超声乳化+iol治疗急闭青合并白内障的临床观察.ppt

超声乳化白内障吸除折叠式人工晶状体植入治疗闭角型青光眼合并白内障的临床观察Clinicalstudyonthemanagementofangle-closureglaucomawithcataractbyphacoemulsificationwithfoldableposteriorchamberintraocularlensimplantation,一、目的（OBJECTIVE）观察颞侧角巩膜缘隧道切口超声乳化白内障吸除联合后房型折叠式人工晶状体植入术治疗合并白内障的急性或慢性闭角型青光眼的疗效。,Toinvestigatetheclinicalresultsofphacoemulsificationwithfoldableposteriorchamberintraocularlens(PC-IOL)implantationinthemanagementofacuteorchronicangle-closureglaucomawithcataract.,二、病例资料（PATIENTSDATA）,2001年9月2003年4月收住本院的33例(52只眼)原发性闭角型青光眼合并白内障患者男18例，女15例年龄4279岁，平均年龄57.328.64岁,FromSeptemberof2001toAprilof200333cases(52eyes)withprimaryangle-closureglaucomaandcataractwereprospectivlystudied.18men，15womenAgeswerefrom42to79，averageagewas57.328.64,1、原发性急性闭角型青光眼组（24眼）术前眼压1754mmHg，平均眼压27.6910.42mmHg周围前房深度0.280.04CK平均远视力0.20.1平均用降眼压药1.7种,1、Primaryacuteangle-closureglaucoma（24eyes）PreoperativeIOPwas1754mmHg，meanIOPwas27.6910.42mmHgMeanlimbicanteriorchamberdepthwas0.280.04CKMeanvisualacuitywas0.20.1Meandrugswas1.7types,2、原发性慢性闭角型青光眼组（28眼）术前眼压1120mmHg，平均眼压16.392.50mmHg周围前房深度0.450.08CK平均远视力0.30.2平均用降眼压药0.8种,2、Primarychronicangle-closureglaucoma（28eyes）PreoperativeIOPwas1120mmHg，meanIOPwas16.392.50mmHgMeanlimbicanteriorchamberdepthwas0.450.08CKMeanvisualacuitywas0.30.2MeandrugstocontrolIOPwas0.8types,三、方法（METHODS）,患者入院后均行角巩膜缘隧道切口超声乳化白内障吸除联合后房型折叠式人工晶状体植入术。AllthepatientswereundergonethePhacoemulsificationwithPC-IOLimplantationthroughtemporalcorneallimbustunnels.,四、结果（RESULTS）,原发性急性闭角型青光眼组术后平均眼压13.132.33mmHg周围前房深度0.660.13CK,Primaryacuteangle-closureglaucomapatientsPostoperativemeanIOPwas13.132.33mmHgMeanlimbicanteriorchamberdepthwas0.660.13CK,术后半年平均远视力为0.50.24眼术后用一种药物控制眼压可达21mmHg以下，其余不需用药物控制眼压即正常,平均用降眼压药0.17种,Meanvisualacuitywas0.50.2halfayearafteroperationOnly4eyesneedsonedrugeachtocontrolIOPbelow21mmHgandtheotherswerenormalwithoutanydrug,meandrugsusedtocontrolIOPwas0.17types,原发性急性闭角型青光眼组术前术后眼压与周围前房深度比较,mmHg,CK,原发性急性闭角型青光眼组术前术后视力与平均用降眼压药物的比较,原发性慢性闭角型青光眼组术后平均眼压11.641.25mmHg周围前房深度0.850.15CK,Primarychronicangle-closureglaucomapatientsPostoperativemeanIOPwas11.641.25mmHgMeanlimbicanteriorchamberdepthwas0.850.15CK,术后半年平均远视力为0.50.32眼术后用一种药物控制眼压可达21mmHg以下，其余不需用药物控制眼压即正常,平均用降眼压药0.07种,Meanvisualacuitywas0.50.3halfayearafteroperationOnly2eyesneedsonedrugeachtocontrolIOPbelow21mmHgandtheotherswerenormalwithoutanydrug,meandrugsusedtocontrolIOPwas0.07types,原发性慢性闭角型青光眼组术前术后眼压与周围前房深度比较,mmHg,CK,原发性慢性闭角型青光眼组术前术后视力与平均用降眼压药物的比较,术后并发症,术后1天：角膜轻度水肿13例（25）前房闪辉轻度39例（75），中度10例（19.2）术后1周：以上表现全部消失。所有术眼人工晶状体均在位，未出现偏位、夹持。,Complicationsafteroperation,Thedayafteroperation：mildcorneaedema13eyes（25）Tyn(+):39eyes（75）mildly，10eyes（19.2）seriously1weekafteroperation：allaboveweredisappearedAllIOLswerestableinthecentricarea,五、讨论（DISCUSSION),眼前段空间狭窄,晶状体较厚且位置靠前,晶状体虹膜膈前移,虹膜背面与前囊紧密相贴,瞳孔阻滞,虹膜根部被推向小梁网,前房变浅,房角变窄、闭合,眼压升高,白内障超声乳化手术,晶状体有形成分吸出,提供虹膜后退的空间,降低眼压,术中前房压力升高,机械性使房角开放,超声作用,减少房水分泌,解除瞳孔阻滞,经颞侧角巩膜缘切口优点,将12点方位的角巩膜缘留出，为将来眼压控制不理想时再行滤过手术留有足够的空间避免了经透明角膜切口导致的术后散光、角膜炎症反应重等不良后果,Advantagesoftemporalcorneallimbustunnels,Reservethe12oclockcorneallimbustunnelsforthefilteringoperationsifneededinthefutureAvoidsomeseverecomplicationsafteroperationthroughthecorneasuchasastigmatismandkeratitis,六、小结（SUMMARY）,颞侧角巩膜缘隧道切口超声乳化白内障吸除联合后房型折叠式人工晶状体植入术治疗合并白内障的急性或慢性闭角型青光眼可以降低眼压加深前房提高视力减少用药,Phacoemulsificationwithposteriorchamberfoldableintraocularlensimplantat