1、超聲乳化白內(nèi)障吸除折疊式人工晶狀體植入治療閉超聲乳化白內(nèi)障吸除折疊式人工晶狀體植入治療閉角型青光眼合并白內(nèi)障的臨床察看角型青光眼合并白內(nèi)障的臨床察看 Clinical study on the management of angle-closure glaucoma with cataract by phacoemulsification with foldable posterior chamber intraocular lens implantation 一、目的OBJECTIVE 初步察看顳側(cè)角鞏膜緣隧道切口超聲乳化白內(nèi)障吸除結(jié)合后房型折疊式人工晶狀體植入術(shù)治療合并白內(nèi)障的急性或慢性閉

2、角型青光眼的療效。 To investigate the clinical results of phacoemulsification with foldable posterior chamber intraocular lens (PC-IOL) implantation in the management of acute or chronic angle-closure glaucoma with cataract. 二、病例資料PATIENTS DATA2019年9月2019年4月收住本院的33例(52只眼)原發(fā)性 閉角型青光眼合并白內(nèi)障患者男18例，女15例年齡4279歲，平均年

3、齡57.328.64歲From September of 2019 to April of 2019 33 cases (52 eyes ) with primary angle-closure glaucoma and cataract were prospectivly studied.18 men，15 womenAges were from 42 to 79，average age was 57.328.641、原發(fā)性急性閉角型青光眼組24眼 術(shù)前眼壓1754mmHg，平均眼壓27.6910.42mmHg 周圍前房深度0.280.04 CK 平均遠(yuǎn)視力0.2 0.1 平均用降眼壓藥1.

4、7種1、Primary acute angle-closure glaucoma 24 eyesPreoperative IOP was 1754mmHg，mean IOP was 27.6910.42mmHgMean limbic anterior chamber depth was 0.280.04 CKMean visual acuity was 0.2 0.1Mean drugs was 1.7 types2、原發(fā)性慢性閉角型青光眼組28眼 術(shù)前眼壓1120mmHg ，平均眼壓16.392.50mmHg 周圍前房深度0.450.08 CK 平均遠(yuǎn)視力0.3 0.2 平均用降眼壓藥0.8

5、種2、 Primary chronic angle-closure glaucoma28 eyesPreoperative IOP was 1120mmHg ，mean IOP was 16.392.50mmHgMean limbic anterior chamber depth was 0.450.08 CKMean visual acuity was 0.3 0.2Mean drugs to control IOP was 0.8 types三、 方法 METHODS 患者入院后均行角鞏膜緣隧道切口超聲乳化白內(nèi)障吸除結(jié)合后房型折疊式人工晶狀體植入術(shù)。 All the patients we

6、re undergone the Phacoemulsification with PC-IOL implantation through temporal corneal limbus tunnels.四、 結(jié)果 RESULTS 原發(fā)性急性閉角型青光眼組 術(shù)后平均眼壓13.132.33 mmHg 周圍前房深度0.660.13 CK Primary acute angle-closure glaucoma patientsPostoperative mean IOP was 13.132.33 mmHgMean limbic anterior chamber depth was 0.660.1

7、3 CK 術(shù)后半年平均遠(yuǎn)視力為0.50.24眼術(shù)后用一種藥物控制眼壓可達(dá)21mmHg以下， 其他不需用藥物控制眼壓即正常,平均用降眼壓藥0.17種 Mean visual acuity was 0.50.2 half a year after operation Only 4 eyes needs one drug each to control IOP below 21mmHg and the others were normal without any drug,mean drugs used to control IOP was 0.17 types原發(fā)性急性閉角型青光眼組術(shù)前術(shù)后眼壓與

8、周圍前房深度比較0 05 510 1015 1520 2025 2530 30眼 壓（IOP）眼 壓（IOP）0 00.10.10.20.20.30.30.40.40.50.50.60.60.70.7周圍前房深度（limbic anterior周圍前房深度（limbic anteriorchamber depth ）chamber depth ）術(shù)前術(shù)前術(shù)后術(shù)后mmHgCK原發(fā)性急性閉角型青光眼組術(shù)前術(shù)后視力與平均用降眼壓藥物的比較0 00.050.050.10.10.150.150.20.20.250.250.30.30.350.350.40.40.450.450.50.5視力（vision

9、）視力（vision）0 00.20.20.40.40.60.60.80.81 11.21.21.41.41.61.6平均用藥數(shù)（drug types）平均用藥數(shù)（drug types）術(shù)前術(shù)前術(shù)后術(shù)后 原發(fā)性慢性閉角型青光眼組 術(shù)后平均眼壓11.641.25 mmHg 周圍前房深度0.850.15 CK Primary chronic angle-closure glaucoma patientsPostoperative mean IOP was 11.641.25 mmHgMean limbic anterior chamber depth was 0.850.15 CK 術(shù)后半年平均遠(yuǎn)

10、視力為0.50.32眼術(shù)后用一種藥物控制眼壓可達(dá)21mmHg以下， 其他不需用藥物控制眼壓即正常,平均用降眼壓藥0.07種 Mean visual acuity was 0.50.3 half a year after operation Only 2 eyes needs one drug each to control IOP below 21mmHg and the others were normal without any drug,mean drugs used to control IOP was 0.07 types原發(fā)性慢性閉角型青光眼組術(shù)前術(shù)后眼壓與周圍前房深度比較0 02

11、 24 46 68 810 1012 1214 1416 1618 18眼 壓（IOP）眼 壓（IOP）0 00.10.10.20.20.30.30.40.40.50.50.60.60.70.70.80.80.90.9周圍前房深度（limbic anterior周圍前房深度（limbic anteriorchamber depth ）chamber depth ）術(shù)前術(shù)前術(shù)后術(shù)后mmHgCK原發(fā)性慢性閉角型青光眼組術(shù)前術(shù)后視力與平均用降眼壓藥物的比較0 00.050.050.10.10.150.150.20.20.250.250.30.30.350.350.40.40.450.450.50.5

12、視力（vision）視力（vision）0 00.20.20.40.40.60.60.80.81 11.21.2平均用藥數(shù)（drug types）平均用藥數(shù)（drug types）術(shù)前術(shù)前術(shù)后術(shù)后術(shù)后并發(fā)癥 術(shù)后1天： 角膜輕度水腫13例25 前房閃輝輕度39例75，中度10例19.2 術(shù)后1周：以上表現(xiàn)全部消逝。 一切術(shù)眼人工晶狀體均在位，未出現(xiàn)偏位、夾持。Complications after operationThe day after operation： mild cornea edema 13 eyes25 Tyn(+):39 eyes75mildly，10 eyes19.2 se

13、riously1 week after operation：all above were disappearedAll IOLs were stable in the centric area五、討論DISCUSSION)眼前段空間狹窄眼前段空間狹窄晶狀體較厚晶狀體較厚且位置靠前且位置靠前晶狀體虹膜膈前移晶狀體虹膜膈前移虹膜反面與前虹膜反面與前囊嚴(yán)密相貼囊嚴(yán)密相貼虹膜根部被推向小梁網(wǎng)虹膜根部被推向小梁網(wǎng)前房變淺前房變淺房角變窄、閉合房角變窄、閉合晶狀體有構(gòu)成分吸出晶狀體有構(gòu)成分吸出提供虹膜后退的空間提供虹膜后退的空間術(shù)中前房壓力升高術(shù)中前房壓力升高機(jī)械性使房角開放機(jī)械性使房角開放超聲作用超聲作

14、用減少房水分泌減少房水分泌經(jīng)顳側(cè)角鞏膜緣切口優(yōu)點(diǎn) 將12點(diǎn)方位的角鞏膜緣留出，為未來(lái)眼壓控制不理想時(shí)再行濾過(guò)手術(shù)留有足夠的空間 防止了經(jīng)透明角膜切口導(dǎo)致的術(shù)后散光、角膜炎癥反響重 等不良后果Advantages of temporal corneal limbus tunnels Reserve the 12 oclock corneal limbus tunnels for the filtering operations if needed in the future Avoid some severe complications after operation through the cornea such as astigmatism and keratitis六、小 結(jié)SUMMARY 顳側(cè)角鞏膜緣隧道切口超聲乳化白內(nèi)障吸除結(jié)合后房型折疊式人工晶狀體植入術(shù)治療合并白內(nèi)障的急性或慢性閉角型青光眼可以 降低眼壓 加深前房 提高視力 減少用藥 Phacoemulsification with posterior chamber folda