University Eye Clinic Maastricht, Maastricht University Medical Center+, Maastricht.
Canisius Wilhelmina Ziekenhuis, Nijmegen, The Netherlands.
J Glaucoma. 2018 Aug;27(8):711-716. doi: 10.1097/IJG.0000000000000998.
The purpose of this study is to evaluate the effect of early phacoemulsification on the management of acute angle closure glaucoma in patients with coexisting cataract after initial treatment with medical therapy and laser peripheral iridotomy.
This study involved a retrospective analysis of patients presenting to the Maastricht University Medical Center+ with acute angle closure and coexisting cataract between 2005 and 2015. Patients were included after initial treatment with a standard protocol comprising topical and systemic medical therapy and laser peripheral iridotomy. Patients underwent small-incision phacoemulsification with intraocular lens implantation into the capsular bag by experienced surgeons within 3 months of the acute angle closure episode. The effect on intraocular pressure, number of glaucoma medications, visual acuity, and complications was assessed.
A total 35 patients were included in the study (mean age, 71±10 y; 20% male; mean refractive error, +1.6±1.8 diopters). The mean duration between acute angle closure episode and phacoemulsification was 37±22 days. There were no complications. Intraocular pressure decreased in all patients from 17.0±8.2 mm Hg to 13.2±3.9 mm Hg after 3 months (P=0.008), whereas the mean number of glaucoma medications decreased from 2.9±1.1 to 0.7±0.9 (P<0.001), with 56% of patients discontinuing all medications. Visual acuity improved from 0.9±0.9 logMAR to 0.2±0.3 logMAR (P<0.001).
Early phacoemulsification with intraocular lens implantation results in a reduced intraocular pressure and number of glaucoma medications after an acute angle closure glaucoma crisis in patients with coexisting cataract. Although surgery may be challenging, the results are promising, with significant improvement in visual acuity in most patients.
本研究旨在评估在初始药物治疗和激光周边虹膜切开术治疗后，对伴有白内障的急性闭角型青光眼患者进行早期超声乳化白内障吸除术对其治疗的影响。
本研究为回顾性分析，纳入了 2005 年至 2015 年间在马斯特里赫特大学医学中心就诊的急性闭角型青光眼合并白内障患者。所有患者均在初始标准治疗方案（包括局部和全身药物治疗以及激光周边虹膜切开术）后出现急性闭角型青光眼发作。在急性闭角型青光眼发作后 3 个月内，由经验丰富的外科医生进行小切口超声乳化白内障吸除术并植入囊袋内人工晶状体。评估眼压、青光眼药物使用数量、视力和并发症的影响。
本研究共纳入 35 例患者（平均年龄 71±10 岁；20%为男性；平均屈光度+1.6±1.8 屈光度）。急性闭角型青光眼发作与超声乳化白内障吸除术之间的平均时间间隔为 37±22 天。所有患者均无并发症。术后 3 个月，所有患者的眼压从 17.0±8.2 mmHg 降至 13.2±3.9 mmHg（P=0.008），青光眼药物使用数量从 2.9±1.1 降至 0.7±0.9（P<0.001），56%的患者停止使用所有药物。视力从 0.9±0.9 logMAR 提高至 0.2±0.3 logMAR（P<0.001）。
对于伴有白内障的急性闭角型青光眼患者，在急性闭角型青光眼发作后进行早期超声乳化白内障吸除术和人工晶状体植入术可降低眼压和青光眼药物使用数量。尽管手术可能具有挑战性，但结果是有希望的，大多数患者的视力显著提高。
