【摘要】 目的：探讨白内障超声乳化并人工晶状体植入术治疗闭角型青光眼临床前期或先兆期患者术中是否需要联合周边虹膜切除术。方法：40例40眼原发性闭角型青光眼临床前期或先兆期病例，术前随机分成A组(白内障超声乳化+人工晶状体植入)和B组(白内障超声乳化+人工晶状体植入+周边虹膜切除术)，对比两组术后视力、眼压、前房深度、Scheie前房角分级进行统计分析。结果：两组病例都未发生黄斑囊样水肿、驱逐性大出血等并发症。1例联合周边虹膜切除的患者出现前房积血，对症治疗后出血吸收。两组病例术后视力较术前提高，术后两组视力、眼压、前房深度、Scheie前房角分级比较差异无显著性。结论：闭角型青光眼临床前期、先兆期采用白内障超声乳化摘除晶状体，可有效预防青光眼的急性发作，并显著提高患者的视力，术中不需要另行周边虹膜切除术。
【关键词】 白内障超声乳化并人工晶状体植入术;周边虹膜切除术;原发性闭角型青光眼临床前期或先兆期
Study of whether or not to combine peripheral iridotomy with phacoemulsification and intraocular lens implantation for angleclosure glaucoma in the preclinical and presymptomatic phases
GuoPing Kuang, KeFeng Liu, ShaoYing Feng, Juan Li, TingYi Li, XiaoPing Zhou, ShuYang Chen
1 Department of Ophthalmology, the First Peoples Hospital of Chenzhou City, Chenzhou 423000,Hunan Province, China; 2 Xiangnan University, Chenzhou 423000,Hunan Province,China
AbstractAIM: To evaluate whether or not to combine peripheral iridotomy with phacoemulsification and intraocular lens implantation to remedy patients with angleclosure glaucoma in the preclinical and presymptomatic phases. METHODS: Forty patients 40 eyes with angleclosure glaucoma in the preclinical and presymptomatic phases were randomly divided into two groups: group A (phacoemulsification and intraocular lens implantation) and group B ( phacoemulsification and intraocular lens implantation combined with peripheral iridotomy),to statistically analyze the postoperative corrected vision,intraocular pressure,anterior chamber depth,grading of the anterior chamber angle (scheie) of the two groups.RESULTS: No severe complications occurred in two groups, hyphema occurred in one eye in the group B, and it recovered after symptomatic treatment. The two groups corrected vision were improved postoperatively compared with. preoperative. There was no significant diference in the postoperative corrected vision,intraocular pressure,anterior chamber depth,grading of the anterior chamber angle (scheie) between group A and group B.CONCLUSION: The management of angleclosure glaucoma in the preclinical and presymptomatic phases by phacoemulsification and intraocular lens implantation can prevent its acute on set and improve the corrected vision. Its not necessary to combine peripheral iridotomy with phacoemulsification and intraocular lens.
KEYWORDS: phacoemulsification and intraocular lens implantation;peripheral iridotomy;angleclosure glaucoma;preclinical and presymptomatic phases of angleclosure glaucoma
0引言
目前公认有效的原发性闭角型青光眼预防性治疗主要有周边虹膜切除术和激光周边虹膜造孔术，通过沟通前后房，防止瞳孔阻滞引起的青光眼急性发作。但由于年龄增加、手术等原因，白内障可加速形成，而必须进行白内障摘除术。近年来，采用白内障超声乳化并人工晶状体植入术治疗青光眼合并白内障的患者，取得了较好的疗效[1]，我们对闭角型青光眼临床前期或先兆期行白内障手术摘除进行了初步的的研究，发现能有效的预防青光眼的发作并显著提高视力[2]，但对于术中是否联合周边虹膜切除不甚明了，因此我们进行了初步研究，现报道如下。
1对象和方法
1.1对象
观察200609/200804确诊为原发性闭角型青光眼临床前期或先兆期40例40眼，男14例14眼,女26例26眼,年龄42～70岁,其中右眼18例，左眼22例。术前常规检查中央前房深度、晶状体厚度、眼轴长度、眼压、视力、房角镜，前房深度、晶状体厚度和眼轴长度连续测量5次,取其平均值。(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1眼急性闭角型青光眼发作病史，而另1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，一过性黑矇,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，将40眼随机分成两组，A组行白内障超声乳化+人工晶状体植入23例23眼，B组行白内障超声乳化+人工晶状体植入+周边虹膜切除术21例21眼。
[1] [2] 下一页 |
