Gunning F P, Greve E L
J Cataract Refract Surg. 1998 Oct;24(10):1347-56. doi: 10.1016/s0886-3350(98)80227-7.
To evaluate the long-term effects of extraction of incipient cataracts or clear lenses on glaucoma control in patients with subacute or chronic angle-closure glaucoma.
Department of Ophthalmology, University of Amsterdam, The Netherlands.
This retrospective analysis comprised 22 extracapsular lens extractions with implantation of a posterior chamber intraocular lens in 18 patients with chronic or subacute angle-closure glaucoma (Group 1). The effect of glaucoma control was evaluated using visual field examination, diurnal intraocular pressure (IOP) curves, gonioscopic appearance, and number of antiglaucoma medications. The results were compared with those in 25 eyes of 19 patients with chronic angle-closure glaucoma in whom a filtering procedure was performed (Group 2).
Glaucoma control was achieved in 15 eyes (68%) in Group 1 and in 17 eyes (68%) in Group 2. Mean preoperative IOP was 27.9 mm Hg +/- 8.1 (SD) and 29.0 +/- 7.7 mm Hg, respectively. Mean postoperative IOP was 17.1 +/- 2.9 mm Hg (Group 1) and 14.8 +/- 6.6 mm Hg (Group 2) after a mean follow-up of 52.6 and 58.9 months, respectively. Mean number of ocular hypotensive medications preoperatively was 2.3 +/- 0.8 in Group 1 and 2.2 +/- 0.8 in Group 2 and at last follow-up, 1.3 +/- 0.7 and 0.52 +/- 0.8, respectively. Twenty eyes (91%) in Group 1 had the same or better final visual acuity than before surgery. In Group 2, the final visual acuity was unchanged or better in 13 eyes (52%) and worse in 12 eyes (48%); subsequent cataract surgery was performed in 9 (75%) of these 12 eyes. Additional incisional surgery was done or recommended in 6 eyes (27%) in Group 1 and 20 eyes in Group 2 (80%).
Drainage surgery in patients with angle-closure glaucoma proved to be associated with multiple surgical interventions and deterioration in visual function. The choice of first a cataract procedure with the option of a future trabeculectomy may be a more attractive approach in patients with subacute or chronic angle-closure glaucoma than trabeculectomy followed by an optional cataract procedure.
评估摘除早期白内障或透明晶状体对亚急性或慢性闭角型青光眼患者眼压控制的长期效果。
荷兰阿姆斯特丹大学眼科。
这项回顾性分析纳入了18例慢性或亚急性闭角型青光眼患者，共进行了22次囊外晶状体摘除联合后房型人工晶状体植入术（第1组）。通过视野检查、昼夜眼压（IOP）曲线、前房角镜检查结果和抗青光眼药物数量评估眼压控制效果。将结果与19例慢性闭角型青光眼患者的25只接受滤过手术的眼睛（第2组）进行比较。
第1组15只眼（68%）眼压得到控制，第2组17只眼（68%）眼压得到控制。术前平均眼压分别为27.9 mmHg±8.1（标准差）和29.0±7.7 mmHg。平均随访52.6个月和58.9个月后，第1组术后平均眼压为17.1±2.9 mmHg，第2组为14.8±6.6 mmHg。第1组术前平均降眼压药物数量为2.3±0.8，第2组为2.2±0.8；末次随访时，分别为1.3±0.7和0.52±0.8。第1组20只眼（91%）最终视力与手术前相同或更好。第2组中，13只眼（52%）最终视力未变或更好，12只眼（48%）更差；这12只眼中9只（75%）随后进行了白内障手术。第1组6只眼（27%）进行了或建议进行额外的切口手术，第2组20只眼（80%）进行了额外的切口手术。
闭角型青光眼患者的引流手术与多次手术干预和视功能恶化相关。对于亚急性或慢性闭角型青光眼患者，先选择白内障手术并保留未来小梁切除术的选择可能比先进行小梁切除术再选择白内障手术更具吸引力。
