1、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)障的臨床觀察 Clinical study on the management of angle-closure glaucoma with cataract by phacoemulsification with foldable posterior chamber intraocular lens implantation,一、目的（OBJECTIVE） 初步觀察顳側(cè)角鞏膜緣隧道切口超聲乳化白內(nèi)障吸除聯(lián)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的療效。,To investigate the clinic

2、al 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 DATA）,2001年9月2003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，平均年齡57.328.64歲,From September of

3、2001 to April of 2003 33 cases (52 eyes ) with primary angle-closure glaucoma and cataract were prospectivly studied. 18 men，15 women Ages were from 42 to 79，average age was 57.328.64,1、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1.7種,1、Primary acute angle

4、-closure glaucoma （24 eyes） Preoperative IOP was 1754mmHg，mean IOP was 27.6910.42mmHg Mean limbic anterior chamber depth was 0.280.04 CK Mean visual acuity was 0.2 0.1 Mean drugs was 1.7 types,2、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種,2、 Primary c

5、hronic angle-closure glaucoma（28 eyes） Preoperative IOP was 1120mmHg ，mean IOP was 16.392.50mmHg Mean limbic anterior chamber depth was 0.450.08 CK Mean visual acuity was 0.3 0.2 Mean 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)障吸除聯(lián)合后房型折疊式人工晶狀體植入術(shù)。 All the patients were u

6、ndergone 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 patients Postoperative mean IOP was 13.132.33 mmHg Mean limbic anterior chamber depth was 0.660.

7、13 CK,術(shù)后半年平均遠(yuǎn)視力為0.50.2 4眼術(shù)后用一種藥物控制眼壓可達(dá)21mmHg以下， 其余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

8、眼壓與周圍前房深度比較,mmHg,CK,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,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 patients Postoperative mean IOP was 11.641.25 mmHg Mean limbic anterior chamber depth was 0.850.15 CK,術(shù)后半年平均遠(yuǎn)視力為0.50.3 2眼術(shù)后用一種藥物控制眼壓可達(dá)21mmHg以下， 其余不需用藥物控制眼壓即正常

9、,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,mmHg,CK,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,術(shù)后并發(fā)癥,術(shù)后1天：

10、 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)全部消失。 所有術(shù)眼人工晶狀體均在位，未出現(xiàn)偏位、夾持。,Complications after operation,The day after operation： mild cornea edema 13 eyes（25） Tyn(+):39 eyes（75）mildly，10 eyes（19.2） seriously 1 week after operation：all above were disappeared All IOLs were stable in the centric a

11、rea,五、討論 （DISCUSSION),眼前段空間狹窄,晶狀體較厚且位置靠前,晶狀體虹膜膈前移,虹膜背面與前囊緊密相貼,瞳 孔 阻 滯,虹膜根部被推向小梁網(wǎng),前房變淺,房角變窄、閉合,眼 壓 升 高,白內(nèi)障超聲乳化手術(shù),晶狀體有形成分吸出,提供虹膜后退的空間,降低眼壓,術(shù)中前房壓力升高,機(jī)械性使房角開放,超聲作用,減少房水分泌,解除瞳孔阻滯,經(jīng)顳側(cè)角鞏膜緣切口優(yōu)點,將12點方位的角鞏膜緣留出，為將來眼壓控制不理想時再行濾過手術(shù)留有足夠的空間 避免了經(jīng)透明角膜切口導(dǎo)致的術(shù)后散光、角膜炎癥反應(yīng)重 等不良后果,Advantages of temporal corneal limbus tunne

12、ls,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)障吸除聯(lián)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 foldable intraocular lens implantation in tr