CAJ | 학술논문

目的：探讨原发性急性闭角型青光眼持续性高眼压行睫状体光凝后因眼压仍高行超声乳化术的临床疗效。方法选择原发性急性闭角型青光眼持续性高眼压患者12例（12只眼）行经巩膜二极管激光睫状体光凝（ TDCP），因光凝后眼压仍高且合并白内障，行白内障超声乳化吸除联合后房型人工晶状体植入术。测量光凝前、光凝后1周、超声乳化术前、术后1周、3个月时的眼压和视力。记录患者症状和术中、术后并发症。结果睫状体光凝前、光凝后1周、超声乳化术前、术后1周、3个月时的眼压分别为（50．83±9．86） mm Hg、（15．70±6．23） mm Hg、（27．63±4．59）mm Hg、（13．89±4．82）mm Hg、（16．98±3．51）mm Hg；视力分别是0．1030±0．1277、0．1380±0.1266、0．0989±0．0835、0．2589±0．2033、0．2630±0．2036。光凝后1周、超声乳化术前与光凝前相比眼压下降，差异有统计学意义（ P ＜0．001）。超声乳化术后1周、3个月时与超声乳化术前相比眼压下降，差异有统计学意义（ P＜0．001）。超声乳化术后1周、3个月时眼压比较，差异无统计学意义（ P ＝0．229）。光凝前后、超声乳化术前的视力相比，差异无统计学意义。超声乳化术后1周、3个月与超声乳化术前相比视力提高，差异有统计学意义（P值分别为0．015和0．013）。光凝后当天诉眼痛者2例，予止痛药口服后缓解，之后所有患者均未再诉患眼剧烈疼痛或严重的眼部不适。光凝后1例前房出血，2 d后吸收。2例光凝后持续性前房闪辉超过1个月。结论原发性急性闭角型青光眼持续性高眼压可首选TDCP治疗；如果术后存在残余青光眼且合并白内障，可行超声乳化术进一步降低眼压；TDCP对后续的超声乳化术无不良影响。
목적：탐토원발성급성폐각형청광안지속성고안압행첩상체광응후인안압잉고행초성유화술적림상료효。방법선택원발성급성폐각형청광안지속성고안압환자12례（12지안）행경공막이겁관격광첩상체광응（ TDCP），인광응후안압잉고차합병백내장，행백내장초성유화흡제연합후방형인공정상체식입술。측량광응전、광응후1주、초성유화술전、술후1주、3개월시적안압화시력。기록환자증상화술중、술후병발증。결과첩상체광응전、광응후1주、초성유화술전、술후1주、3개월시적안압분별위（50．83±9．86） mm Hg、（15．70±6．23） mm Hg、（27．63±4．59）mm Hg、（13．89±4．82）mm Hg、（16．98±3．51）mm Hg；시력분별시0．1030±0．1277、0．1380±0.1266、0．0989±0．0835、0．2589±0．2033、0．2630±0．2036。광응후1주、초성유화술전여광응전상비안압하강，차이유통계학의의（ P ＜0．001）。초성유화술후1주、3개월시여초성유화술전상비안압하강，차이유통계학의의（ P＜0．001）。초성유화술후1주、3개월시안압비교，차이무통계학의의（ P ＝0．229）。광응전후、초성유화술전적시력상비，차이무통계학의의。초성유화술후1주、3개월여초성유화술전상비시력제고，차이유통계학의의（P치분별위0．015화0．013）。광응후당천소안통자2례，여지통약구복후완해，지후소유환자균미재소환안극렬동통혹엄중적안부불괄。광응후1례전방출혈，2 d후흡수。2례광응후지속성전방섬휘초과1개월。결론원발성급성폐각형청광안지속성고안압가수선TDCP치료；여과술후존재잔여청광안차합병백내장，가행초성유화술진일보강저안압；TDCP대후속적초성유화술무불량영향。
Objective To evaluate the effects of phacoemulsification for residual glaucoma after cyclophotocoagula -tion on primary acute angle-closure glaucoma with persistent high intraocular hypertension (IOP).Methods Twelve pa-tients (12 eyes) received phacoemulsification for the treatment of high IOP and cataract .These patients previously were treated with transscleral diode laser cyclophotocoagulation ( TDLP) for persistent high IOP caused by acute angle-closure glaucoma.IOP and visual acuity were recorded at five different time points , including before TDLP and 1 week after TDLP, before phacoemulsification and 1 week, 3 months after phacoemulsification .Patients'symptoms, intraoperative and postop-erative complications were also recorded .Results IOPs were 50.83 ±9.86 mm Hg and 15.70 ±6.23 mm Hg before and after TDLP, respectively.Peri-phacoemulsification IOPs were 27.63 ±4.59 mm Hg (pre-), 13.89 ±4.82 mm Hg (1 week), and 16.98 ±3.51 mm Hg (3 months), respectively.Accordingly, visual acuity measurements were 0.1030 ± 0.1277, 0.1380 ±0.1266, 0.0989 ±0.0835, 0.2589 ±0.2033, and 0.2630 ±0.2036.The IOPs at 1 week after TDCP and before phacoemulsification were both significantly lower than that before TDCP ( P <0.001).The IOPs at 1 week and 3 months after phacoemulsification were both significantly lower than that before phacoemulsification ( P <0.001).There was no statistical difference in IOP between 1 week and 3 months after phacoemulsification ( P =0.229).Visual acuity improved at 1 week and 3 months after phacoemulsification ( P =0.015 and P =0.013).Two patients reported acute oc-ular pain after TDCP and the symptoms were relieved after administration of analgesics .Except that , there was no acute pain or serious eye discomfort .Hyphema was found in one patient and resolved 2 days later.In two patients there were per-sistent anterior chamber flare for longer than 1 month.Conclusions TDLP is the first choice to treat primary acute angle-closure glaucoma with persistent high IOP , while phacoemulsification is effective for residual glaucoma combined with cata-ract after TDLP .TDLP has no harmful effects on phacoemulsification .