超声乳化白内障吸除折叠式人工晶状体植入治疗闭角型青光眼合并白内障的临床观察 Clinical study on the management of angle-closure glaucoma with cataract by phacoemulsification with foldable posterior chamber intraocular lens implantation

一、目的（OBJECTIVE） 初步观察颞侧角巩膜缘隧道切口超声乳化白内障吸除联合后房型折叠式人工晶状体植入术治疗合并白内障的急性或慢性闭角型青光眼的疗效。 To investigate the clinical results of phacoemulsification with foldable posterior chamber intraocular lens (PC-IOL) implantation in the management of acute or chronic angle-closure glaucoma with cataract.

二、病例资料（PATIENTS DATA） 2001年9月～2003年4月收住本院的33例(52只眼)原发性 闭角型青光眼合并白内障患者 男18例，女15例 年龄42～79岁，平均年龄57.32±8.64岁 From September of 2001 to April of 2003 33 cases (52 eyes ) with primary angle-closure glaucoma and cataract were prospectivly studied. 18 men，15 women Ages were from 42 to 79，average age was 57.32±8.64

1、原发性急性闭角型青光眼组（24眼） 术前眼压17~54mmHg，平均眼压27.69±10.42mmHg 周围前房深度0.28±0.04 CK 平均远视力0.2 ±0.1 平均用降眼压药1.7种 1、Primary acute angle-closure glaucoma （24 eyes） Preoperative IOP was 17~54mmHg，mean IOP was 27.69±10.42mmHg Mean limbic anterior chamber depth was 0.28±0.04 CK Mean visual acuity was 0.2 ±0.1 Mean drugs was 1.7 types

2、原发性慢性闭角型青光眼组（28眼） 术前眼压11~20mmHg ，平均眼压16.39±2.50mmHg 周围前房深度0.45±0.08 CK 平均远视力0.3 ±0.2 平均用降眼压药0.8种 2、 Primary chronic angle-closure glaucoma（28 eyes） Preoperative IOP was 11~20mmHg ，mean IOP was 16.39±2.50mmHg Mean limbic anterior chamber depth was 0.45±0.08 CK Mean visual acuity was 0.3 ±0.2 Mean drugs to control IOP was 0.8 types

三、 方法 （METHODS） 患者入院后均行角巩膜缘隧道切口超声乳化白内障吸除联合后房型折叠式人工晶状体植入术。 All the patients were undergone the Phacoemulsification with PC-IOL implantation through temporal corneal limbus tunnels.

四、 结果 （RESULTS） 原发性急性闭角型青光眼组 术后平均眼压13.13±2.33 mmHg 周围前房深度0.66±0.13 CK Primary acute angle-closure glaucoma patients Postoperative mean IOP was 13.13±2.33 mmHg Mean limbic anterior chamber depth was 0.66±0.13 CK

术后半年平均远视力为0.5±0.2 4眼术后用一种药物控制眼压可达21mmHg以下， 其余不需用药物控制眼压即正常,平均用降眼压药0.17种 Mean visual acuity was 0.5±0.2 half a year after operation Only 4 eyes needs one drug each to control IOP below 21mmHg and the others were normal without any drug,mean drugs used to control IOP was 0.17 types

原发性急性闭角型青光眼组 术前术后眼压与周围前房深度比较 mmHg CK

原发性急性闭角型青光眼组 术前术后视力与平均用降眼压药物的比较

原发性慢性闭角型青光眼组 术后平均眼压11.64±1.25 mmHg 周围前房深度0.85±0.15 CK Primary chronic angle-closure glaucoma patients Postoperative mean IOP was 11.64±1.25 mmHg Mean limbic anterior chamber depth was 0.85±0.15 CK

术后半年平均远视力为0.5±0.3 2眼术后用一种药物控制眼压可达21mmHg以下， 其余不需用药物控制眼压即正常,平均用降眼压药0.07种 Mean visual acuity was 0.5±0.3 half a year after operation Only 2 eyes needs one drug each to control IOP below 21mmHg and the others were normal without any drug,mean drugs used to control IOP was 0.07 types

原发性慢性闭角型青光眼组 术前术后眼压与周围前房深度比较 mmHg CK

原发性慢性闭角型青光眼组 术前术后视力与平均用降眼压药物的比较

Complications after operation 术后并发症 术后1天： 角膜轻度水肿13例（25％） 前房闪辉轻度39例（75％），中度10例（19.2％） 术后1周：以上表现全部消失。 所有术眼人工晶状体均在位，未出现偏位、夹持。 Complications after operation The day after operation： mild cornea edema 13 eyes（25％） Tyn(+):39 eyes（75％）mildly，10 eyes（19.2％） seriously 1 week after operation：all above were disappeared All IOLs were stable in the centric area

五、讨论 （DISCUSSION)

瞳 孔 阻 滞 眼 压 升 高 眼前段空间狭窄 晶状体虹膜膈前移 前房变浅 虹膜根部被推向小梁网 晶状体较厚且位置靠前 房角变窄、闭合 虹膜背面与前囊紧密相贴

白内障超声乳化手术 降低眼压 超声作用 晶状体有形成分吸出 术中前房压力升高 减少房水分泌 提供虹膜后退的空间 机械性使房角开放 解除瞳孔阻滞 降低眼压

Advantages of temporal corneal limbus tunnels 经颞侧角巩膜缘切口优点 将12点方位的角巩膜缘留出，为将来眼压控制不理想时再行滤过手术留有足够的空间 避免了经透明角膜切口导致的术后散光、角膜炎症反应重 等不良后果 Advantages of temporal corneal limbus tunnels Reserve the 12 oclock corneal limbus tunnels for the filtering operations if needed in the future Avoid some severe complications after operation through the cornea such as astigmatism and keratitis

六、小 结（SUMMARY） 降低眼压 加深前房 提高视力 减少用药 颞侧角巩膜缘隧道切口超声乳化白内障吸除联合后房型折叠式人工晶状体植入术治疗合并白内障的急性或慢性闭角型青光眼可以 降低眼压 加深前房 提高视力 减少用药 Phacoemulsification with posterior chamber foldable intraocular lens implantation in treating angle-closure glaucoma with cataract through temporal corneal limbus tunnels decrease the IOP，increase the depth of anterior chamber and visual acuity and few drugs needed as well

谢 谢 ！