CAJ | 학술논문

目的：探讨术前或术中辅助降压后超声乳化白内障吸除人工晶状体植入术治疗急性闭角型青光眼急性发作期的效果。 　　方法：收治87例92眼急性闭角型青光眼患者，入院时眼压均在45．0mmHg以上，术前通过全身及局部使用最大剂量降眼压药物处理，眼压能降至25．0mmHg以下者于降压后2～3d内行白内障超声乳化吸除人工晶状体植入手术（60眼），如眼压依然高于30．0mmHg且前房深度尚可者，术前先行前房穿刺降压并于降压后1～2d内行白内障超声乳化白内障摘除联合人工晶状体植入并前房角分离术（25眼），如药物降压后眼压仍高于35．0mmHg且前房较浅，则手术时行玻璃体腔穿刺抽取部分玻璃体腔液后再前房穿刺实现降眼压后行白内障超声乳化白内障摘除联合人工晶状体植入并前房角分离术（7眼）。对术前检查和术后6mo随访检查结果进行比较分析，包括眼压、视力、手术并发症及中央前房深度和前房角宽度等。 　　结果：随访6mo～2a，全部病例在随访期间眼压均可控制在20．0mmHg以下，其中有2眼在6mo时需20g/L卡替洛尔滴眼液点眼。术前视力均低于0．3，术后视力：＜0．1者5眼，0．1～0．3者22眼，＜0．3～0．5者50眼，＞0．5者15眼。前房及房角：术后前房均明显加深，房角全部开放者8眼，开放大于270度者23眼，开放≥180度者56眼，开放＜180度者5眼。术后并发症：60眼出现较明显的前房反应，其中有16眼出现前房纤维素性渗出。 　　结论：超声乳化白内障吸除人工晶状体植入术对于急性发作的急性闭角型青光眼有良好的疗效，能及时控制眼压并挽救患者的视功能。前房穿刺或玻璃体穿刺是术前眼压控制不良者有效降眼压手段，有利于提高手术的安全性。
목적：탐토술전혹술중보조강압후초성유화백내장흡제인공정상체식입술치료급성폐각형청광안급성발작기적효과。 　　방법：수치87례92안급성폐각형청광안환자，입원시안압균재45．0mmHg이상，술전통과전신급국부사용최대제량강안압약물처리，안압능강지25．0mmHg이하자우강압후2～3d내행백내장초성유화흡제인공정상체식입수술（60안），여안압의연고우30．0mmHg차전방심도상가자，술전선행전방천자강압병우강압후1～2d내행백내장초성유화백내장적제연합인공정상체식입병전방각분리술（25안），여약물강압후안압잉고우35．0mmHg차전방교천，칙수술시행파리체강천자추취부분파리체강액후재전방천자실현강안압후행백내장초성유화백내장적제연합인공정상체식입병전방각분리술（7안）。대술전검사화술후6mo수방검사결과진행비교분석，포괄안압、시력、수술병발증급중앙전방심도화전방각관도등。 　　결과：수방6mo～2a，전부병례재수방기간안압균가공제재20．0mmHg이하，기중유2안재6mo시수20g/L잡체락이적안액점안。술전시력균저우0．3，술후시력：＜0．1자5안，0．1～0．3자22안，＜0．3～0．5자50안，＞0．5자15안。전방급방각：술후전방균명현가심，방각전부개방자8안，개방대우270도자23안，개방≥180도자56안，개방＜180도자5안。술후병발증：60안출현교명현적전방반응，기중유16안출현전방섬유소성삼출。 　　결론：초성유화백내장흡제인공정상체식입술대우급성발작적급성폐각형청광안유량호적료효，능급시공제안압병만구환자적시공능。전방천자혹파리체천자시술전안압공제불량자유효강안압수단，유리우제고수술적안전성。
AIM: To investigate the clinical effects of phacoemulsification combined with post chamber intraocular lens ( PC-IOL) implantations for primary acute angle-closure glaucoma. METHODS:The clinical data of 87 cases (92 eyes) with primary acute angle-closure glaucoma complicated with cataract of which intraocular pressure ( IOP ) over 45.0mmHg were collected.Phacoemulsification and PC-IOL implantations were performed for 60 eyes which IOP was controlled to 25.0mmHg below by general and topic medical management.IOP of 25 eyes was over 30.0mmHg and the depth of anterior chamber was well, puncture of anterior chamber was performed to decrease the IOP. Then 1 day to 2 days later, phacoemulsification, PC-IOL implantations and goniosynechialysis were performed. IOP of 7 eyes were still over 35.0mmHg with shallow of anterior chamber, phacoemulsification and PC -IOL implantation combined with goniosynechialysis and paracentesis anterior chamber were performed after vitreous aspiration and puncture of anterior chamber. IOP, visual acuity, surgery complications, central anterior chamber depth and gonioscopie findings before and post operation were recorded and analyzed. RESULTS: The IOP of all cases was controlled under 20.0mmHg during the follow-up 6 months to 2 years.2%carteolol hydrochloride only need for two cases after 6 months.The visual acuity were improved for most cases, the visual acuity were better than 0.3 of 65 eyes post-operation while all were lower than 0.3 pre-operation. The depth of anterior chamber was deeper in all cases and the anterior chamber angle opening range was more than 180 degree in 87 eyes.More than 60 cases suffered the complications of anterior chamber inflammation and 16 cases anterior fibrinous exudates. CONCLUSION:Phacoemulsification is safe and effective in management of primary acute angle-closure glaucoma complicated with cataract. Goniosynechialysis, paracentesis anterior chamber and vitreous aspirations were benefit for the patient whose IOP was uncontrolled before surgery.