目的：研究房角关闭≥180°(动态房角镜检)的原发性闭角型青光眼合并白内障患者行白内障超声乳化联合人工晶状体植入联合房角分离术前后房角形态的变化，并评价此手术的疗效。

方法：前瞻性系列病例研究。观察2013-01/12在我院行白内障手术的房角关闭≥180°(动态房角镜检)的原发性闭角型青光眼合并白内障患者79例79眼术前、术后1、6mo的房角形态、眼压、最佳矫正视力的变化情况。术前与术后各时间点前房角开放距离500(AOD500)、小梁网与虹膜间夹角500(TIA500)比较采用配对t检验，术前与术后各时间点房角粘连度、最佳矫正视力均采用Kruskal-Wallis H检验。

结果：术后1mo 58眼无需用药眼压控制正常，术后6mo 56眼无需用药眼压控制正常。术后1、6mo与术前相比房角粘连情况、AOD500、TIA500、最佳矫正视力差异均有统计学意义(P<0.05)。术后最佳矫正视力除8眼视神经萎缩无改善，其余最佳矫正视力均有提高。

结论：对于单纯性瞳孔阻滞性闭角型青光眼合并白内障患者行白内障超声乳化联合人工晶状体植入联合前房角分离术是安全有效的； 对于病史较长、虹膜附着位置靠前的非瞳孔阻滞性及多种机制共存型闭角型青光眼合并白内障患者，则术后可能需要联合药物治疗。

AIM: To study themorphological changes of anterior chamber angle in patients with primary angle-closure glaucoma(PACG)and in whom the closed anterior chamber angle was ≥180°(determined by gonioscopy dynamicly)before and after phacoemulsification combined with goniosynechialysis and to evaluate the clinical efficacy of this surgry.

METHODS:A prospective case series study. Seventy-nine cases(79 eyes)with cataract were enrolled. They went to our hospital for phacoemulsification and were diagnosed as PACG, in whom the closed anterior chamber angle was ≥180°(determined by gonioscopy dynamicly). They were observed for the changes of anterior chamber angle, intraocular pressure(IOP)and the best-corrected visual acuity(BCVA)pre- and post-operative from January to December in 2013.The angle opening distance 500(AOD500)and trabecular-iris angle 500(TIA500)before and after surgeries were analyzed using paired student t-test. The range of goniosynechia and BCVA before and after surgeries were analyzed using Kruskal-Wallis H test.

RESULTS:The IOPs of 58 eyes were normal(≤21mmHg)without any medications at 1mo after operation, and 56 eyes at 6mo after operation. The range of goniosynechia, AOD500, TIA500 and BCVA before operation had significant difference compared with those at 1 and 6mo after operation(P<0.05). The BCVA were improved except 8 eyes with optic atrophy.

CONCLUSION:Phacoemulsification combined with goniosynechialysisis is an effective method for angle closure glaucoma simply caused by pupillary block, coexisted with cataract. The angle closure glaucoma without pupillary block which has long course and the location of peripheral iris is anterior and the closure glaucoma coexisted with cataract caused by several different mechanisms should be treated with medicine management after phacoemulsification combined with goniosynechialysisis.

2012年度武汉市卫生局临床医学科研项目(No.WX12B21)