Trikha Sameer, Perera Shamira A, Husain Rahat, Aung Tin
aSingapore Eye Research Institute, Singapore National Eye Centre bDuke-NUS Graduate Medical School cDepartment of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Curr Opin Ophthalmol. 2015 Mar;26(2):128-34. doi: 10.1097/ICU.0000000000000128.
Lens extraction for primary angle-closure glaucoma (PACG) is a subject of increased interest recently, with advocates promoting its benefits of anatomical opening of the angle, intraocular pressure (IOP) reduction and improved vision. The present review seeks to evaluate recent available evidence to provide clarity on this potential intervention within the armamentarium of approaches for PACG.
The emergence of recent case-control studies, cohort studies and randomized controlled trials has provided a stronger evidence base to equip ophthalmic surgeons with the necessary information to utilize lens extraction in the management of PACG, and to consider whether this should be combined with trabeculectomy or goniosynechialysis. Imaging modalities such as anterior segment optical coherence tomography have yielded new insights into the mechanical features of the lens in angle closure, with the lens thickness and lens vault now quantifiable. A trend is emerging regarding the improvement in IOP control, reduced complication rates and reduced need for IOP-lowering medications in patients who undergo lens extraction for PACG. These issues are discussed, along with aspects of preoperative assessment and surgical techniques.
Good outcomes in terms of long-term IOP control have been found following lens extraction for PACG. Lens extraction should be considered in patients with PACG, especially with hyperopia, or a thick and anteriorly vaulted lens.
近期，原发性闭角型青光眼（PACG）的晶状体摘除术越来越受到关注，支持者们宣扬其在房角解剖性开放、降低眼压（IOP）及改善视力方面的益处。本综述旨在评估近期可得证据，以明确PACG治疗方法中这一潜在干预措施的情况。
近期病例对照研究、队列研究及随机对照试验的出现，为眼科医生提供了更有力的证据基础，使其具备在PACG治疗中运用晶状体摘除术所需的信息，并考虑是否应将其与小梁切除术或房角粘连分离术相结合。前段光学相干断层扫描等成像方式对闭角型青光眼晶状体的力学特征有了新的认识，现在晶状体厚度和晶状体拱高均可量化。对于接受PACG晶状体摘除术的患者，在眼压控制改善、并发症发生率降低以及降低降眼压药物需求方面正呈现出一种趋势。本文将讨论这些问题以及术前评估和手术技术等方面。
PACG晶状体摘除术后在长期眼压控制方面已取得良好效果。PACG患者，尤其是远视患者或晶状体厚且前拱的患者，应考虑进行晶状体摘除术。
