白内障超声乳化摘除+后房型折叠式人工晶体植入术治疗闭角型青光眼76例分析

【摘要】目的观察白内障超声乳化摘除+后房型折叠式人工晶体植入术治疗合并白内障的闭角型青光眼的疗效。方法回顾分析我科住院行白内障超声乳化摘除+后房型折叠式人工晶体植入术治疗合并白内障的闭角型青光眼且资料完整的76例(106眼)，其中78眼为原发性急性闭角型青光眼，28眼为原发性慢性闭角型青光眼，患者均伴有明显的晶状体混浊。随访6个月至24个月，平均145个月。结果急性闭角型青光眼组术前眼压(482士137)mm Hg(1 mm Hg=0133 kPa)，术后眼压

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(129士38)mm Hg。慢性闭角型青光眼组术前眼压(336±92)mm Hg。术后眼压(336±92)mm Hg。术后90只眼(850％)最佳矫正视力提高。结论白内障超声乳化摘除+后房型折叠式人工晶体植入术可有效治疗合并白内障的闭角型青光眼。
【关键词】白内障超声乳化摘除；折叠式人工晶体；闭角型青光眼
Analysis of 76 cases on the cure of angleclosure glaucoma with phacoemulsification cataract excision and posterior chamber folding intraocular lensTANG Yaobing,WANG Xiaoyan.Puyang city oil field general hospital,Puyang 457001,China
【Abstract】ObjectiveTo observe the effect on the cure of angleclosure glaucoma using phacoemulsification cataract excision and posterior chamber folding intraocular lens MethodsAnalyse 76 angleclosure glaucoma cases (106 eyes) in our department,which are cured using phacoemulsification cataract excision and posterior chamber folding intraocular lensAmong the 108 eyes, 78 eyes are primary acute angleclosure glaucoma, 28 eyes are primary chronic angleclosure glaucoma The patients all he obvious clouded lens Followup of patients after the operation for 6 to 24 months(145 months in erage) ResultsThe intraocular pressures of acute angleclosure glaucoma before operation are (482±137)mm Hg(1 mm Hg=0133 kPa), but after operation they are (129±38)mm Hg The intraocular pressures of chronic angleclosure glaucoma before operation are (336±92)mm Hg, but after operation they are (336±92)mm HgThe best corrected visual acuity improves among 90 eyes(accounting for 850％)ConclusionThe use of phacoemulsification cataract excision and posterior chamber folding intraocular lens in curing angleclosure glaucoma is effective.
【Key words】Phacoemulsification cataract excision; Folding intraocular lens; Angleclosure glaucoma
作者单位：457001濮阳市油田总医院对于白内障合并闭角型青光眼的治疗，部分眼科医生主张先行小梁切除术，3～6个月眼压稳定后再行白内障摘除手术，另有部分认为行青白联合手术较佳。近些年已有医院采用超声乳化白内障摘除联合人工晶状体植入术治疗合并白内障的闭角型青光眼。我院眼科已从2005年开始，采用白内障超声乳化摘除+后房型折叠式人工晶体植入术治疗合并白内障的闭角型青光眼，取得了较满意结果，现分析报告如下。
1资料与方法
11一般资料选取2005～2011年6年间，于我院进行白内障超声乳化摘除+后房型折叠式人工晶体植入术治疗且资料完整的闭角型青光眼患者76例(106眼)，男34例，女42例；年龄45～86岁，平均686岁。多数为原发性急性闭角型青光眼，为78眼，原发性慢性闭角型青光眼28眼。患者术前行视力测试，矫正视力均为04以下，且均表现为明显的晶状体混浊。入院后行常规裂隙灯显微镜、红绿色觉、光定位、房角镜检查，测眼压、角膜曲率及其他必要的眼底辅助检查。
12方法首先对于眼压高的患者采取全身或局部应用降眼压药物，尽量使眼压接近正常以便手术。术前3 d常规局部应用抗生素眼液点眼，术前30 min复方托品酰胺滴眼液散瞳。常规消毒铺无菌巾，04%奥布卡因滴眼液表麻。放置开睑器，32 mm穿于10点位做透明角膜切口，15°侧切刀于2点位角膜缘辅助切口，粘弹剂(透明质酸钠)充盈前房，连续环形撕囊，水分离，水分层，超声乳化吸出晶状体核，注吸残余皮质，再次注入粘弹剂充盈前房及囊袋,植入后房型折叠式人工晶体，冲洗前房粘弹剂，切口自闭达水密状态，地塞米松针25 mg球结膜射，包扎术眼。术后一周内每天用妥布霉素地塞米松的眼膏点眼或静脉滴注。术后进行随访6～24个月，平均135个月。

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