CAJ | 학술논문

目的观察药物和激光治疗无效的急性闭角型青光眼在高眼压状态下施行晶状体摘除联合IOL植入和房角分离手术的效果.方法回顾性系列病例研究.2011年3月至2012年6月在北京协和医院眼科急诊及门诊就诊经药物及激光治疗后眼压不能控制的急性闭角型青光眼患者23例(25眼),平均年龄(70.6±5.9)岁.根据瞳孔状态分为瞳孔失弛缓组(12眼)和瞳孔正常组(13眼).所有患眼行超声乳化摘除晶状体联合IOL植入和房角分离术,瞳孔失弛缓患者制作直径4.5 mm居中的连续环形撕囊.有效性观察指标为眼压、BCVA、前房深度、降眼压药物数量,随诊(23.5±6.2)个月.使用配对t检验对术前和末次随诊数据进行了比较,绘制瞳孔失弛缓组和瞳孔正常组眼压和视力变化曲线.安全性指标为术中和术后并发症发生情况.结果 25只患眼术前和末次随访的眼压为(38.20±6.04)mmHg和(15.20±2.41)mmHg,用药为(2.96±0.89)种和(0.20±0.81)种,前房深度为(1.92±0.18)mm和(2.58±0.26)mm,BCVA(logMAR)为1.03±0.53和0.13±0.20.上述指标术前术后比较差异均有统计学意义.1眼术中后囊膜破裂,1眼术后恶性青光眼,1眼术后角膜失代偿.结论对于常规药物和激光不能控制眼压的急性闭角型青光眼,晶状体摘除联合IOL植入和房角分离手术可以有效地解除青光眼急性发作状态,操作具有较高的安全性.瞳孔失弛缓病例可利用晶状体前囊膜组织制作假瞳孔.
목적 관찰약물화격광치료무효적급성폐각형청광안재고안압상태하시행정상체적제연합IOL식입화방각분리수술적효과.방법 회고성계렬병례연구.2011년3월지2012년6월재북경협화의원안과급진급문진취진경약물급격광치료후안압불능공제적급성폐각형청광안환자23례(25안),평균년령(70.6±5.9)세.근거동공상태분위동공실이완조(12안)화동공정상조(13안).소유환안행초성유화적제정상체연합IOL식입화방각분리술,동공실이완환자제작직경4.5 mm거중적련속배형시낭.유효성관찰지표위안압、BCVA、전방심도、강안압약물수량,수진(23.5±6.2)개월.사용배대t검험대술전화말차수진수거진행료비교,회제동공실이완조화동공정상조안압화시력변화곡선.안전성지표위술중화술후병발증발생정황.결과 25지환안술전화말차수방적안압위(38.20±6.04)mmHg화(15.20±2.41)mmHg,용약위(2.96±0.89)충화(0.20±0.81)충,전방심도위(1.92±0.18)mm화(2.58±0.26)mm,BCVA(logMAR)위1.03±0.53화0.13±0.20.상술지표술전술후비교차이균유통계학의의.1안술중후낭막파렬,1안술후악성청광안,1안술후각막실대상.결론 대우상규약물화격광불능공제안압적급성폐각형청광안,정상체적제연합IOL식입화방각분리수술가이유효지해제청광안급성발작상태,조작구유교고적안전성.동공실이완병례가이용정상체전낭막조직제작가동공.
Objective To evaluate the effectiveness and safety of phacoemulsification and viscogoniosynechialysis in managing refractory acute angle-closure glaucoma (ACG).Methods This was a retrospective case series.The medical records of 23 patients (25 eyes) with refractory primary acute angle-closure glaucoma who underwent combined phacoemulsification and viscogoniosynechialysis from March 2011 to June 2012 at Peking Union Medical College Hospital were examined.Eyes were divided into an atonic pupil group (12 eyes) and a normal pupil group (13 eyes) based on pupil function.Phacoemulsification and viscogoniosynechialysis were performed and a 4.5 mm diameter continuous curvilinear capsulorhexis (CCC) was made in the atonic pupil group.Intraocular pressure (IOP),visual acuity,anterior chamber depth (ACD) and need for drops were recorded with a mean follow-up of 23.5±6.2 months (18-33 months).Pre-and post-operative data were compared with a paired-samples t test.Intraocular pressure curves of the atonic pupil group and normal pupil group were plotted.Complications and treatments were recorded.Results Significant differences were found preoperatively and postoperatively for mean IOP (38.20±6.04 mmHg vs.15.20±2.41 mmHg),BCVA (1.03±0.53 vs.0.13±0.20),anterior chamber depth (1.92±0.18 mm vs.2.58±0.26 mm) and number of antiglaucoma medications (2.96±0.89 vs.0.20±0.81) (P＜0.01).One patient (4％) had two complications and 1 patient (4％) had 1 complication.Conclusion Combined phacoemulsification and viscogoniosynechialysis is an effective and relatively safe procedure to relieve an episode of laser and medically unresponsive ACG.