目的 探讨超声乳化吸除联合人工晶状体植入术治疗闭角型青光眼合并白内障患者的临床疗效,评估该手术方法的临床应用价值.方法 选取2015年3月-2016年3月在延安市人民医院就诊的闭角型青光眼合并白内障患者80例.采用超声乳化吸除联合人工晶状体植入术对患者进行治疗,且在术后常规随访6个月,观察完成随访的70例患者(共70只患眼)的视力矫正情况、眼压改善情况、前房角开放情况以及并发症发生情况.结果(1)术后3 d视力<0.1和0.1～0.2范围的患者所占比例(24.29％和27.14％)较术前下降,视力0.2～0.4和>0.4范围的患者所占比例(25.71％和22.86％)较术前升高,患者的视力呈不断改善的趋势,与术前相比差异具有统计学意义(P<0.05).但术后6个月与术后3个月相比,视力变化改善相当,差异无统计学意义(P>0.05).(2)患者术后眼压呈不断下降的趋势,且下降速度较快,术后3 d眼压[(14.6±4.9)mmHg]改善明显,与术前眼压 [(38.9±7.2)mmHg] 相比差异具有统计学意义(P<0.05).术后3个月眼压[(9.8±4.3)mmHg]与术后6个月眼压[(10.2±5.1)mmHg]相比差异无统计学意义(P>0.05).(3)静态下房角开放>1/2的患者数量在术后呈不断上升的趋势,且术后6个月与术前比较差异有统计学意义(P<0.05),动态下房角关闭>1/2的患者数量在术后呈不断下降的趋势,且术后6个月与术前比较差异有统计学意义(P<0.05).(4)术后发生角膜水肿、前房炎性渗出共5例,并发症总发生率为7.14％,经简单治疗后症状很快消失.未发现眼底结构改变、眼球出血等严重并发症.结论 超声乳化吸除联合人工晶状体植入可以显著改善患者的视力、眼压、前房角开放情况等指征,且术后并发症少,具有较高的临床应用价值.%Objective To evaluate the clinical efficacy of phacoemulsification combined with intraocular lens(IOL)in the treatment of angle-closure glaucoma complicated with cataract and to evaluate the clinical application of this method.Methods 80 cases of cataract patients with angle-closure glaucoma were collected from March 2015 to March 2016 in Yan''an People''s Hospital.The patients were treated with phacoemulsification and intraocular lens implantation.The patients were followed up for 6 months.The visual acuity correction and intraocular pressure(IOP)were observed in 70 patients(70 eyes).The opening of the anterior chamber angle and the occurrence of complications.Results(1)The proportion of patients(24.29％and 27.14％)decreased in the range of 0.1-0.1 and 0.1-0.2,and the proportion of patients with visual acuity of 0.2-0.4 and >0.4(25.71％and 22.86％),and the difference was statistically significant(P<0.05).However,there was no significant difference in visual acuity compared with 3 months after operation(P>0.05);(2)There was a trend towards falling of Postoperative IOP in patients,postoperative IOP [(14.6±4.9)mmHg] was significantly improved at 3rd day compared with the preoperative IOP [(38.9±7.2)mmHg](P<0.05).No significant difference of IOP was observed between the 3rd month [(9.8±4.3)mmHg] and the 6th month [(10.2±5.1)mmHg](P>0.05);(3)the number of patients with static lower open angle more than 1/2 after surgery showed a trend towards rising,there was significant difference of static lower angle between the 6th month and the preoperative(P<0.05);the number of patients with dynamic lower closed angle more than 1/2 showed a trend towards declining,and there was significant difference of dynamic lower closed angle between the 6th month and the preoperative(P<0.05);(4)there were 5 cases of corneal edema and anterior chamber inflammatory bleeding,and the total incidence of complications was 7.14％,and the symptoms were quickly eliminated after simple treatment.No serious complications such as changes in the structure of the eye and the hemorrhage of the eyeball were found.Conclusion Phacoemulsification combined with intraocular lens implantation was presented to be able to significantly improve the visual acuity,IOP,open anterior chamber angle and other indications,and less postoperative complications,thus it was of high clinical value.
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