摘要
目的观察原发性闭角型青光眼(primary angle-closure glaucoma,PACG)合并白内障行白内障超声乳化吸出联合房角分离术(phacoemulsification combined with goniosynechialysis,Phaco-GSL)后房角形态的变化,评价Phaco-GSL治疗PACG的疗效。方法观察确诊为PACG合并白内障住院患者50例共50只眼,所有病例房角黏连(peripheral anterior synechiae,PAS)范围>180°。将患者用单盲法随机分为2组,每组各25例25只眼,分别为Phaco-GSL治疗组(A组)和单纯Phaco对照组(B组),用房角镜检查手术后1、3个月房角变化,同时观察手术后1周、1个月、3个月的眼压。结果①房角:A组房角开放>180°以上为100%,房角为宽角,能看到小梁网5例(20%)、巩膜突12例(48%)、睫状体带8例(32%);B组手术后1个月房角开放>180°为48%,手术后3个月有2例房角再次发生黏连;A组手术后房角开放>180°明显优于B组(P<0.05);在2组房角开放的病例中,随着时间推移,色素逐渐变少。②眼压:手术前眼压25～58 mmHg,平均28.67 mmHg。手术后不用降眼压药眼压正常者A组86.67%,B组41.33%,2组有统计学差异(P<0.01)。结论①对于PACG合并白内障的患者,Phaco-GSL可以使房角重新开放,在重新开放的房角中,房角的虹膜插入位置、房角的度数以及虹膜形态等状态长期稳定,降眼压效果好。②对于PAS>180°的PACG合并白内障的患者,可以通过Phaco-GSL来治疗,不必联合小梁切除。
Objective To observe the changes of chamber angle after phacoemulsification and echialysis （Phaco-GSL） for primary angle-closure glaucoma （PACG） with cataract, and evaluate the tic effect of Phaco-GSL on PACG. Methods our hospital, and peripheral anterior synechiae Fifty patients （50 eyes） with PACG and cataract were （PAS） of all their affected eyes was over 180 degrees. goniosyn- therapeutreated in By single blind method, they were randomly divided into Phaco-GSL treated group （treatment group） and single phacoemulsification group （control group）. The chamber angles were checked with gonioscopy 1 and 3 months after operation, and intraocular pressure （IOP） of 50 eyes was examined 1 week, 1 and 3 months after operation. Results （1）In group A, the rate that chamber angles reopened were over 180 degrees was 100%, and the chamber angles were wide, trabecular meshwork visible in 5 cases （20%）, scleral spur visible in 12 cases （48%） and ciliary band visible in 8 cases （32%）. In group B, the chamber angles reopened over 180 degrees were in 12 cases （48 % ） 1 month after operation and PAS reoccurred in 2 affected eyes. The effect of reopening chamber angle in group A was better than that in group B （P 〈 0.05 ）. The degree of pigmentation decreased gradually over time in reopened eyes after operation ; （2）IOP was 25 - 58 mmHg （ average 28.67 ） before operation. After operation 23 eyes （92%） in group A and 9 eyes （ 18.37% ） in group B acquired normal IOP without using anti-glaucoma drugs, with significant difference between the 2 groups （ P 〈 0. 01 ）. Conclusion Phaco-GSL can reopen chamber angles for the patients with PACG and cataract, and position of iris insertion, and angle of anterior chamber and iris shape are stable in reopened angles. PACG and cataract patients with PAS 〉 180 degrees can be treated by cataract extraction combined with goniosynechialysis, while trabeculectomy is not necessary.
出处
《第三军医大学学报》
CAS
CSCD
北大核心
2009年第2期169-171,共3页
Journal of Third Military Medical University
