【摘要】： 青光眼是全世界不可逆盲的最常見(jiàn)的原因。近年來(lái)國(guó)內(nèi)學(xué)者依據(jù)其發(fā)病機(jī)制將原發(fā)性閉角型青光眼分為以下三種類型：?jiǎn)渭冃酝鬃铚�、單純性非瞳孔阻滯型及混合機(jī)制型。單純性非瞳孔阻滯型也有虹膜高褶型之稱,在我國(guó)很少見(jiàn),僅7.1%的原發(fā)性閉角型青光眼屬于此型,混合機(jī)制型占原發(fā)性閉角型青光眼的54.8%。 閉角型青光眼患者具有淺前房、窄房角和眼軸短等特點(diǎn),隨著年齡增加,睫狀體帶松弛,晶狀體增厚6造成相對(duì)瞳孔阻滯。在白內(nèi)障的病程中,隨著年齡的增加,晶狀體膨脹,前后徑增大,位置前移,使晶狀體與虹膜的接觸面積增大,后房的房水從瞳孔排向前房的阻力逐漸增大,形成瞳孔阻滯。當(dāng)后房壓力不能克服瞳孔阻滯時(shí),周邊虹膜膨隆明顯,導(dǎo)致房角狹窄、甚至關(guān)閉。因此,臨床上白內(nèi)障合并閉角型青光眼的病人較常見(jiàn)。 以往治療白內(nèi)障合并閉角型青光眼的手術(shù)通常采用白內(nèi)障囊外摘除人工晶體植入聯(lián)合青光眼小梁切除術(shù)。但近年來(lái)關(guān)于白內(nèi)障合并閉角型青光眼的手術(shù)方式,成為眼科界爭(zhēng)論的問(wèn)題之一。國(guó)內(nèi)外眼科學(xué)者在白內(nèi)障摘除術(shù)與抗青光眼手術(shù)分階段治療中,發(fā)現(xiàn)單純白內(nèi)障手術(shù)由于晶體摘除可加深前房,開(kāi)放尚未粘連的房角,對(duì)部分閉角型青光眼具有控制眼壓的作用,于是提出了單純白內(nèi)障手術(shù)治療閉角型青光眼的治療方法,從而擴(kuò)大了晶狀體摘除術(shù)的應(yīng)用范圍。該方法不但可簡(jiǎn)化手術(shù)程序,而且能改善患者視力狀況。但仍有部分房角粘連牢固的病人未得到改善,眼壓仍然高于正常水平。 據(jù)最近報(bào)道：晶狀體摘出聯(lián)合人工晶狀體(10L)植入術(shù),房角粘連分離術(shù),超聲乳化白內(nèi)障吸出術(shù)聯(lián)合房角粘連分離術(shù)(phacoemulsification with goniosynechialysis,簡(jiǎn)稱PEGS),都能成功地降低閉角型青光眼患者的眼壓。 目的 觀察白內(nèi)障囊外摘除人工晶體植入聯(lián)合房角分離術(shù)治療合并有白內(nèi)障的急性閉角型青光眼的療效以及術(shù)后房角形態(tài)的改變。 方法 我們選擇2003年1月至2009年6月確診為急性閉角型青光眼合并白內(nèi)障患者84例(88只眼),行白內(nèi)障囊外摘除聯(lián)合房角分離術(shù),進(jìn)行回顧性分析,對(duì)其手術(shù)前后的視力、眼壓、視野、中央前房深度、房角形態(tài)進(jìn)行對(duì)照觀察。 結(jié)果 術(shù)后隨訪3-6個(gè)月,84例(88只眼)有69例(71只眼)視力較術(shù)前明顯提高。88只眼術(shù)后中央前房深度均加深,術(shù)前前房深度1.673±0.476mm,術(shù)后前房深度3.414±0.167mm。84只眼術(shù)后眼壓明顯降低,術(shù)前眼壓28.437±3.321 mmHg，術(shù)后眼壓13.981±5.173 mmHg。術(shù)后3月房角鏡檢查84例(88只眼)房角均較術(shù)前有不同程度的開(kāi)放。60例(62只眼)術(shù)后6月復(fù)查視野無(wú)縮小。 結(jié)論 白內(nèi)障囊外摘除聯(lián)合房角分離術(shù)是治療合并有白內(nèi)障的急性閉角型青光眼的有效方法。能使此類患者降低眼壓、加深前房、開(kāi)放房角和提高視力。
[Abstract]:Glaucoma is the most common cause of irreversible blindness worldwide. In recent years, according to its pathogenesis, primary angle-closure glaucoma has been classified into three types: simple pupillary block, simple non-pupillary block and mixed mechanism. Simple non-pupillary block type is also known as high iris fold type. It is rare in China. Only 7.1% of primary angle-closure glaucoma belongs to this type, and mixed mechanism type accounts for 54.8% of primary angle-closure glaucoma. The patients with angle-closure glaucoma have the characteristics of shallow anterior chamber, narrow angle of atrium and short eye axis. With the age, the ciliary zone is relaxed and the lens thickens, which results in the relative pupil block. In the course of cataract, with the increase of age, the lens dilates, the anteroposterior diameter increases, the position moves forward, the contact area between the lens and the iris increases, and the resistance of the aqueous humor in the posterior chamber from the pupil to the anterior chamber increases gradually, resulting in pupil block. When posterior chamber pressure can not overcome pupillary block, peripheral iris bulges obviously, leading to angular stenosis or even closure. Therefore, cataract with angle closure glaucoma is more common in clinical patients. Extracapsular cataract extraction (Ecce) and intraocular lens implantation (IOL) combined with trabeculectomy are usually used in the treatment of cataract with angle closure glaucoma. However, the surgical methods of cataract combined with angle closure glaucoma have become one of the controversial issues in ophthalmology in recent years. In the phased treatment of cataract extraction and anti-glaucoma surgery, domestic and foreign ophthalmologists found that simple cataract surgery can deepen the anterior chamber and open the unadherent angle because of lens extraction. Partial angle-closure glaucoma has the function of controlling intraocular pressure, so a simple cataract surgery is put forward to treat angle closure glaucoma, thus expanding the scope of application of lens extraction. This method not only simplifies the procedure, but also improves the visual acuity of patients. However, some patients with solid adhesion of the angle of atrium were not improved, and IOP was still above normal level. It has been reported recently that lens extraction combined with intraocular lens (10L) implantation, atrial angle adhesion separation, phacoemulsification cataract extraction combined with atrial angle adhesion separation (phacoemulsification with goniosynechialysis,) can successfully reduce the intraocular pressure in patients with angle closure glaucoma. Objective to observe the effect of extracapsular cataract extraction and intraocular lens implantation combined with angle separation in the treatment of acute angle closure glaucoma with cataract. Methods from January 2003 to June 2009, 84 patients (88 eyes) with acute angle-closure glaucoma and cataract were treated with extracapsular cataract extraction and angle separation. Visual acuity, intraocular pressure, visual field, depth of central anterior chamber and angle of atrium were observed before and after operation. Results after 3 to 6 months follow-up, 69 eyes (71 eyes) of 84 eyes (88 eyes) improved their visual acuity, and the depth of central anterior chamber deepened in 88 eyes after operation. The preoperative depth of anterior chamber was 1.673 鹵0.476 mm, the postoperative depth of anterior chamber was 3.414 鹵0.167mm.84, and the intraocular pressure was significantly decreased. The preoperative intraocular pressure was 28.437 鹵3.321 mmHg, and the postoperative IOP was 13.981 鹵5.173 mmHg.. The angle of atrial angle of 84 cases (88 eyes) was open to different degree after 3 months of operation, and the visual field of 60 cases (62 eyes) was not reduced in 6 months after operation. Conclusion extracapsular cataract extraction combined with angle separation is an effective method for the treatment of acute angle-closure glaucoma with cataract. These patients can reduce intraocular pressure, deepen anterior chamber, open room angle and improve visual acuity.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2010
【分類號(hào)】：R779.6

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