白内障小切口囊外摘除联合小梁切除治疗PACG合并白内障
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摘要
目的:观察白内障小切口囊外摘除联合小梁切除术治疗原发性急性、慢性闭角型青光眼的疗效。方法:急性闭角型青光眼合并白内障23例24眼,慢性闭角型青光眼合并白内障11例12眼,进行白内障小切口囊外摘除联合小梁切除术,均一期植入人工晶状体。结果:术后随访1mo,急性闭角型青光眼组术前平均眼压30.68±7.60mmHg,术后17.83±5.95mmHg,差异有统计学意义(P<0.05);慢性闭角型青光眼组术前平均眼压29.27±5.55mmHg,术后18.12±1.88mmHg,差异有统计学意义(P<0.05)。术前、术后两组间平均眼压差异无统计学意义。术后眼压控制良好者(6~21mmHg)者26眼(72%),局部使用抗青光眼药物后眼压控制良好者8眼(22%),总体有效控制率94%,眼压不能控制者(22~30mmHg)2眼(6%);术后视力提高者32眼(89%),没有发生严重并发症。结论:白内障小切口囊外摘除联合小梁切除术对于原发性闭角型青光眼(PACG)合并白内障的治疗可以有效控制眼压、提高视力,并发症少;其在控制眼压方面对于原发性急/慢性闭角型青光眼无差异。
AIM:To observe the therapeutic effects ofextracapsular cataract extraction(ECCE) by small incision with trabeculectomy in treating primary acute and chronic angle-closure glaucoma.METHODS:Twenty-three patients(24 eyes) were acute angel-closure glaucoma with cataract,while 11 patients(12 eyes) were chronic angel-closure glaucoma with cataract.All of them were performed ECCE and IOL implantation combined with trabeculectomy.RESULTS;Follow up for 1 month,before operation,the mean IOL of acute angel-closure glaucoma was(30.68±7.60)mmHg;after operation,IOL was(17.83±5.95)mmHg,the difference was statistically significant.Before operation,the mean IOL of chronic angel-closure glaucoma was(29.27±5.55) mmHg;after operation,IOL was(18.12 ± 1.88) mmHg.The difference was also statistically significant.The differences of average intraocular pressure in two groups were not statistically significant.After surgery,intraocular pressure(IOP) of26 eyes(72.3%) was under control(6-21 mmHg) without anti-glaucoma drug,IOP of 8 eyes(22.2%) were kept in normal state with anti-glaucoma drug.The total effective rate amounts to 94%.while 2 eyes'(6%) intraocular pressure were still as high as 22-30mmHg even with antiglaucoma drug.There was obvious improvement in visual acuity in 32 eyes(89%) with no serious complications.CONCLUSION:ECCE by small incision andintraocular lens implantation combined with trabeculectomy is an effective and safe surgery technique in treating primary angle-closure glaucoma and cataract,which can effectively manage intraocular pressure and improve visual acuity with few complication.And there is no difference in IOP management between the acute and chronic angel-closure glaucoma.
AIM:To observe the therapeutic effects ofextracapsular cataract extraction(ECCE) by small incision with trabeculectomy in treating primary acute and chronic angle-closure glaucoma.METHODS:Twenty-three patients(24 eyes) were acute angel-closure glaucoma with cataract,while 11 patients(12 eyes) were chronic angel-closure glaucoma with cataract.All of them were performed ECCE and IOL implantation combined with trabeculectomy.RESULTS;Follow up for 1 month,before operation,the mean IOL of acute angel-closure glaucoma was(30.68±7.60)mmHg;after operation,IOL was(17.83±5.95)mmHg,the difference was statistically significant.Before operation,the mean IOL of chronic angel-closure glaucoma was(29.27±5.55) mmHg;after operation,IOL was(18.12 ± 1.88) mmHg.The difference was also statistically significant.The differences of average intraocular pressure in two groups were not statistically significant.After surgery,intraocular pressure(IOP) of26 eyes(72.3%) was under control(6-21 mmHg) without anti-glaucoma drug,IOP of 8 eyes(22.2%) were kept in normal state with anti-glaucoma drug.The total effective rate amounts to 94%.while 2 eyes'(6%) intraocular pressure were still as high as 22-30mmHg even with antiglaucoma drug.There was obvious improvement in visual acuity in 32 eyes(89%) with no serious complications.CONCLUSION:ECCE by small incision andintraocular lens implantation combined with trabeculectomy is an effective and safe surgery technique in treating primary angle-closure glaucoma and cataract,which can effectively manage intraocular pressure and improve visual acuity with few complication.And there is no difference in IOP management between the acute and chronic angel-closure glaucoma.
引文
1 Foster PJ,Johnson GJ.Glaucoma in china;how big is the problem?Br J Ophthalmol 2001;85(11):1277-1282
2 Congdon NA,Youlin Q,Quigley H,et al.Biometry and primary angleclosure glaucoma among Chinese,while,and black populations.Ophthalmology 1997;104(9):1489-1495
3王宁利,欧阳浩,周文炳,等.中国人闭角型青光眼房角关闭机制的研究.中华眼科学杂志2000;36(1):46-51
4 Lowe KF.Aetiology of the anatomical basis for angle-closure glaucoma.Br J Ophthalmol 1970;54(3):161-165
5张秀兰.现阶段对青光眼白内障联合手术的认识.眼科2012;21(1):3-6
6王泽飞,何锐,方爱武.闭角型青光眼合并白内障人工晶状体植入术后眼前节变化的观察.中国实用眼科杂志2013;31(1):33-37
7才瑜,Lim Z,Lim BA,等.超声乳化联合小梁切除术及术中应用5-氟尿嘧啶治疗青光眼合片白内障的长期疗效观察.中华眼科杂志2005;41(2):128-131
8沈萍,陈惠英.高眼压青光眼白内障三联手术的临床观察.国际眼科杂志2009;9(10):1965-1966
2 Congdon NA,Youlin Q,Quigley H,et al.Biometry and primary angleclosure glaucoma among Chinese,while,and black populations.Ophthalmology 1997;104(9):1489-1495
3王宁利,欧阳浩,周文炳,等.中国人闭角型青光眼房角关闭机制的研究.中华眼科学杂志2000;36(1):46-51
4 Lowe KF.Aetiology of the anatomical basis for angle-closure glaucoma.Br J Ophthalmol 1970;54(3):161-165
5张秀兰.现阶段对青光眼白内障联合手术的认识.眼科2012;21(1):3-6
6王泽飞,何锐,方爱武.闭角型青光眼合并白内障人工晶状体植入术后眼前节变化的观察.中国实用眼科杂志2013;31(1):33-37
7才瑜,Lim Z,Lim BA,等.超声乳化联合小梁切除术及术中应用5-氟尿嘧啶治疗青光眼合片白内障的长期疗效观察.中华眼科杂志2005;41(2):128-131
8沈萍,陈惠英.高眼压青光眼白内障三联手术的临床观察.国际眼科杂志2009;9(10):1965-1966