【摘要】 目的探讨治疗原发性闭角型青光眼三种手术方式的适应症和初步临床疗效观察。方法采用非随机临床对照研究方法。拟订手术适应症,对临床收治的63例72眼原发性闭角型青光眼进行手术处理:单纯抗青光眼手术——复合式小梁切除术(Trabeculectomy,Trab)、青-白联合手术——复合式小梁切除联合超声乳化白内障吸除+晶体囊袋折叠式人工晶体植入术(Phacotrabeculectomy+IOL,PhacoTrab+IOL)和单纯白内障手术——超声乳化白内障吸除+晶体囊袋折叠式人工晶体植入术(Phaco+IOL)。比较不同适应症下三种手术方式初步的临床疗效。包括眼压控制情况、前房深度和房水流畅系数(C值)的变化,超声生物显微镜(UBM)观察房角和滤过泡,以及用抗青光药物辅助情况及并发症等。随访时间平均(11.7±4.9)个月。结果均经统计学处理。结果三组术后在随访期内均能将眼压控制在理想范围,术后眼压较术前明显降低(三组P值均<0.001),前房深度:PhacoTrab+IOL和Phaco+IOL组术后明显较术前加深,差异有统计学意义(P值均<0.001),但Trab组术前后改变不明显(P>0.05);UBM观察房角:PhacoTrab+IOL和Phaco+IOL组明显较术前加宽或重新开放,相应组C值术后较术前提高,差异有统计学意义(P分别<0.001和<0.01),Trab组房角变化不明显,但术后C值较术前亦有改善(P<0.001);三组均未见严重术中并发症;术后早期炎症反应最轻者为Phaco+IOL组;远期并发症Trab组有5眼发生低眼压。最后对视力的变化也作了讨论。结论不同手术方式适合不同的病人情况。超声乳化白内障吸除术因其具有相对房角开放和C值改善以及视力提高等优势,可考虑作为原发性闭角型青光眼治疗的选择性手段之一,但要注意适应症的选择。更多还原

【Abstract】 Objective To propose the indications and preliminary clinical resuls of three types ofmicrosurgery on management of primary angle-closure glaucoma. Methods The indications of three types ofmicrosurgery were set up for a non-randomized comparison study on 72 eyes (63 cases) with primary acute orchronic angle-closure glaucoma which were performed trabeculectomy only (Trab group), phacortrabeculectomyplus intraocular lens implantation (Phaco Trab+IOL group) and phacoemulsification with IOL (Phaco+IOL).The preliminary clinical results of three groups were compared. The mean follow-up was 11.7±4.9 months.Results The postoperative IOP in three groups were well controlled postoperatively vs.preoperatively (All P<0.001). The anterior chamber depth was seen deeper in Phaco Trab+IOL and Phaco+IOL group postopera-tively vs. preoperatively (both P<0.001), while in Trab group wasn’t seen significantly change (P>0.05); TheUBM showed that anterior angle was widen or reopened in Phaco Trab+IOL and Phaco+IOL group, The corre-sponding C values in these two groups were increased postoperatively vs. preoperatively (P<0.001 and P<0.01,respectively). However, even though the angle wasn’t seen reopened in Trab group under the UBM, the C value was significantly increased (P<0.001). No sever intraoperative complications happened in three groups. Themildest postoperative inflammatory response was seen in Phaco+IOL group. There were 5 eyes happened sus-tained hypotonus in Trab group. Conslusion The indications of three types of microsurgery will be benefitsfor management primary angle-closure glaucoma. Phaco Trab+IOL and Phaco+IOL group have better improve-ment in visual acuity, angle reopened and C value, and could be considered as new alternative for managedprimary angle-closure glaucoma.更多还原