【摘要】 目的：探讨急性闭角型青光眼在高眼压状态下行白内障超声乳化术的临床疗效。方法：对31例31眼持续高眼压状态下的急性闭角型青光眼合并白内障患者行白内障超声乳化联合后房折叠人工晶状体植入术，随访6mo～2a，观察术后视力、眼压及前房角的变化。结果：术后视力明显改善，矫正视力≤0.1者2眼(6%)，0.1～0.2者8眼(26%),0.3～0.6者15眼(48%),0.8～1.0者6眼(19%)。术后1wk眼压均控制正常。术中或术后未出现脉络膜上腔出血、视网膜出血或睫状环阻塞性青光眼等严重并发症。结论：急性闭角型青光眼持续高眼压状态下行白内障超声乳化吸出是安全有效的。
【关键词】 超声乳化;急性闭角型青光眼;高眼压
Clinical Study of Cataract Phacoemulsification in the management of acuteclosure glaucoma with continuous high intraocular pressureXueFeng Lü, XianZhi Bai, YaJun Shen, Qun Ma Department of Ophthalmology,Zhongshan Hospital of Hubei Province,Wuhan 430033,Hubei Province,ChinaAbstractAIM: To investigate the clinical results of phacoemulsification in the management of acuteclosure glaucoma with continuous high intraocular pressure.METHODS: The phacoemulsification operations were performed in 31 case 31 eyes of acuteangleclosure glaucoma and cataract under higher intraocular pressure.The postoperative follow up was 6months to 2 years, and the vision and complications were observed.RESULTS: The visual acuity of all cases was improved, the corrected visual acuity in 2 eyes(6%) was under 0.1, 8 eyes (26%) between 0.1 and 0.2, 15 eyes(48%) between 0.3 and 0.6, 6 eyes(19%) between 0.8 and 1.0. The postoperative intraocular pressure remained normal in all eyes after one week. No serious complications such as choroidal hemorrhage,intraocular hemorrhage and malignant glaucoma were found.CONCLUSION: The phacoemulsification with posterior chamber intraocular lens implantation in the management of acuteangleclosure glaucoma under higher intraocular pressure is safe and efficient.
KEYWORDS: phacoenulsification; acuteangle closure glaucoma; high intraocular pressure0 引言
急性闭角型青光眼是眼科常见的急症，急性发作时眼压急剧升高，经过积极药物治疗大部分患者眼压可控制正常，但有少部分患者对药物治疗无明显效果，需要在高眼压下及早手术治疗。我院对31例31眼急性闭角型青光眼合并白内障患者在持续高眼压下行超声乳化白内障吸除术，现总结报告如下。
1 对象和方法
1.1 对象
我院选择200503/200806对应用可耐受的最大剂量降眼压药物治疗2d后眼压仍>40mmHg(1kPa=7.5mmHg)的急性闭角型青光眼31例31眼进行手术治疗。其中男9例，女22例，年龄52～77(平均63)岁。病程2h～3d。视力:光感～0.05。患者均有不同程度的晶状体混浊，核Ⅱ～Ⅳ级。
1.2 方法
术前30min给予200g/L甘露醇250mL快速静滴，常规球后麻醉并充分按摩眼球。上方角巩膜缘隧道切口，作好隧道后，先在3∶00位透明角膜作辅助穿刺口，缓放房水进一步降低眼压，注入黏弹剂维持前房，主切口前房穿刺，5.5mm连续环形撕囊，水分离，原位机械碎核加超声乳化吸除晶状体核，I/A吸除皮质后植入后房型折叠人工晶状体。卡米可林缩瞳后，在虹膜根部360°范围内注入黏弹剂，以液压的方式充分做房角分离，吸净黏弹剂，术毕加深前房、水密切口。术后常规给予全身及局部抗生素及激素治疗并随访3mo～2a。
2 结果
2.1 视力
术后视力明显改善，矫正视力≤0.1者2眼(6%)，0.1～0.2者8眼(26%),0.3～0.6者15眼(48%),0.8～1.0者6眼(19%)。
2.2 眼压
术后1wk眼压均控制在11.55±5.08mmHg，术后6mo 2眼(6%)需局部加用降眼压药物。
2.3 前房角
术后前房角全开放29眼(94%)，部分开放2眼(6%)但粘连闭合<90°。
2.4 术中并发症
无后囊破裂、玻璃体脱出及暴发性脉络膜上腔出血、睫状环阻塞性青光眼等严重并发症。
2.5 术后并发症
术后合并角膜水肿5眼(16%)，前房渗出3眼(10%)，经药物治疗后吸收。
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