摘要
目的:探讨白内障超声乳化及前段玻璃体切除联合瞳孔成形术治疗急性闭角型青光眼的手术技巧及短期疗效。方法:回顾性分析因原发或继发急性闭角型青光眼所致瞳孔散大需行白内障手术患者11例(11只眼),瞳孔直径≥5 mm。白内障超声乳化及前段玻璃体切除术后行小切口单根缝线环瞳孔成形,分析其手术前后眼压、前房深度等眼前段解剖学参数变化及其相关性。结果:术后所有患者眼前段光学相干断层成像(optical coherence tomography,OCT)显示前房深度增加,房角开放可,瞳孔圆,无畏光、眩光、复视等。瞳孔直径术后[(2.76±0.21)mm]较术前[(6.20±0.67)mm]明显缩小,眼压术后[(19.15±5.71)mmHg]较术前[(31.95±17.62)mmHg]明显下降,最佳矫正视力(best corrected visual acuity,BCVA)术后(0.22±0.18)较术前(0.99±0.40)明显提高。术中并发症前房出血2只眼,一过性眼压高3只眼,术后早期前房炎症反应常见,行对症治疗后均恢复正常。结论:白内障超声乳化及前段玻璃体切除联合瞳孔成形术安全有效,能够确切地缩小瞳孔,稳定前房结构及协助开放房角,有利于术后眼压控制,改善畏光眩光、提高视觉质量,促进青光眼患者的眼压及视觉质量的康复。
Objective:To investigate the short-term outcome of phacoemulsification combined with anterior vitrectomy and pupilloplasty for the treatment of acute angle closure glaucoma.Methods:Retrospective analysis of 11 cases(11 eyes)of primary or secondary acute angle closure glaucoma patients,with dilated pupil(≥5 mm)and cataract,underwent phacoemulsification combined with anterior vitrectomy and single-suture-loop pupilloplasty,were involved in this study.In this iris cerclage suturing technique to correct atonic pupil in the pseudophakic eye,the pupil is sutured with a 10-0 polypropylene loop through three 1.0 mm stab incisions.The intraocular pressure and related ocular anatomy parameter change and its correlation were analyzed pre-and post-operatively.Results:All the cases had deepened anterior chamber and wider anterior chamber angle post-operatively.The technique created a pupil that is precisely sized and rather round.The postoperative diplopia,glare and polyopia due to larger pupil no more appeared.Post-operative pupil diameter was(2.76±0.21)mm which was significantly reduced than the pre-operative pupil diameter of(6.20±0.67)mm.Post-operative intraocular pressure was(19.15±5.71)mmHg which was significantly reduced than the pre-operative intraocular pressure of(31.95±17.62)mmHg.Post-operative best corrected visual acuity(BCVA)was(0.22±0.18)which was significantly reduced than the pre-operative BCVA of(0.99±0.40).Hyphema occurred in 2 eyes intraoperatively.Intraocular pressure increased post-operatively in 3 eyes.The inflammation of anterior chamber at the early postoperative period fully recovered after antiinflammatory treatment.Conclusion:Phacoemulsification combined with anterior vitrectomy and pupilloplasty provides a reasonably simple and safe way to correct a large pupil after acute angle closure glaucoma,further improve the angle opening,and help control the intraocular pressure.The surgery operation is relatively effective,with less complications.It is also benefit to relieve the symptoms as post-operative glare and photophobia,restoring the eye to a more natural and functional anatomic state for glaucoma patients.
作者
刘诗亮
常雪娇
陈志祺
周雄武
LIU Shi-liang;CHANG Xue-jiao;CHEN Zhi-qi;ZHOU Xiong-wu(Department of Ophthalmology,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,Hubei,China)
出处
《加速康复外科杂志》
2020年第3期105-110,共6页
JOURNAL OF ENHANCED RECOVERY AFTER SURGERY
