CAJ | 학술논문

目的：探讨原发性青光眼合并白内障手术方式临床效果。方法本组53例63眼,根据房角粘连情况将38例48眼闭角青光眼合并白内障患者分为：房角粘连关闭≤180°12眼，采用超乳联合房角分离术；180°＜房角粘连关闭≤270°20眼，采用超乳联合房角分离、虹膜周边切除术；房角粘连关闭＞270°16眼，采用超乳、房角分离联合小梁切除术(简称三联)，15例开角型青光眼合并白内障，视力低于0.4者，行超乳联合小梁切除术，随访3个月～5年，对比术前、术后的视力、眼压、前房深度及前房角变化。结果29眼急性闭角型青光眼和19眼慢性闭角型青光眼术后眼压控制在正常范围，视力恢复良好；6只慢性闭角型青光眼房角粘连＞2/3，术后近期眼压控制好，术后1.8～2.0年眼压再次增高，药物效果好，眼压控制在正常范围。15例开角型青光眼合并白内障者，术后视力均提高，术后眼压12眼控制正常范围，3眼术后近期眼压控制好，1.0～1.5年眼压再次增高，药物控制眼压良好。结论对于原发性闭角型青光眼合并白内障患者，根据房角关闭情况：行超乳联合房角分离术、虹膜周边切除术超乳联合小梁切除术（三联术），开角性青光眼合并白内障患者，超乳联合小梁切除术可有效控制眼压，但仍需长期随访。
목적：탐토원발성청광안합병백내장수술방식림상효과。방법본조53례63안,근거방각점련정황장38례48안폐각청광안합병백내장환자분위：방각점련관폐≤180°12안，채용초유연합방각분리술；180°＜방각점련관폐≤270°20안，채용초유연합방각분리、홍막주변절제술；방각점련관폐＞270°16안，채용초유、방각분리연합소량절제술(간칭삼련)，15례개각형청광안합병백내장，시력저우0.4자，행초유연합소량절제술，수방3개월～5년，대비술전、술후적시력、안압、전방심도급전방각변화。결과29안급성폐각형청광안화19안만성폐각형청광안술후안압공제재정상범위，시력회복량호；6지만성폐각형청광안방각점련＞2/3，술후근기안압공제호，술후1.8～2.0년안압재차증고，약물효과호，안압공제재정상범위。15례개각형청광안합병백내장자，술후시력균제고，술후안압12안공제정상범위，3안술후근기안압공제호，1.0～1.5년안압재차증고，약물공제안압량호。결론대우원발성폐각형청광안합병백내장환자，근거방각관폐정황：행초유연합방각분리술、홍막주변절제술초유연합소량절제술（삼련술），개각성청광안합병백내장환자，초유연합소량절제술가유효공제안압，단잉수장기수방。
ObjectiveTo study the clinical effect of the surgery way of primary glaucoma complicated with cataract. Methods Of the 53 cases with 63 eyes, 38 cases (48 eyes) with angle-closure glaucoma complicated with cataract were divided into 12 eyes with closed goniosynechia≤180° treated by phacoemulsification combined with goniosynechialysis, 16 eyes with closed goniosynechia between 180° and 270° treated by phacoemulsification, goniosynechialysis combined with peripheral iridectomy, 16 eyes with closed goniosynechia>270° treated by phacoemulsification, goniosynechialysis combined with trabeculectomy (triple). Of the 15 cases with open angle glaucoma complicated with cataract, the patients who had the visual acuity lower than 0.4 were treated by phacoemulsification combined with trabeculectomy and were follow-up from 3 months to 5 years. To compare the visual acuity, intraocular pressure (IOP), anterior chamber depth and the changes of anterior chamber angle of before and after surgery.Results The intraocular pressure had been controlled in the normal range and the visual acuity had been good recovery in 29 eyes with acute angle-closure glaucoma and 19 eyes with chronic angle-closure glaucoma. 6 eyes with chronic angle-closure glaucoma had goniosynechia >2/3 and got effective IOP control. Drug had got effective to control the IOP which had increased again after 1.8 to 2 years later to be in normal range. Of the 15 patients with open angle glaucoma complicated with cataract, the postoperative visual acuity was improved, the postoperative IOP was that, 12 eyes were controlled in normal range, 3 eyes which had increased again after 1.0 to 1.5 years later were controlled by drug in normal range. ConclusionAccording to the closed goniosynechia to select phacoemulsification combined with goniosynechialysis or peripheral iridectomy phacoemulsification combined with trabeculectomy (triple). Phacoemulsification combined with trabeculectomy could effectively control the IOP of patients with open angle glaucoma complicated with cataract, but should be followed-up for long term.