急性闭角型青光眼高眼压下行超声乳化白内障摘除手术临床观察

摘要

Objective To evaluate the effect and risk of phacoemulsification combined intraocular lens im-plantation under high intraocular pressure (IOP) in treating acute angle closure glaucoma (AACG). Methods Seven-teen patients (17 eyes) of AACG who received the treatment (phacoemulsification combined intraocular lens implanta-tion under high IOP) in our department during May 2013 to September 2014 were retrospectively analyzed. All pa-tients were followed up for one month, with visual acuities (VA), IOP, the number of corneal endothelial cells and com-plications observed. Results The average IOP was (43.82 ± 6.50) mmHg before the surgery, (20.12 ± 10.09) mmHg one day after the surgery, and (14.21 ± 5.39) mmHg one month after the surgery. At the time point of one month after the surgery, the IOPs of 15 eyes without any drugs and 2 eyes treated with 1~2 kinds of anti-glaucoma drugs were all normal (≤21 mmHg). The difference was statistically significant (P<0.01). One month after the surgery, the VAs of 15 eyes were all improved, with no postoperative corneal endothelial decompensation found, and corneal edema were improved after intraocular pressure control. Abnormal complications included lens subluxation of 3 eyes, posterior capsule rupture of 2 eyes, and limited choroid hemorrhage of 1 eye. Conclusion Phacoemulsification is a relatively safe and effective treatment for those AACG patients who found drug therapy ineffective. The IOP and VA can be well controlled and improved significantly after the surgery.%目的：评估急性闭角型青光眼高眼压下行超声乳化白内障摘除联合人工晶体植入手术的疗效和风险。方法回顾性分析2013年5月至2014年9月在我科高眼压下急诊行超声乳化白内障摘除联合人工晶体植入手术治疗的急性闭角型青光眼患者17例17眼，术后随访1个月，观察手术前后视力、眼压、角膜内皮细胞计数及术中并发症。结果术前平均眼压(43.82±6.50) mmHg，术后1 d平均眼压(20.12±10.09) mmHg，术后1个月平均眼压(14.21±5.39) mmHg，15眼眼压≤21 mmHg，2眼联合1~2种抗青光眼药物眼压≤21 mmHg，术后1个月平均眼压与术前平均眼压比较，差异有显著统计学意义(P<0.01)。术后1个月15眼视力较术前提高。全部病例术后未发生角膜内皮失代偿，眼压控制后角膜水肿均获得改善。术中3眼晶体不全脱位，2眼晶体后囊破裂，1眼局限性脉络膜出血。结论对于药物治疗眼压不能控制、病情逐渐加重的急性闭角型青光眼患者，急诊行超声乳化白内障摘除联合人工晶体植入手术治疗成功率较高，治疗安全有效，术后眼压控制良好，术后视力明显提高。