目的:探讨白内障超声乳化联合前房角粘连分离术治疗急性闭角型青光眼的临床疗效,并与传统小梁切除术比较。方法:分析2004-01/2009-01在我科住院治疗的、急性发作3d以内的闭角型青光眼合并白内障患者58例58眼,将全部患者随机分为A,B两组。在给予药物控制眼压平稳后,A组患者行白内障超声乳化后房型人工晶状体植入联合前房角粘连分离术;B组患者行传统小梁切除术,随访11±1.5(平均12)mo,观察两组手术前后平均眼压、房角、最佳矫正视力、中央前房深度的变化。结果:术后疗效对比:A组术后12mo,眼压17.46±3.25mmHg;术后中央前房深度3.11±0.54mm,较术前明显加深;术后房角明显增宽;术后最佳矫正视力较术前明显提高。B组术后12mo,眼压15.01±3.68mmHg;中央前房深度2.05±0.10mm,与术前相比,无明显变化;术后视力与术前相比变化不大。A组术后12mo,眼压与B组相比,存在统计学差异(P<0.05),但仍可控制在正常眼压范围。结论:对于药物可控制的急性闭角型青光眼,白内障超声乳化后房型人工晶状体植入联合前房角粘连分离术是一种安全有效的方法,患者不仅视力明显提高,而且远期眼压也能得到有效控制。

AIM:To evaluate and compare outcomes between phacoemulsification combined with goniosynechialysis and trabeculectomy in the management of primary acute angle-closure glaucoma.METHODS:This study was a prospective observational series of fifty-eight eyes of fifty-eight patients.There were twenty-nine eyes in each group.Group A were treated with phacoemulsification combined with goniosynechialysis after the intraocular pressure(IOP)was controlled;group B were treated with trabeculectomy after appropriate medical treatment.Best-corrected visual acuity(BCVA),central anterior chamber depth,grading of chamber angle,and IOP were measured preoperatively and at day 1,day 3,month 1,month 3,month 6 and month 12 postoperatively.RESULTS:There were statistically significant differences in BCVA 1 month and 6 months postoperatively(higher than in group A).1 month postoperatively anterior chamber angles in group A were wider than that in group B.There were no statistically significant differences in IOP preoperatively and 1 month,3,6 months postoperatively between the two groups.Statistically significant differences were observed in IOP 1 day,3 days postoperatively between the two groups.All of IOP in both groups were less than 21mmHg.CONCLUSION:Phacoemulsification combined with goniosynechialysis may be an effective treatment option for primary angle-closure glaucoma responsive to medical therapy.

R779.6