超声乳化白内障摘出治疗急性闭角型青光眼临床观察

目的探讨超声乳化术治疗白内障合并急性闭角型青光眼的疗效。方法施行超声乳化白内障摘出联合人工晶状体植入术治疗白内障合并急性闭角型青光眼22例（22只眼）。结果术后17只眼眼压控制在13～21mmHg。最佳矫正视力较手术前提高2～4行。结论晶状体超声乳化摘出联合人工晶状体植入术是治疗白内障合并急性闭角型青光眼的一种有效手术方式,特别是对于急性闭角型青光眼合并成熟期和近成熟期的白内障尤为适合。     

原发性闭角型青光眼合并白内障术后视觉质量变化及影响因素

近年来,白内障超声乳化吸除加人工晶状体植入联合房角分离手术逐渐成为治疗原发性闭角型青光眼合并白内障的主要有效手段,然而随着医疗技术不断进步,术后眼压的控制不再是唯一的追求,患者对术后的视觉质量期望越来越高。为了使患者术后拥有更好的屈光状态和更高的视觉质量,需减少因原发性闭角型青光眼所带来的负面影响,个性化选择不同人工晶状体或计算公式等。视觉质量评价指标包括视力、对比敏感度、高阶像差、主观感受等。因此,本文就原发性闭角型青光眼合并白内障患者行白内障超声乳化吸除加人工晶状体植入联合房角分离手术术后屈光漂移、高阶像差、对比敏感度变化及其影响因素以及人工晶状体的选择做出综述。     

晶状体超声乳化人工晶状体植入治疗原发性闭角型青光眼

目的探讨晶状体超声乳化吸出联合后房人工晶状体植入术,治疗白内障合并原发性闭角型青光眼的疗效。方法本院收治白内障合并原发性闭角型青光眼37例(37眼),术前控制眼压,经视力、眼压、前房角镜和裂隙灯显微镜等检查后,均单独采用晶状体超声乳化吸出联合后房人工晶状体植入。结果术后随访6~18个月,视力较术前提高,视力>0.5者20眼,占54.05%,22例术后眼压<18mmHg,另5例用1种降眼压药物眼压控制在18mmHg以下。结论晶状体超声乳化后房人工晶状体植入可有效地治疗合并白内障的原发性闭角型青光眼。     

超声乳化白内障摘出联合人工晶状体植入术治疗急性闭角型青光眼临床观察

目的 探讨治疗急性闭角型青光眼的手术方法.方法 施行超声乳化白内障摘出联合人工晶状体植入术治疗急性闭角型青光眼17例(17眼).结果 术后15眼眼压控制在13～21 mmHg.最佳矫正视力较手术前提高2～4行.结论 白内障行晶状体超声乳化摘出联合人工晶状体植入术是治疗急性闭角型青光跟的一种有效手术方式,特别是对于急性闭角型青光眼合并成熟期和近成熟期的白内障尤为适合.     

超声乳化联合房角粘连分离术治疗闭角型青光眼合并白内障

目的探讨超声乳化联合房角粘连分离术治疗闭角型青光眼合并白内障的临床效果。方法闭角型青光眼合并白内障53例（53眼）。进行超声乳化联合房角粘连分离术治疗,观察手术后视力、眼压、前房、视野和并发症情况。结果术后视力比术前显著提高。术后眼压正常。前房角增宽。结论超声乳化联合房角粘连分离术可有效解除原发性闭角型青光眼发病机制中晶状体因素所致的瞳孔阻滞,是治疗闭角型青光眼合并白内障一种有效方法。     

超乳治疗慢性闭角型青光眼临床观察

目的观察透明角膜切口晶状体超声乳化吸出联合人工晶状体植入治疗慢性闭角型青光眼合并白内障的疗效。方法原发性慢性闭角型青光眼20例(22眼),视力<0.1,晶状体不同程度浑浊,行晶状体超声乳化吸出联合人工晶状体植入术。结果术前用药后眼压(28.63±13.27)mmHg,术后为(15.42±3.86)mmHg(t=4.243,P<0.05);术后房角不同程度开放。结论透明角膜切口晶状体超声乳化吸出联合人工晶状体植入术可有效地治疗因晶状体阻滞合并白内障的慢性闭角型青光眼。     

原发性闭角型青光眼合并白内障超声乳化手术临床观察

目的:探讨原发性闭角型青光眼合并白内障超声乳化手术疗效。方法:原发性闭角型青光眼合并白内障32眼,其中急性期的28眼行白内障超声乳化手术;慢性期4眼行白内障超声乳化联合小梁切除术。结果:术后第1d,9眼出现角膜内皮线状皱折,5眼角膜基质轻度水肿、混浊,2～4d后消退,角膜恢复透明,房水炎症细胞＋～＋＋,经术后抗炎治疗1wk,前房炎症细胞消失;术后1wk随访,急性期的28眼,眼压均在10~20mmHg之间,慢性期4眼,眼压7~9mmHg。术后2wk随访,所有患者眼压均在10~20mmHg之间。所有患者术后视力均得到不同程度的提高。结论:超声乳化白内障吸除联合人工晶状体植入术,治疗原发性闭角型青光眼合并白内障是一种安全、有效、化繁为简的选择,避免了单纯青光眼术后再次行白内障手术的可能。     

原发性闭角型青光眼合并白内障的术式选择

目的:探讨原发性闭角型青光眼合并白内障的手术方式选择.方法:选取闭角型青光眼合并白内障患者90例96眼,根据房角粘连程度及病程长短,非随机选择施行超声乳化+人工晶状体植入术(Phaco+IOL)、超声乳化+人工晶状体植入联合虹膜周切手术(Phaco+ IOL+ PLI)、超声乳化+人工晶状体植入联合小梁切除术(Phacotrab+ IOL),观察手术前后的视力、眼压、前房轴深、滤过泡,随访时间为1 mo.结果:三种手术方式治疗青光眼合并白内障,术后视力均显著提高(P＜0.05)、眼压明显降低(P＜0.05),术后1wk;1 mo三组之间眼压比较无显著差异.结论:微切口透明角膜超声乳化及联合手术治疗青光眼手术是安全的.房角粘连＜90°可行超声乳化联合人工晶状体植入;90°＜房角粘连为＜180°行超声乳化联合人工晶状体植入+联合周边虹膜切除术;如果病程长且房角粘连＞180°,考虑行超声乳化联合人工晶状体植入+小梁切除术.     

超声乳化人工晶状体植入治疗原发闭角青光眼

目的　探讨晶状体超声乳化吸出联合后房人工晶状体植入术 ,治疗白内障合并原发性闭角型青光眼的疗效。方法　 2 0 0 1年 3月～ 2 0 0 2年 12月本院收治白内障合并原发性闭角型青光眼 2 7例。术前控制眼压 ,经视力检查、前房角镜和裂隙灯显微镜等检查后 ,均单独采用晶状体超声乳化吸出联合后房人工晶状体植入。结果　术后随访 6～ 18月。视力均较术前提高 ,视力 >0 .5者占 5 1 9%。 2 2例术后眼压 <18mmHg( 1mmHg =0 .13 3kPa) ,另 5例用一种降眼压药物眼压控制在 18mmHg以下。结论　超声乳化后房人工晶状体植入可有效地治疗合并白内障的原发性闭角型青光眼     

超声乳化白内障吸除人工晶状体植入术治疗原发性闭角型青光眼

目的探讨晶状体超声乳化吸除联合后房型人工晶状体植入术治疗白内障合并原发性闭角型青光眼的疗效。方法2002年2月～2004年3月本院收治白内障合并原发性闭角型青光眼34例（36只眼）。术前控制眼压,经视力检查、前房角镜和裂隙灯显微镜等检查后,均单独采用晶状体超声乳化吸除联合后房型人工晶状体植入术。术后随访1—12个月。结果32只眼视力较术前提高,视力〉0．5者占69．5％;33只眼术后眼压〈21mmHg（1mmHg=0．133kPa）,另3只眼用一种降眼压药物眼压控制在21mmHg以下;全部治疗眼前房加深,房角粘连范围减轻。结论超声乳化白内障吸除联合后房型人工晶状体植入术可有效地治疗合并白内障的原发性闭角型青光眼。     

Primary lens extraction for glaucoma management: A review article

Recently, primary lens extraction alone gained more acceptance as an alternative surgical approach for glaucoma management. This view was supported by the advances in phacoemulsification and intraocular lenses with greater safety and visual recovery, in addition to a substantial reduction of intraocular pressure and deepening of the anterior chamber and filtration angle. The decrease in IOP after cataract surgery in primary open-angle glaucoma (POAG) is mild, less predictable, related to baseline levels, and may return to presurgical values after an initial period of reduction. Therefore, the IOP-lowering effect of primary cataract extraction in POAG may be insufficient to achieve adequate IOP control. The IOP reduction after lens extraction is consistently greater in eyes with primary angle closure glaucoma (PACG) than in eyes with POAG. Primary lens extraction in acute PACG eliminates, or at least, reduces the risk of recurrence of acute attacks and deepens the anterior chamber and widens the angle which reduces the risk of progression of peripheral anterior synechiae and development of chronic PACG. Primary lens extraction may be more preferable to glaucoma incisional surgery in mild to moderate PACG eyes with appositional angle closure. The decision to do lens extraction as a primary treatment for glaucoma should be individualized based upon several factors other than the effect on IOP. These factors include patients’ characteristics, surgeons’ skills and preferences, status of glaucoma control, type of cataract and intraocular lens implanted, and potential harm of laser treatment for late capsular opacification and fibrosis.     

Uncontrolled primary angle closure glaucoma: results of early intercapsular cataract extraction and posterior chamber lens implantation

In this study we retrospectively evaluated the effect of intercapsular or extracapsular cataract extraction and posterior chamber lens implantation in 67 eyes of 57 patients with different types of primary angle closure glaucoma (PACG) in combination with cataract. We subdivided this patient population into three groups, based on the preoperative methods of intraocular pressure (IOP) control. The best results were obtained in patients with acute PACG (55% IOP reduction) and in patients with uncontrolled PACG (44% IOP reduction). In the other PACG groups an IOP reduction of between 20 and 33% was achieved. A long-term postoperative IOP of less than 21 mmHg was established in 63 eyes or 94%.In 91% the glaucoma medication was reduced, 65% of all eyes needed no glaucoma medication post-operatively.We conclude that an intercapsular cataract extraction with PC-IOL implantation should be considered in both controlled and uncontrolled PACG in patients with cataract, instead of filtering surgery or combined procedures.Even in eyes with relatively good visual acuity, cataract extraction might be considered as a means of achieving glaucoma control.     

There is insufficient evidence to recommend lens extraction as a treatment for primary open-angle glaucoma: an evidence-based perspective

Cataract extraction in primary open-angle glaucoma has not been thought to provide a clinically useful or predictable decrease in IOP. This concept has now been challenged, with the opposite belief being promulgated: namely, that lens exchange should be considered as treatment for glaucoma. This revelation could bring a significant change in the glaucoma treatment paradigm. There are no randomised controlled trials to guide the role of lens extraction in primary open-angle glaucoma. The available evidence suggests at most a modest reduction in IOP from cataract extraction - greater in the presence of pseudoexfoliation - which is likely to be of marginal benefit, and only in milder forms of open-angle glaucoma. There is currently no evidence of any quality to suggest that lens extraction routinely represents a clinically useful treatment for primary open-angle glaucoma.     

白内障超声乳化联合前房角成形术治疗原发性闭角型青光眼的疗效观察

目的:评价白内障超声乳化后房型人工晶状体植入联合前房角成形术治疗原发性闭角型青光眼(primary angle-closure glaucoma,PACG)合并白内障的临床疗效。方法:分析1998-01/2008-01在我科住院的PACG患者35例35眼,其中急性PACG28例,慢性PACG7例,均有不同程度的晶状体混浊,行白内障超声乳化后房型人工晶状体植入联合前房角成形术,随访6mo。结果:术后平均眼压14.6±2.3mmHg,比术前用药后眼压23.2±3.6mmHg明显降低,中央前房深度由术前的1.64±0.32mm,增加到术后的3.16±0.53mm,差异均有统计学意义(P<0.05)。术后32眼(91%)最佳矫正视力均有不同程度提高。结论:白内障超声乳化后房型人工晶状体植入联合前房角成形术,可有效治疗PACG合并白内障。     

晶状体手术在原发性闭角型青光眼治疗中的发展现状

晶状体因素在原发性闭角型青光眼(PACG)的发病机制中有着重要作用,浅前房、瞳孔阻滞和前房角拥挤等均与晶状体厚度、位置等参数改变有关。晶状体摘除术作为PACG的治疗手段由来已久,而白内障手术与传统青光眼手术的结合也是目前常用的治疗手段。本文就目前临床常用的超声乳化白内障吸除术(PE)及其与抗青光眼手术的联合应用对于PACG患者的治疗效果展开总结讨论,评价PE手术在PACG治疗中的地位。     

Increased aquaporin-1 levels in lens epithelial cells with primary angle-closure glaucoma

AIM: To determine the levels of aquaporin-1 (AQP-1) in the lens epithelial cells (LECs) of primary glaucoma and to clarify its correlation with lens thickness. METHODS: This study comprised 64 eyes of 64 patients with primary glaucoma, who were divided into 3 groups: 25 eyes of 25 patients with acute primary angle-closure glaucoma (APACG), 19 eyes of 19 patients with chronic primary angle-closure glaucoma (CPACG) and 20 eyes of 20 patients with primary open angle glaucoma (POAG). This study also included 12 eyes of 12 patients with senile cataract as controls. The levels of AQP-1 in LECs were examined by real-time quantitative polymerase chain reaction (RT-qPCR) and immunohistochemistry. The lens thickness was measured by A-scan ultrasonography. RESULTS: The AQP-1 mRNA levels of LECs were 0.84±0.27, 0.69±0.34, 0.44±0.19 and 0.51±0.21 in APACG, CPACG, POAG and senile cataract group, respectively. The levels of AQP-1m RNA were significantly higher in PACG groups compared with those in senile cataract and POAG group (all P<0.05). The immunohistochemistry showed the AQP-1 expression were strong-positive in PACG groups, but weak-positive in senile cataract and POAG group. A positive correlation was found between AQP-1 mRNA levels and the lens thickness (r=0.645, P<0.001). CONCLUSION: These findings show that the higher expression of AQP-1 in LECs may contribute to increased lens thickness, which might be associated with the occurrence and development of PACG.     

晶状体摘出术:降低眼压的新途径？

晶状体超声乳化摘出术治疗原发性闭角型青光眼（primary angle-closure glaucoma,PACG）可以有效加深前房,扩大房角,降低眼压（intraocular pressure,IOP）;研究表明晶状体摘出术对于原发性开角型青光眼（primary open-angle glaucoma,POAG）、剥脱性青光眼等也可以有效地降低IOP。关于透明晶状体摘出术作为PACG治疗的方式一直存在着过度医疗等争议,但随着研究的不断深入,透明晶状体摘出术的安全性和有效性逐渐被证实。     

超声乳化术治疗闭角型青光眼合并白内障的疗效

目的:评估超声乳化手术治疗原发性闭角型青光眼(primary angle-closure glaucoma,PACG)的临床效果及预后影响因素。方法:对合并PACG白内障的患者60例70眼,其中急性PACG43眼,慢性PACG27眼。采用超声乳化白内障摘出联合折叠式人工晶状体植入手术治疗,手术前后观察视力、眼压、房角镜检查、前房深度等。术后随访6mo。结果:手术前后比较:视力提高(P<0.05);平均眼压下降(P<0.01);房角不同程度开放(P<0.01);前房深度增加(P<0.01)。手术成功率:急性PACG组高于慢性PACG组,差异有统计学意义(P<0.05)。结论:超声乳化手术对急性PACG治疗效果优于慢性PACG,慢性期及慢性PACG治疗效果差。     

白内障手术对滤过术后的原发性闭角型青光眼前房深度和晶状体位置的影响

目的比较滤过术后晶状体混浊的原发性闭角型青光眼(PACG)与单纯老年性白内障患者超声乳化白内障吸出联合人工晶状体(IOL)植入术手术前后前房深度和晶状体位置的改变。设计比较性病例系列。研究对象小梁切除术后具有功能性滤过泡且未用药下眼压≤21 mm Hg的PACG患者16例(16眼)及年龄、性别匹配的单纯老年性白内障患者17例(17眼)。方法在超声乳化白内障吸出联合IOL植入术前及术后1周行眼前段相干光断层扫描(AS-OCT),比较PACG组和对照组手术前后的前房深度和晶状体位置参数。主要指标中央前房深度(ACD)、前房宽度(ACW)、晶状体厚度(LT)和晶状体矢高(CLR)。结果术前PACG组的ACD(1.74±0.33)mm较正常对照组(2.67±0.21)mm浅(t=-5.961,P=0.00),LT(5.38±0.44)mm和CLR(0.98±0.46)mm较正常对照组(分别为4.72±0.25 mm和0.51±0.17 mm)大(t=-3.707、3.028,P=0.00和0.04),两组间ACW比较无统计学差异(t=1.608,P=0.09);术后两组间的ACD(3.32±0.20 mm vs.3.65±0.40 mm)、ACW(11.12±0.42 mm vs.11.30±0.25 mm)和CLR(-0.60±0.14 mmvs.-0.56±0.29 mm)比较均无统计学差异(P均>0.05);手术后两组间ACD的平均增加值(1.58 mm vs.0.98 mm),CLR的平均减少值(1.58 mm vs.1.06 mm)有统计学差异(t=0.771、0.236,P=0.04、0.00)。结论滤过术后的PACG患者前房深度仍比正常人浅,晶状体较厚且位置靠前;行超声乳化吸出联合IOL植入术后可明显加深前房深度、改善前房拥挤的现象。     

Factors that influence intraocular pressure after cataract surgery in primary glaucoma

Objective: We sought to find predictive factors for favourable postoperative intraocular pressure (IOP) after cataract surgery in patients with primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG).Study Design: Retrospective evaluation of patients who had undergone cataract surgery.Participants: Forty-eight patients with POAG and 48 patients with PACG.Methods: Various clinical factors were evaluated retrospectively in 96 patients. All patients had undergone standard 2.75-3.5 mm limbal incision cataract surgery. Clinical parameters in patients with successful postoperative IOP courses were compared with those in unsuccessful patients. Success was defined as an IOP between 6 and 21 mm Hg, with fewer antiglaucoma medications needed compared with before surgery, and no need of additional glaucoma surgery.Results: In POAG, eyes with a highest preoperative IOP of <31 mm Hg or those being treated with <3 antiglaucoma medications before surgery had a significantly higher probability of success. In PACG, the probability of success was significantly higher if the highest preoperative IOP was <42 mm Hg, the number of antiglaucoma medications before surgery was <3, or the areas of peripheral anterior synechiae were <4 clock hours.Conclusions: Primary small-incision cataract surgery using phacoemulsification and foldable intraocular lens implantation may be the procedure of choice in patients with medically controlled glaucoma and coexisting visually significant cataracts, considering the highest preoperative IOP and number of antiglaucoma medications in POAG and PACG, and the area of peripheral anterior synechiae in PACG.