摘要目的 讨论分析白内障超声乳化联合房角分离术治疗原发性闭角型青光眼术后高眼压的原因,以及临床治疗策略.方法 前瞻性研究,对2013年1月至2014年12月在武汉爱尔眼科医院行白内障超声乳化联合房角分离术治疗原发性闭角型青光眼患者253例,共计266只眼,均常规行白内障超声乳化联合房角分离术,观察术前,术后1周,1月及6月不同时段眼压,观察术后22例高眼压患者最佳矫正视力,视野,房角形态,分析其病因及处理方法.结果 白内障超声乳化联合房角分离术后不同时段发生高眼压22只眼中,其中术后房角分离成功,房角始终开放,但眼压仍然升高者8例;术后房角暂时开放但再次关闭者8例;术后房角始终未能开放者6例.所有高眼压22例患者均通过相关对症处理,眼压再次控制正常,青光眼未见进展,视力及视野未见进一步明显损害.结论 以白内障超声乳化联合房角分离术治疗原发性闭角型青光眼需严格选择手术适应证,对于单纯性瞳孔阻滞性闭角型青光眼合并白内障患者施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安全有效;对于病史较长、青光眼进展严重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,则需权衡利弊,术后出现高眼压风险增高,需仔细分析其原因,采取对应的方案进行有针对性的治疗.

abstractsObjective To discuss the cause and clinical treatment of raised intraocular pressure after phacoemulsification combined with goniosychialysis for the treatment of Angle-Closure Glaucoma.Methods Prospective analysis of 253 primary angle closure glaucoma cases (266 eyes) after the treatment of phacoemulsification combined with goniosychialysis during January 2013 to December 2014 in our hospital,of which IOP,best corrected visual acuity,visual field,central anterior chamber depth,and the change of configuration about anterior chamber angle were observed preoperatively,1 week,1 month and 6 months after surgery.Results High intraocular pressure was observed in 22 cases during different periods after phacoemulsification combined with goniosychialysis,in which anterior chamber angles were successfully separated and remain open in 8 cases;anterior chamber angles were temporarily separated but soon closed again in 8 cases;and anterior chamber angles failed to open in 6 cases.All 22 patients with raised intraocular pressure were successfully controlled again,the visual acuity and visual field had no significant damage.Conclusions Phacoemulsification combined with goniosynechialysisis is an effective method for the pure pupillary block angle closure glaucoma,but for non pupillary block angle closure glaucoma and multiple mechanism angle closure glaucoma with long course of disease,there are higher risk of postoperatively raised intraocular pressure.We should carefully analyze the reason,and take the corresponding solution for treatment.