Dias-Santos Arnaldo, Ferreira Joana, Abegão Pinto Luís, Domingues Isabel, Silva José Pedro, Cunha João Paulo, Reina Maria
Department of Ophthalmology, Central Lisbon Hospital Center, Lisbon, Portugal,
Int Ophthalmol. 2015 Apr;35(2):173-8. doi: 10.1007/s10792-014-9926-8. Epub 2014 Apr 12.
Primary angle closure occurs as a result of crowded anterior segment anatomy, causing appositional contact between the peripheral iris and trabecular meshwork, thereby obstructing aqueous outflow. Several studies highlight the role of the crystalline lens in its pathogenesis. The objective of this work is to compare the long-term efficacy of phacoemulsification versus laser peripheral iridotomy (LPI) in the management of chronic primary angle closure (CPAC). Prospective case-control study with 30 eyes of 30 patients randomly divided in two groups: 15 eyes in the LPI group and 15 eyes in the IOL group. Patients in the LPI group underwent LPI using argon and Nd:YAG laser. Patients in the IOL group underwent phacoemulsification with posterior chamber intraocular lens (IOL) implantation. Examinations before and after the procedure included gonioscopy, Goldmann applanation tonometry, and anterior chamber evaluation using the Pentacam rotating Scheimpflug camera. The mean follow-up time was 31.13 ± 4.97 months. There was a statistically significant reduction in the intraocular pressure (IOP) and number of anti-glaucoma medications (p < 0.01) only in the IOL group. Anterior chamber depth, angle, and volume were all higher in the IOL group (p < 0.01) at the end of the follow-up period. Phacoemulsification with posterior chamber IOL implantation results in a higher anterior chamber depth, angle, and volume, when compared to LPI. Consequently, phacoemulsification has greater efficacy in lowering IOP and preventing its long-term increase in patients with CPAC and cataract.
原发性房角关闭是由于眼前节解剖结构拥挤，导致周边虹膜与小梁网发生贴附性接触，从而阻碍房水流出。多项研究强调了晶状体在其发病机制中的作用。本研究的目的是比较超声乳化术与激光周边虹膜切开术（LPI）在慢性原发性房角关闭（CPAC）治疗中的长期疗效。对30例患者的30只眼进行前瞻性病例对照研究，随机分为两组：LPI组15只眼，人工晶状体（IOL）组15只眼。LPI组患者使用氩激光和钕：钇铝石榴石激光进行LPI。IOL组患者接受超声乳化联合后房型人工晶状体植入术。手术前后的检查包括前房角镜检查、Goldmann压平眼压测量以及使用Pentacam旋转式Scheimpflug相机进行前房评估。平均随访时间为31.13±4.97个月。仅IOL组的眼压（IOP）和抗青光眼药物数量有统计学意义的降低（p<0.01）。随访期末，IOL组的前房深度、房角和容积均更高（p<0.01）。与LPI相比，后房型人工晶状体植入的超声乳化术可导致更高的前房深度、房角和容积。因此，超声乳化术在降低CPAC合并白内障患者的眼压及预防眼压长期升高方面具有更大的疗效。
