'an County，Jingzhou434300.
【Abstract】 Objective To observe the curative effect on treating primary angle-closure glaucoma patients who complicated with cataract with phacoemulsification.Methods 25patients(28eyes)with cataract and primary angle-closure glaucoma complicated with different degrees lens opacity.Among them，12eyes wereⅠ～Ⅱdegree nucleus，16eyes withⅢ～Ⅳdegree nucleus.The corrected visual acuity:sense of light～0.2，examination with slit-lamp micro-scope:the anterior chamber border≤1/4CTwith the iris border swelling.Chamber angle examination:the scope of adhe-sion and closure≤2/3round.The IOP(intraocular pressure)，visual acuity，the depth of anterior chamber border and the major complication were observed postoperatively.The follow-up was ranged from6to12months.Results 26eyes(92.86%)with IOP were lower than21mmHg，and only2eyes(7.14%)with the pressure higher than21mmHg，but lower than30mmHg，were controlled in normal by using timolol.The vision of all patients were improved differently.Only2eyes with corrected vision were lower than0.1.The fundus examination:the papilla of optic nerve became pale，C/D=0.8～0.9.Postoperatively，the anterior chamber borders depth was higher than1CT.Conclusion Phacoemulsification not only could improve the vision，but also could control IOP of the patients.
Key words phacoemulsification cataract glaucoma angle-closure
近年来在关于闭角型青光眼发病机制的研究中，晶状体的位置以及厚度的变化已被认为起着相当重要的作用 [1] ，是眼压升高的重要因素之一。笔者对2000年来因闭角型青光眼合并白内障的住院患者施行了白内障超声乳化及人工晶状体植入手术，对术后的眼压、视力、周边前房深度及主要并发症等情况进行了随访观察，现将其结果报告如下。
1 资料与方法
1.1 一般资料 闭角型青光眼合并白内障致视力下降者25例28眼，其中男7眼，女21眼。年龄51～69岁，视力光感～0.2，混浊的晶状体核Ⅰ～Ⅱ级核12眼，Ⅲ～Ⅳ级核16眼;裂隙灯检查，周边前房均≤14CT，伴周边虹膜膨隆;房角检查，粘连关闭范围均≤23圆周。全部病例用毛果芸香碱及噻吗心安点眼即可控制眼压至正常。
1.2 方法 全部病例术前2d停用缩瞳药物，用噻吗心安点眼，每日2次，口服乙酰唑胺0.25g，每日2次控制眼压，术前1h快速静脉滴注20%甘露醇250ml，术前30min用复方阿托品酰胺散瞳，均采取表面麻醉，角膜缘内切口，用粘弹剂分离粘连的房角，晶状体表面环形撕囊，水分离，晶状体核超声乳化，吸除残留皮质，囊袋内植入后房型人工晶状体，吸除前房内残留粘弹剂，密闭角膜缘内切口。
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