原发性急性闭角型青光眼持续性高眼压睫状体光凝后残余青光眼行超声乳化术的临床疗效

摘要

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。%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 .