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超声乳化吸除联合IOL植入术治疗不同房角关闭范围的闭角型青光眼

时间:2016-02-24 11:54来源:未知 作者:admin 点击:
超声乳化吸除联合IOL植入术治疗不同房角关闭范围的闭角型青光眼的效果 Clinical research of phacoemulsification with posterior chamber intraocular lens implantation for glaucoma with different goniosynechia ranges 投稿时间: 2015-10-21 最后修改
超声乳化吸除联合IOL植入术治疗不同房角关闭范围的闭角型青光眼的效果
Clinical research of phacoemulsification with posterior chamber intraocular lens implantation for glaucoma with different goniosynechia ranges
投稿时间: 2015-10-21  最后修改时间: 2016-01-12
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DOI:10.3980/j.issn.1672-5123.2016.2.25
关键词:  闭角型青光眼  超声乳化  人工晶状体植入术  房角分离
Key Words:  angle-closure glaucoma  phacoemulsification  intraocular lens implantation  goniosynechialysis
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作者 单位
李庆雨 中国辽宁省盘锦市中心医院眼科
谷淑颖 中国辽宁省盘锦市中心医院眼科
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摘要:
      目的:探讨不同房角关闭范围的闭角型青光眼采用超声乳化吸除联合后房型人工晶状体植入进行治疗的疗效,为闭角型青光眼的治疗提供依据。

 

     方法:闭角型青光眼患者47例54眼进行研究,所有患者均进行超声乳化吸除联合后房型人工晶状体植入术治疗。按照房角关闭粘连程度分为3组,房角关闭粘连≤1/2周者为A组(13眼); 1/2<房角关闭粘连≤3/4者为B组(18眼); 房角关闭粘连>3/4者为C组(23眼),观察三组患者术后2wk的房角和眼压情况,并观察术后3mo内的并发症情况。

 

     结果:三组患者治疗后2wk的眼压均较治疗前相比显著降低,且B、C两组眼压降低幅度显著优于A组,差异有统计学意义(P<0.05); 三组患者术后周边虹膜前粘连范围明显减少,其中A组患者房角重新开放13眼,开放率达100%,B组房角开放14眼,开放率达78%,C组房角开放16眼,开放率为70%,三组间相比差异有统计学意义(P<0.05); 治疗后仅有C组3眼再次发生青光眼,发生率为13%,与其他两组相比差异有统计学意义(P<0.05); A组患者术后无并发症发生; B组有3眼角膜水肿、2眼房角关闭粘连>3/4; C组5眼房角关闭粘连>3/4,1眼有前房消失,3眼角膜水肿,1眼脉络膜上腔出血,三组患者术后并发症发生率组间相比差异具有统计学意义(P<0.05),且B、C两组再次出现房角关闭粘连率显著高于A组,差异有统计学意义(P<0.05)。

 

     结论:对于轻中度房角关闭粘连的闭角型青光眼患者采用超声乳化吸除联合后房型人工晶状体植入术治疗效果显著,术后房角达到开放,但对于重度房角粘连患者其术后并发症较多,尤其是可能出现青光眼的复发。

Abstract:
      AIM:To study the effect of phacoemulsification with posterior chamber intraocular lens implantation to treat glaucoma with different angle-closure range, which may provide a better way to treat the angle-closure glaucoma.

 

     METHODS:There were 47 cases(54 eyes)with angle-closure glaucoma, and all of them underwent phacoemulsification and posterior chamber intraocular lens implantation. According to the range of goniosynechia, these patients were divided into three groups:the eyes with the range of goniosynechia≤1/2 were group A(13 eyes); the eyes with 1/23/4 were group C(23 eyes). We observed the status of anterior chamber angle and the intraocular pressure(IOP)of the three groups at 2wk after operations.

 

     RESULTS:Compared to the preoperative condition, the IOP of the three groups at 2wk after operations decreased significantly. The IOP reductions of group B and C were more significant than that of group A, and the differences were significant(P<0.05). The adhered peripheral iris range of the 3 groups significantly reduced after operations. There were 13 eyes in group A with angles reopened, and the opened rate was 100%; there were 14 eyes in group B with angles reopened, and the opened rate was 78%; there were 16 eyes in group C with angles reopened, and the opened rate was 70%. The differences among the three groups were statistically significant(P<0.05). There were only 3 eyes in group C with recurred glaucoma after treatments, the recurrence rate was 13%, and compared to the other two groups, the difference was statistically significance(P<0.05). No complications occured in group A; 3 eyes with corneal edema and 2 eyes with goniosynechia >3/4 appeared in group B; in group C, there were 5 eyes with goniosynechia>3/4, 1 eye with disappeared anterior chamber, 3 eyes with corneal edema, 1 eye with choroidal hemorrhage. The differences of postoperative complication rate among the three groups was statistically significant(P<0.05). The rates of recurred goniosynechia in group B and C were higher than that of the group A, and the difference was statistically significant(P<0.05).

 

     CONCLUSION:For patients with angle closure glaucoma who have mild to moderate goniosynechia, phacoemulsification with posterior chamber intraocular lens implantation is an effective way. After operations, their closed anterior angle reopened. But to the patients with severe adhesions, there are more complications after operations, especially the glaucoma may reoccur.

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