Chinese Medical Sciences Journal ›› 2022, Vol. 37 ›› Issue (2): 127-133.doi: 10.24920/003902

• 论著 • 上一篇    下一篇

超声乳化白内障摘除、人工晶状体植入、房角分离联合假瞳孔成形治疗伴有瞳孔散大固定的难治性急性闭角型青光眼

王尔茜,卞爱玲,张扬,张顺华*()   

  1. 中国医学科学院 北京协和医院眼科,北京 100730
  • 收稿日期:2021-03-23 接受日期:2022-03-10 出版日期:2022-06-30 发布日期:2022-07-07
  • 通讯作者: 张顺华 E-mail:zhangshh@pumch.cn

Phacoemulsification, Intraocular Lens Implantation, Goniosynechialysis, and Pseudo-Pupilloplasty for Refractory Acute Primary Angle Closure with Atonic Dilated Pupil

Erqian Wang,Ailing Bian,Yang Zhang,Shunhua Zhang*()   

  1. Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
  • Received:2021-03-23 Accepted:2022-03-10 Published:2022-06-30 Online:2022-07-07
  • Contact: Shunhua Zhang E-mail:zhangshh@pumch.cn

摘要:

目的 评估超声乳化白内障摘除、人工晶状体植入、房角分离联合假瞳孔成形治疗伴有瞳孔散大固定的难治性急性闭角型青光眼的有效性及安全性。
方法 我们开展的此项回顾性系列病例研究,共纳入经药物及激光治疗后眼压仍不能控制的伴有瞳孔散大固定的急性闭角型青光眼患者,所有患眼行超声乳化白内障摘除、人工晶状体植入、房角分离联合假瞳孔成形。假瞳孔成形是指制作直径4.5 mm的居中连续环形撕囊,使之因术后前囊膜机化逐渐成为假瞳孔。记录所有患眼术前及术后眼压、最佳矫正视力、前房深度,记录术中和术后并发症情况。
结果 共纳入19名患者的20只患眼,随访19.7 ± 9.8月。术前眼压44.0 ± 9.8 mmHg,术后眼压下降,末次随访时眼压为15.5 ± 2.6 mmHg (P < 0.0001)。术前前房深度1.77 ± 0.21 mm,术后前房加深,末次随访时前房深度为3.40 ± 0.20 mm (P < 0.0001)。20只眼中有12只眼存在残余房角粘连,但其中仅有3只眼需要抗青光眼药物控制眼压。术前最佳矫正视力为1.18 ± 0.55,在术后逐渐提升,术后1天、1个月、3个月和末次随访时,最佳矫正视力分别为0.58 ± 0.22,0.26±0.09,0.11±0.09和0.11±0.09。所有眼均在术后3个月内逐渐形成假瞳孔。未观察到术中和术后并发症。
结论 对于常规药物和激光不能控制眼压的合并瞳孔散大固定的急性闭角型青光眼,超声乳化白内障摘除、人工晶状体植入、房角分离联合假瞳孔成形手术是可行的手术方法。除了能分离房角、长期控制眼压外,随假瞳孔形成,视功能也能获得逐步提高。

关键词: 抗生素预防, 白内障摘除术, 眼睑清洁, 微生物群

Abstract:

Objective To evaluate the efficacy and safety of prompt phacoemulsification, intraocular lens implantation, visco-goniosynechialysis, combined with pseudo-pupilloplasty for refractory acute primary angle closure (APAC) with atonic dilated pupil and to describe a feasible method of pupilloplasty.
Methods A consecutive series of refractory APAC patients who had atonic dilated pupil and undergone prompt phacoemulsification combined with pseudo-pupilloplasty at our center were retrospectively analyzed. Pseudo-pupilloplasty referred to a method of pupilloplasty which included 4.5-mm capsulorhexis, postoperative opacification of anterior capsule residue, and ultimate pseudo-pupil formation. Preoperative and postoperative measurements included intraocular pressure (IOP), best corrected visual acuity (BCVA), and anterior chamber depth (ACD). Intraoperative and postoperative complications were documented. The process of pseudo-pupil formation was also observed.
Results A total of 20 eyes of 19 APAC patients were followed up for 19.7 ± 9.8 months. IOP was lowered from preoperative 44.0 ± 9.8 mmHg to 15.5 ± 2.6 mmHg at final visit (t=11.945, P< 0.001). ACD was deepened from preoperative 1.77 ± 0.21 mm to 3.40 ± 0.20 mm at final visit (t=-27.711, P< 0.001). Twelve of 20 eyes had residual angle synechiae, whereas only 3 eyes needed anti-glaucoma medications. No severe complication was observed. All eyes had pseudo-pupil gradually formed within 3 months, accompanied with the gradual improvement of BCVA from preoperative 1.18 ± 0.55 to 0.58 ± 0.22, 0.26 ± 0.09, 0.11 ± 0.09, and 0.11 ± 0.09 at postoperative day 1, month 1, month 3, and last visit.
Conclusions Prompt phacoemulsification-goniosynechialysis is effective and safe for refractory APAC with atonic dilated pupil. Pseudo-pupilloplasty is a feasible procedure for pupil reconstruction.

Key words: acute primary angle closure, phacoemulsification, pupilloplasty

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