超声乳化白内障吸除人工晶状体植入治疗闭角型青光眼
|
摘要
目的:
观察超声乳化白内障吸除联合人工晶状体植入术治疗合并白内障的原发性急、慢性闭角型青光眼的疗效和安全性。
对象与方法:
1.研究方法:术式选择:单纯白内障经上方巩膜隧道切口行超声乳化+囊袋内人工晶状体植入术;闭角型青光眼经颞上方透明角膜切口行超声乳化+囊袋内人工晶状体植入术。观察项目:观察术前术后视力、眼压、房角开放情况、周边前房深度、中央前房深度(anterior chamber depth,ACD)、与眼轴长度(total length,TL)比、术后用药情况及并发症。随访时间为3～24个月,平均(8.5士4.5)个月。
2.前瞻性临床研究,病例选择:研究组:原发性闭角型青光眼合并老年性白内障患者,年龄50～80岁,视力手动眼前～0.8,无眼部其它病变及眼部手术史。对照组:单纯老年性白内障患者。按研究设计方案随机连续性选择2005年1月至2006年12月收住本院的非青光眼的单纯白内障26例(28眼),原发性闭角型青光眼60例(70眼),其中急性闭角型青光眼(以下简称急闭)29眼,慢性闭角型青光眼(以下简称慢闭)27眼。
3.统计学分析:采用SPSS11.0统计软件进行数据处理。
结果:
1.眼压控制成功率:急闭组(n=43)完全成功95.3%,条件成功4.7%;慢闭组(n=27)完全成功77.8%,条件成功14.8%,手术失败7.4%。
2.眼压及青光眼用药:单纯白内障组(n=28)手术前平均眼压(13.59士4.03)mmHg,术后平均眼压(12.76士3.73)mmHg,术前术后无显著差异(t=1.9201,P>0.05)。急闭临床前期组(n=14)术前平均眼压11.77士1.89mmHg,比术后平均眼压10.44士1.66mmHg下降(t=3.9910,P<0.01)。急闭发作期组(n=29)手术前平均眼压(19.78士9.73)mmHg,比术后平均眼压(10.97士2.31)mmHg明显下降(t=4.7441,P<0.001)。慢闭组(n=27)术前平均眼压(19.94士4.14)mmHg,比术后平均眼压(15.07士3.81)mmHg下降(t=4.4976, P<0.01)。急闭组手术后眼压低于慢闭组,术前术后变化更加显著。
急闭组手术前平均使用青光眼药物(1.08士1.13)种,比手术后平均用药(0.08士0.28)种明显减少(t=4.6257, P<0.001)。慢闭组手术前平均使用青光眼药物(1.36士0.70)种,比手术后平均用药(0.12士0.41)明显减少(t=7.9425, P<0.001)。
3.房角开放率及粘连程度:急、慢闭组术后前房角均较术前增宽(急闭组χ2=51.3333, P<0.001;慢闭组χ2=34.9091, P<0.001)。
4.中央及周边前房深度:急闭组中央前房深度术前为(2.07士0.23)mm,术后增加到(3.62士0.36)mm(t=8.8408,P<0.001);慢闭组术前为(2.36士0.36) mm,术后增加到(4.03士0.46)mm(t=6.632 ,P<0.001)。急闭组ACD/TL术前为(0.093+0.009),术后增加为(0.159+0.012)(t=10.8306 ,P<0.001);慢闭组ACD/TL术前为(0.104+0.015),术后增加为(0.179+0.009)(t=5.9432 ,P<0.001)。
急闭、慢闭两组手术后周边前房深度均较手术前增加(急闭χ2=58.0000,P<0.001;慢闭χ2=54.0000, P<0.001)。
5.视力: 56眼原发性闭角型青光眼术后48眼(85.7%)最佳矫正视力提高,28眼(50.0%)矫正视力>0. 5。术后8眼(14.3%)矫正视力不提高。两组手术后视力较手术前均增加,差异有显著性意义(Willcoxon符号秩检验,P<0.05)。
6.并发症:全部患者术中均未发生后囊膜破裂,术后炎症反应轻,术后有19眼(15.1%)发生轻度角膜内皮水肿,术后全部患者均未出现角膜内皮失代偿、视网膜脱离等严重并发症。
结论:
超声乳化白内障吸除联合人工晶状体植入术对合并白内障的闭角型青光眼患者的眼压、房角、前房深度以及视功能等方面都产生有益的影响。该术对单纯白内障术后眼压无影响,对急闭临床前期产生降低眼压作用。由于急、慢性闭角型青光眼患者术后的眼压、房角及用药情况不同,超声乳化白内障吸除治疗急性闭角型青光眼的疗效优于慢性闭角型青光眼。
Objective:
To study the clinical results and safety of phacoemulsification with foldable posterior chamber intraocular lens (PC-IOL) implantation in the management of acute or chronic primary angle-closure glaucoma(APACG or CPACG) with cataract.
Patients and methods:
1.Research methods: Through tunnel incision phacoemulsification and posterior intraocular lens implantation (Phaco+IOL) in eye with simple cataract. Through corneal incision phacoemulsification and intraocular lens implantation in eye with primary angle-closure glaucoma.Preoperative and postoperative visual acuity、intraocular pressure(IOP)、the rate of open-angle、depth of anterior chamber(ACD)、total length of the eye(TL)、antiglaucoma medications and complications were observed. Postoperative time of following up was 3～24 months, average(8.5±4.5) months.
2.Cases: Research group: Prospective clinical trial and consecutive case series. 26 cases(28 eyes) with simple cataract, 60 cases(70 eyes) primary angle-closure glaucoma with cataract ,including 29 eyes with acute primary angle-closure glaucoma, 27 eyes with chronic primary angle-closure glaucoma were randomly choosed from January 2005 to December 2006. visual acuity distribute from hand movement to 0.8,age from 50 to 80,without other eye diseases or ocular surgery. Comparison group: patients of homologous age and visual acuity with simple age related cataract.
3.Statistic analysis: Data was evaluated by SSPS 11.0 statistic software.
Results:
1.The success probabilities assessed with postoperative IOP level: The total success probability was 95.3%; the partial success probability was 4.7% in the group of APACG .The total success probability was 77.8%; the partial success probability was 14.8%;the failure probability was 7.4% in the group of CPACG .
2.IOP and antiglaucoma medication: In simple cataract group (n=56), preoperative IOP was (13.59±4.03)mmHg; postoperative IOP was (12.76±3.73)mmHg(t=1.9201,P>0.05); In preclinical stage of APACG group (n=14), preoperative IOP was (11.77±1.89) mmHg; postoperative IOP was (10.44±1.66)mmHg(t=3.9910,P<0.01);In period of onset of APACG group(n=29),preoperative IOP was (19.78±9.73)mmHg; postoperative IOP was (10.97±2.31)mmHg(t=4.7441,P<0.001); In CPACG group(n=27),preoperative IOP was (19.94±4.14)mmHg; postoperative IOP was (15.07±3.81)mmHg(t=4.4976, P<0.01).Postoperative IOP of APACG was lower than that of CPACG.
In APACG group preoperative antiglaucoma medication was (1.08±1.13); postoperative antiglaucoma medication was (0.08±0.28)(t=4.6257, P<0.001); In CPACG group preoperative antiglaucoma medication was (1.36±0.70); postoperative antiglaucoma medication was (0.12±0.41)(t=7.9425, P<0.001).
3.The rate of open-angle and the extent of synechiae: In primary acute or chronic angle-closure glaucoma group, angle of anterior chamber was widen, In APACG group,χ2 = 51.3333, P<0.001; In CPACG group,χ2 =34.9091, P<0.001.
4.The central and peripheral depth of the anterior chamber: In APACG group, preoperative depth of the anterior chamber (ACD) was (2.07±0.23)mm; postoperative ACD was (3.62±0.36)mm; (t=8.8408,P<0.001). preoperative ACD/ TL was (0.093+0.009)mm; postoperative ACD /TL was (0.159+0.0126)mm(t=8.8408,P<0.001) .In CPACG group, preoperative ACD was (2.36±0.36)mm; postoperative ACD was (4.03±0.46)mm(t=6.632 ,P<0.001). Preoperative ACD/TL was (0.104+0.015), postoperative ACD /TL was (0.179±0.009)(t=5.9432,P<0.001).
Preoperative limbic ACD of APACG and CPACG was much less than that of postoperative (APACGχ2=58.0000, P<0.001;CPACGχ2=54.0000, P<0.001).
5.Visual acuity: In 56 eyes of PACG, corrected visual acuity of 48 eyes(85.7%) in raised postoperatively; corrected visual acuity of 28 eyes(50%)>0.5. 8 eyes(14.3%) did not raise. Both of acute and chronic primary angle-closure glaucoma group, visual acuity raised Preoperatively(P<0.05).
6.Complications: There is no rupture of posterior capsule membrane during the operation, and the postoperative inflammatory reactions was low. The serious postoperative complications ,such as corneal endothelial decompens and retinal detachment were not discovered.
Conclusions:
That the phacoemulsification with foldable posterior chamber intraocular lens implantation was benefit to IOP, chamber angle, depth of anterior chamber and visual function for primary angle-closure glaucoma with cataract. IOP of simple cataract was not affected, but IOP of preclinical stage of APACG was lowered by phacoemulsification.
Moreover, the surgical curative effect of acute angle-closure glaucoma was better than that of chronic angle-closure glaucoma.
观察超声乳化白内障吸除联合人工晶状体植入术治疗合并白内障的原发性急、慢性闭角型青光眼的疗效和安全性。
对象与方法:
1.研究方法:术式选择:单纯白内障经上方巩膜隧道切口行超声乳化+囊袋内人工晶状体植入术;闭角型青光眼经颞上方透明角膜切口行超声乳化+囊袋内人工晶状体植入术。观察项目:观察术前术后视力、眼压、房角开放情况、周边前房深度、中央前房深度(anterior chamber depth,ACD)、与眼轴长度(total length,TL)比、术后用药情况及并发症。随访时间为3～24个月,平均(8.5士4.5)个月。
2.前瞻性临床研究,病例选择:研究组:原发性闭角型青光眼合并老年性白内障患者,年龄50～80岁,视力手动眼前～0.8,无眼部其它病变及眼部手术史。对照组:单纯老年性白内障患者。按研究设计方案随机连续性选择2005年1月至2006年12月收住本院的非青光眼的单纯白内障26例(28眼),原发性闭角型青光眼60例(70眼),其中急性闭角型青光眼(以下简称急闭)29眼,慢性闭角型青光眼(以下简称慢闭)27眼。
3.统计学分析:采用SPSS11.0统计软件进行数据处理。
结果:
1.眼压控制成功率:急闭组(n=43)完全成功95.3%,条件成功4.7%;慢闭组(n=27)完全成功77.8%,条件成功14.8%,手术失败7.4%。
2.眼压及青光眼用药:单纯白内障组(n=28)手术前平均眼压(13.59士4.03)mmHg,术后平均眼压(12.76士3.73)mmHg,术前术后无显著差异(t=1.9201,P>0.05)。急闭临床前期组(n=14)术前平均眼压11.77士1.89mmHg,比术后平均眼压10.44士1.66mmHg下降(t=3.9910,P<0.01)。急闭发作期组(n=29)手术前平均眼压(19.78士9.73)mmHg,比术后平均眼压(10.97士2.31)mmHg明显下降(t=4.7441,P<0.001)。慢闭组(n=27)术前平均眼压(19.94士4.14)mmHg,比术后平均眼压(15.07士3.81)mmHg下降(t=4.4976, P<0.01)。急闭组手术后眼压低于慢闭组,术前术后变化更加显著。
急闭组手术前平均使用青光眼药物(1.08士1.13)种,比手术后平均用药(0.08士0.28)种明显减少(t=4.6257, P<0.001)。慢闭组手术前平均使用青光眼药物(1.36士0.70)种,比手术后平均用药(0.12士0.41)明显减少(t=7.9425, P<0.001)。
3.房角开放率及粘连程度:急、慢闭组术后前房角均较术前增宽(急闭组χ2=51.3333, P<0.001;慢闭组χ2=34.9091, P<0.001)。
4.中央及周边前房深度:急闭组中央前房深度术前为(2.07士0.23)mm,术后增加到(3.62士0.36)mm(t=8.8408,P<0.001);慢闭组术前为(2.36士0.36) mm,术后增加到(4.03士0.46)mm(t=6.632 ,P<0.001)。急闭组ACD/TL术前为(0.093+0.009),术后增加为(0.159+0.012)(t=10.8306 ,P<0.001);慢闭组ACD/TL术前为(0.104+0.015),术后增加为(0.179+0.009)(t=5.9432 ,P<0.001)。
急闭、慢闭两组手术后周边前房深度均较手术前增加(急闭χ2=58.0000,P<0.001;慢闭χ2=54.0000, P<0.001)。
5.视力: 56眼原发性闭角型青光眼术后48眼(85.7%)最佳矫正视力提高,28眼(50.0%)矫正视力>0. 5。术后8眼(14.3%)矫正视力不提高。两组手术后视力较手术前均增加,差异有显著性意义(Willcoxon符号秩检验,P<0.05)。
6.并发症:全部患者术中均未发生后囊膜破裂,术后炎症反应轻,术后有19眼(15.1%)发生轻度角膜内皮水肿,术后全部患者均未出现角膜内皮失代偿、视网膜脱离等严重并发症。
结论:
超声乳化白内障吸除联合人工晶状体植入术对合并白内障的闭角型青光眼患者的眼压、房角、前房深度以及视功能等方面都产生有益的影响。该术对单纯白内障术后眼压无影响,对急闭临床前期产生降低眼压作用。由于急、慢性闭角型青光眼患者术后的眼压、房角及用药情况不同,超声乳化白内障吸除治疗急性闭角型青光眼的疗效优于慢性闭角型青光眼。
Objective:
To study the clinical results and safety of phacoemulsification with foldable posterior chamber intraocular lens (PC-IOL) implantation in the management of acute or chronic primary angle-closure glaucoma(APACG or CPACG) with cataract.
Patients and methods:
1.Research methods: Through tunnel incision phacoemulsification and posterior intraocular lens implantation (Phaco+IOL) in eye with simple cataract. Through corneal incision phacoemulsification and intraocular lens implantation in eye with primary angle-closure glaucoma.Preoperative and postoperative visual acuity、intraocular pressure(IOP)、the rate of open-angle、depth of anterior chamber(ACD)、total length of the eye(TL)、antiglaucoma medications and complications were observed. Postoperative time of following up was 3～24 months, average(8.5±4.5) months.
2.Cases: Research group: Prospective clinical trial and consecutive case series. 26 cases(28 eyes) with simple cataract, 60 cases(70 eyes) primary angle-closure glaucoma with cataract ,including 29 eyes with acute primary angle-closure glaucoma, 27 eyes with chronic primary angle-closure glaucoma were randomly choosed from January 2005 to December 2006. visual acuity distribute from hand movement to 0.8,age from 50 to 80,without other eye diseases or ocular surgery. Comparison group: patients of homologous age and visual acuity with simple age related cataract.
3.Statistic analysis: Data was evaluated by SSPS 11.0 statistic software.
Results:
1.The success probabilities assessed with postoperative IOP level: The total success probability was 95.3%; the partial success probability was 4.7% in the group of APACG .The total success probability was 77.8%; the partial success probability was 14.8%;the failure probability was 7.4% in the group of CPACG .
2.IOP and antiglaucoma medication: In simple cataract group (n=56), preoperative IOP was (13.59±4.03)mmHg; postoperative IOP was (12.76±3.73)mmHg(t=1.9201,P>0.05); In preclinical stage of APACG group (n=14), preoperative IOP was (11.77±1.89) mmHg; postoperative IOP was (10.44±1.66)mmHg(t=3.9910,P<0.01);In period of onset of APACG group(n=29),preoperative IOP was (19.78±9.73)mmHg; postoperative IOP was (10.97±2.31)mmHg(t=4.7441,P<0.001); In CPACG group(n=27),preoperative IOP was (19.94±4.14)mmHg; postoperative IOP was (15.07±3.81)mmHg(t=4.4976, P<0.01).Postoperative IOP of APACG was lower than that of CPACG.
In APACG group preoperative antiglaucoma medication was (1.08±1.13); postoperative antiglaucoma medication was (0.08±0.28)(t=4.6257, P<0.001); In CPACG group preoperative antiglaucoma medication was (1.36±0.70); postoperative antiglaucoma medication was (0.12±0.41)(t=7.9425, P<0.001).
3.The rate of open-angle and the extent of synechiae: In primary acute or chronic angle-closure glaucoma group, angle of anterior chamber was widen, In APACG group,χ2 = 51.3333, P<0.001; In CPACG group,χ2 =34.9091, P<0.001.
4.The central and peripheral depth of the anterior chamber: In APACG group, preoperative depth of the anterior chamber (ACD) was (2.07±0.23)mm; postoperative ACD was (3.62±0.36)mm; (t=8.8408,P<0.001). preoperative ACD/ TL was (0.093+0.009)mm; postoperative ACD /TL was (0.159+0.0126)mm(t=8.8408,P<0.001) .In CPACG group, preoperative ACD was (2.36±0.36)mm; postoperative ACD was (4.03±0.46)mm(t=6.632 ,P<0.001). Preoperative ACD/TL was (0.104+0.015), postoperative ACD /TL was (0.179±0.009)(t=5.9432,P<0.001).
Preoperative limbic ACD of APACG and CPACG was much less than that of postoperative (APACGχ2=58.0000, P<0.001;CPACGχ2=54.0000, P<0.001).
5.Visual acuity: In 56 eyes of PACG, corrected visual acuity of 48 eyes(85.7%) in raised postoperatively; corrected visual acuity of 28 eyes(50%)>0.5. 8 eyes(14.3%) did not raise. Both of acute and chronic primary angle-closure glaucoma group, visual acuity raised Preoperatively(P<0.05).
6.Complications: There is no rupture of posterior capsule membrane during the operation, and the postoperative inflammatory reactions was low. The serious postoperative complications ,such as corneal endothelial decompens and retinal detachment were not discovered.
Conclusions:
That the phacoemulsification with foldable posterior chamber intraocular lens implantation was benefit to IOP, chamber angle, depth of anterior chamber and visual function for primary angle-closure glaucoma with cataract. IOP of simple cataract was not affected, but IOP of preclinical stage of APACG was lowered by phacoemulsification.
Moreover, the surgical curative effect of acute angle-closure glaucoma was better than that of chronic angle-closure glaucoma.
引文
1.Ritch R,Liebmann J,Tello C. A construct for understanding angle-closure glaucoma: the role of ultrasound biomicroscopy.Ophthalmology Clinics North America.1995,8:281～93.
2.Newell FW.In Ophthalmology: Principles and Concepts. 8th ed. St. Louis: Mosby,1996:379～405
3.王宁利,欧阳洁,周文炳,等.中国人闭角型青光眼房角关闭机制的研究.中华眼科杂志.2000,36:46～51.
4.周文炳.主编.临床青光眼.第二版.北京:人民卫生出版社.2000
5.Saxena S,Agrawal PK,Pratap VB,et al.The predictive value of the relative lens position inprimary angle-closure glaucoma.Ann Ophthalmol 1993,25:4536
6.Lowe RF Aetiology of the anatomical basis for primary angle-closure glaucoma;biometrical comparisons between normal eyes and eyes with primary angle-closure glaucoma.Br J Ophthalmol.1970,54:161～9
7.Gunning FP, Greve EL.Uncontrolled primary angle closure glaucoma: results. of early intercapsular cataract extraction and posterior chamber lens. implantation. Int Ophthalmol.1991,15:237～47
8.Acton J,Salmon JF,Scholtz R.Extracapsular cataract extraction with posterior chamber lens implantation in primary angle-closure glaucoma.J Cataract Refract Surg.1997,23:930～4
9.Obstbaum SA.The lens and angle-closure glaucoma.J Cataract RefractSurg.2000,26:941～942
10.Gunning FP,Greve EL.Lens extraction for uncontrolled angle-closure glaucoma: long-term follow-up.J Cataract Refract Surg.1998,24:1347～1356
11.Kurimoto Y,Park M,Sakaue H,et a1.Changes in the anterior chamber configuration after small-incision cataract surgery with posterior chamber intraocular lens implantation.Am J Ophthalmol.1997,124:775～780
12.Yang CH,Hung PT.Intraocular lens position and anterior chamber angle changes after cataract extraction in eyes with primary angle-closure glaucoma.J Cataract Refract Surg.1997,23:1109～13
13.Jahn CE.Reduced intraocular pressure after phacoemulsification and posterior chamber intraocular lens implantation.J Cataract Refract Surg.1997,23:1260～4
14.Tennen DG,Masket S.Short-and long-term effect of clear corneal incisions on intraocular pressure.J Cataract Refract Surg.1996,22:568～570
15.Shingleton BJ,Gamell LS,O'Donoghue MW,et al.Long-term changes in intraocular pressure after clear corneal phacoemulsification:normal patients versus glaucoma suspect and glaucoma patients.J Cataract Refract Surg.1999,25: 885～890
16. Kaufmann PL.Pressure-dependent outflow.In: R. Ritch, M.B. Shieldsand T. Krupin, Editors, The Glaucomas (2nd ed.),, Mosby, St Louis.1996:307～335
17.Manoj B ,Chako D ,Khan MY.Effect of extracapsular cataract extraction and phacoemulsification performed after trabeculectomy on intraocular pressure.J Cataract Refract Surg.2000,26:75～8
18.Roberts TV,Francis IC,Lertusumitkul S,et al.Primary phacoemulsification for uncontrolled angle-closure glaucoma.J Cataract Refract Surg.2000,26:1012～1016
19.杨春燕,裴颖,凡文博,等.超声乳化晶状体吸除术技人工晶状体植入术后房水肿瘤坏死子、白细胞介素1和过氧化脂质含量的研究.中华眼科杂志(Chin J Ophthalmo1).1999,35(1):63
20.Diestelhorst M,Krieglstein GK.Influence of cataract and posterior chamber lens implantation on the dynamics of the aqueous humor. Prospective study in fluorophotometry.J Fr Ophthalmol.1991,14:255～9
21.孙兴怀.青光眼手术治疗的评价.眼外伤职业病杂志.2003,25(11):723～724
22.Meyer MA,Savitt ML,Kopitas E.The effect of phacoemulsification on aqueous outflow facility.Ophthalmology.1997,104:1221～27
23.Cekic O,Batman C,Totan Y,et al.Changes in anterior chamber depth and intraocular pressure after phacoemulsification and posterior chamber intraocular lens implantation.Ophthalmic SurgLasers.1998,29:639～642
24.Suzuki R,Kuraki S,Fujiwara N.Ten-year follow-up of intraocular pressure after phacoemulsification and aspiration with intraocular lens implantation performed by the same surgeon.Ophthalmologica.1997:211:79～83
25.Tong JT,Miller KM.Intraocular pressure change after sutureless phacoemulsification and foldable posterior chamber lens implantation.J Cataract Refract Surg.1998,24:256～262
26.Sacc S,Marletta A,Pascotto A,et al.Daily tonometric curves after cataract surgery.Br J Ophthalmol.2001,85:24～29
27.Merkur A,Damji KF,Mintsioulis G,et al.Intraocular pressure decrease after phacoemulsification in patients with pseudoexfoliation syndrome.J Cataract Refract Surg.2001,27: 528～532
28.Shingleton BJ,Wadhwani RA,O'Donoghue MW,et al.Evaluation of intraocular pressure in the immediate period after phacoemulsification.J Cataract Refract Surg.2001,27: 524～527
29.Cekic O,Batman C.Effect of capsulorhexis size on postoperative intraocular pressure.J Cataract Refract Surg.1999,25:416～419
30.Radius RL,Schultz K,Sobocinski K,et al.Pseudophakia. and intraocular pressure.Am J Ophthalmol.1984,97:738～42
31.Rhee DJ,Deramo VA,Connolly BP,et al.Intraocular pressure trends after supranormal pressurization to aid closure of sutureless cataractwounds.J Cataract Refract Surg.1999,25:546～549
32.周 健,张丰菊,史跃武. 超声乳化人工晶状体植入术后眼压的观察.眼外伤职业眼病杂志.2005,27(11):816～818
33.王少华,黄振平,陈银.白内障超声乳化人工晶状体植入后的房角和眼压改变.医学研究生学报.2004,17(11)
34.Cigdem A,Sukru B,Tugrul A.Anterior chamber depth,iridocorneal angle width,and intraocular pressure changes after uneventful phacoemulsification in eyes without glaucoma and with open iridocorneal angles.Journal of Cataract & Refractive Surgery.2004,30(4):832～838
35.Altan C,Bayraktar S,Altan T,et al.Anterior chamber depth,iridocorneal angle width, and intraocular pressure changes after uneventful phacoemulsification in eyes without glaucoma and with open iridocorneal angles.J Cataract Refract Surg.2004,30(4):832～838
36.Congdon N,Wang F,Tielsch JM. Issues in the epidemiology and population based screening of primary angle closure glaucoma. Survey Ophthalmol 1992,36:411～423
37.Congdon NG, Quigley HA, Hung PT, et al.Screening techniques for angle-closure glaucoma in rural Taiwan.Acta Ophthalmol Scand 1996,74(2):113～9
38.Aung T,Ang LP,Chan S,et al.Acute primary angle-closure: long-term intraocular pressure outcome in Asian eyes. Am JOphthalmol.2001,131:7～12
39.Hoh ST,Gazzard GA,Oen FTS,et al.Laser iridotomy versus primary phacoemulsification.Asia-Pacific Journal of Ophthalmology.2001,13(4):22～23
40.Steuhl KP,Marahrens P,Frohn C,et al.Intraocular pressure and anterior chamber depth before and after extracapsular cataract extraction with posterior chamber lens implantation. Ophthalmic Surg.1992,23:233～237
41.Pereira FA,Cronemberger S.Ultrasound biomicroscopic study of anterior segment changes after phacoemulsification and foldable intraocular lens implantation.Ophthalmology.2003,110:1799～1806
42.Nonaka A,Kondo T,Kikuchi M,et al.Angle widening and alteration of ciliary process configuration after cataract surgery for primary angle closure.Ophthalmology.2006,113(3):437～41
43.Wong TY,Foster PJ,Seah SK,et al.Rates of hospitalization for angle closure glaucoma in Chinese, Malay, and Indian residents in Singapore.Br J Ophthalmol.2000,84:990～992
44.Action J, Salmon JF, Scheltz R. J Cataract Refract Surg 1997,23: 930～934
45.Noben K, Linsen MC, Zeyen TG. Is combined phacoemulsification and trabeculectomy as effective as trabeculectomy alone. Bull Soc Belge Ophtalmol,1998;270:85～90
46.Tham CC,Leung DY,Lai JS.et al.Letter Unusual presentation of angle-closure glaucoma treated by phacoemulsification.J Cataract Refract Surg.2005,31(8):1477～1478
47.Bobrow JC. Cataract extraction and lens implantation with and without trabeculectomy: an intrapatient comparison. Trans Am Ophthalmol Soc 1998;96:521～556.
48.Smith MF,Doyle JW.Cataract surgery in the glaucoma patient:Advances and modifications.Semin Ophthalmol.1999;14(3):124～9
1.黄焕光.超声生物显微镜在闭角型青光眼诊断和治疗中的应用.医学文选.2005,24(3):435～437
2.Davwid TL, Vincent VW. Thomas YH. et al. Long-term intraocular pressure control after clear corneal phacoemulsification in glaucoma patients. Journal of Cataract & Refractive Surgery.2006,32:183
3.Steuhl KP, Marahrens P, Frohn C, et al. Intraocular pressure and anterior chamber depth before and after extracapsular cataract extraction with posterior chamber lens implantation. Ophthalmic Surg,1992,23:233～237
4.Lyle W A,Jin J C. Comparison of a 3 and 6mm incision in combined phacoemulisification and trabeculectomy. Am J Ophthalmol,1991,111:189～196
5.Kosmin A S,Wishart P K. Long-term intraocular pressure control after cataract extraction with trabeculectomy:phacoemulsification versus extracapsular technique. Cataract Refract Surg,1998,24:249～255
6.Timothy V, Ian C, Sam L, et al. Primary phacoemulsification for uncontrolled angle-closure glaucoma. Journal of Cataract & Refractive Surgery.2000,26(7):1012～1016
7.Kubota , Toguri I , Onizuka N , et al. Phacoemulsification and intraocular lens implantation for angle closure glaucoma after the relief of pupillary block.Ophthalmologica.2003,217(5):325～328
8.Hayashi K,Hayashi H,Nakao F,et al. Effect of cataract surgery on intraocular pressure control in glaucoma patients. J Cataract Refract Surg.2001,27(11):1779～1786
9.Altan C, Bayraktar S, Altan T, et al. Anterior chamber depth, iridocorneal angle width, and intraocular pressure changes after uneventful phacoemulsification in eyes without glaucoma and with open iridocorneal angles. J Cataract Refract Surg.2004,30(4):832～838
10.Ge J, Guo Y, Liu Y. Preliminary clinical study on the management of angle-closure glaucoma by phacoemulsification with foldable posterior chamber intraocular lens implantation.Zhonghua-Yan-Ke-Za-Zhi.2001,37(5):355～358
11.Kurimoto Y,Park M,Sakaue H,et a1.Changes in the anterior chamber configuration after small-incision cataract surgery with posterior chamber intraocular lens implantation. Am J Ophthalmol.1997,124:775～780
12.Frederico A S, Pereira, Sebastiao C. Ultrasound biomicroscopic study of anterior segment changes after phacoemulsification and foldable intraocular lens implantation.Ophthalmology.2003,110(9):1799～1806
13.Nonaka A, Kondo T, Kikuchi M, et al. Angle widening and alteration of ciliary process configuration after cataract surgery for primary angle closure.Ophthalmology.2006 Mar,113(3):437～41
14.Jahn CE. Reduced intraocular pressure after phacoemulsification and posterior chamber intraocular lens implantation.J Cataract Refract Surg,1997,23:1260～1264
15.Kubota T, Toguri I, Onizuka N, et al. Phacomulsification and intraocular lens implantation after the relief of papillary block.Ophthalmologica.2003,217(5):325～328
16.Hayashi K, Hayashi H, Nakao F, et al. Changes in anterior chamber angle width after intraocular lens implantation in eyes with glaucoma.Ophthalmology.2000,107(4):698～703
17.Tin A, Winifred P, David M, et al. Anterior Chamber Depth and the risk of Primary Angle Closure in 2 East Asian Populations. Arch Ophthalmol.2005,123:527～532
18.杨春燕,裴颖,凡文博,等.超声乳化晶状体吸除术及人工晶体植入术后房水肿瘤坏死因子、白细胞介素1和过氧化脂质含量的研究.中华眼科杂志,1999,35(1):63
19.Diestelhorst M , Krieglstein GK. Influence of cataract and posterior chamber lens implantation on the dynamics of the aqueous humor:prospective study in fluorophotometry. J FrOphthalmol,1991,14(4):255～259
20.周文炳.临床青光眼.北京:人民卫生出版社,20OO,l75-l76
21.Camille Hylton. Cataract After Glaucoma Filtration Surgery. Am J Ophthalmol,2003,135:231～232
22.Henry D, Jampel. Effect of technique on intraocular pressure after combined cataract and glaucoma surgery.Ophthalmology.2002,109(12):2215～2224
23.Jacobi,P C. Primary phacoemulsification following acute primary angle closure glaucoma.Ophthalmologe.2005,102(12):1207-1211;quiz 1212～1213
24.Ferrari E, Bandello F, Roman P, et al. Combined clear corneal phacoemulsification and ab interno trabeculectomy: Three-year case series. Journal of Cataract & Refractive Surgery.2005,31(9):1783～1788
25.David S. Friedman. Surgical strategies for coexisting glaucoma and cataract.Ophthalmology.2002(10):1902～19132
26.Jia-Kang Wang. Unusual presentation of angle-closure glaucoma treated by phacoemulsification. J Cataract Refract Surg.2004,30:1371～1373
27.La J, Tham C, Chan J, et al. Phacotrabeculectomy in treatment of primary angle-closure glaucoma and primary open-angle glaucoma.Jpn-J-Ophthalmol.2004,48(4): 408～411
28.Beckers H, De-Kroon, Nuijts R, et al.Phacotrabeculectomy.Doc-Ophthalmol.2000,100(1):43～47
29.Gimbel HV,Penno EE,Ferensowicz M.Combined cataract surgery intraocular lens implantation and viscocanalostomy . J CataractRefract Surg,1999,25:l370～l375
30.Gianoli F,Schnyder CC,Bovey E,et a1.Combined surgery for cataract and gaucoma:phacoemulslfication and deep scleretomy compared with phacoemulsification and trabeculectomy.J Cataract Refract Surg,1999,25:340～346
31.Tanito M,Park M,Nishikawa M,et a1.Comparison of surgical outcomes of combined vicocanalostomy and cataract surgery with combined trabeculotomy and cataract surgery.Am J Ophthalmol,2002,134:513～520
32 . Wishart MS . Shergill T . Porooshani H . Viscocanalostomy and phacoviscocanalostomy:long-term results.J cataract Refract Surg,2002,28:745～751
33.姚克,申屠形超,徐雯,等.超声乳化白内障吸除联合青光眼粘弹剂小管扩张术的临床疗效观察.中华眼科杂志.2004,40(5):291～294
34.Renard J, Giraud J, Oubaaz A,et al. Treatment of acute angle-closure glaucoma. J Fr Ophtalmol.2004,27(6 Pt 2):701～705
35.Dermot McGrath.眼前段的动态成像——先进的成像技术开启秘密之室.EUROTIMES.2006,1:12～16
2.Newell FW.In Ophthalmology: Principles and Concepts. 8th ed. St. Louis: Mosby,1996:379～405
3.王宁利,欧阳洁,周文炳,等.中国人闭角型青光眼房角关闭机制的研究.中华眼科杂志.2000,36:46～51.
4.周文炳.主编.临床青光眼.第二版.北京:人民卫生出版社.2000
5.Saxena S,Agrawal PK,Pratap VB,et al.The predictive value of the relative lens position inprimary angle-closure glaucoma.Ann Ophthalmol 1993,25:4536
6.Lowe RF Aetiology of the anatomical basis for primary angle-closure glaucoma;biometrical comparisons between normal eyes and eyes with primary angle-closure glaucoma.Br J Ophthalmol.1970,54:161～9
7.Gunning FP, Greve EL.Uncontrolled primary angle closure glaucoma: results. of early intercapsular cataract extraction and posterior chamber lens. implantation. Int Ophthalmol.1991,15:237～47
8.Acton J,Salmon JF,Scholtz R.Extracapsular cataract extraction with posterior chamber lens implantation in primary angle-closure glaucoma.J Cataract Refract Surg.1997,23:930～4
9.Obstbaum SA.The lens and angle-closure glaucoma.J Cataract RefractSurg.2000,26:941～942
10.Gunning FP,Greve EL.Lens extraction for uncontrolled angle-closure glaucoma: long-term follow-up.J Cataract Refract Surg.1998,24:1347～1356
11.Kurimoto Y,Park M,Sakaue H,et a1.Changes in the anterior chamber configuration after small-incision cataract surgery with posterior chamber intraocular lens implantation.Am J Ophthalmol.1997,124:775～780
12.Yang CH,Hung PT.Intraocular lens position and anterior chamber angle changes after cataract extraction in eyes with primary angle-closure glaucoma.J Cataract Refract Surg.1997,23:1109～13
13.Jahn CE.Reduced intraocular pressure after phacoemulsification and posterior chamber intraocular lens implantation.J Cataract Refract Surg.1997,23:1260～4
14.Tennen DG,Masket S.Short-and long-term effect of clear corneal incisions on intraocular pressure.J Cataract Refract Surg.1996,22:568～570
15.Shingleton BJ,Gamell LS,O'Donoghue MW,et al.Long-term changes in intraocular pressure after clear corneal phacoemulsification:normal patients versus glaucoma suspect and glaucoma patients.J Cataract Refract Surg.1999,25: 885～890
16. Kaufmann PL.Pressure-dependent outflow.In: R. Ritch, M.B. Shieldsand T. Krupin, Editors, The Glaucomas (2nd ed.),, Mosby, St Louis.1996:307～335
17.Manoj B ,Chako D ,Khan MY.Effect of extracapsular cataract extraction and phacoemulsification performed after trabeculectomy on intraocular pressure.J Cataract Refract Surg.2000,26:75～8
18.Roberts TV,Francis IC,Lertusumitkul S,et al.Primary phacoemulsification for uncontrolled angle-closure glaucoma.J Cataract Refract Surg.2000,26:1012～1016
19.杨春燕,裴颖,凡文博,等.超声乳化晶状体吸除术技人工晶状体植入术后房水肿瘤坏死子、白细胞介素1和过氧化脂质含量的研究.中华眼科杂志(Chin J Ophthalmo1).1999,35(1):63
20.Diestelhorst M,Krieglstein GK.Influence of cataract and posterior chamber lens implantation on the dynamics of the aqueous humor. Prospective study in fluorophotometry.J Fr Ophthalmol.1991,14:255～9
21.孙兴怀.青光眼手术治疗的评价.眼外伤职业病杂志.2003,25(11):723～724
22.Meyer MA,Savitt ML,Kopitas E.The effect of phacoemulsification on aqueous outflow facility.Ophthalmology.1997,104:1221～27
23.Cekic O,Batman C,Totan Y,et al.Changes in anterior chamber depth and intraocular pressure after phacoemulsification and posterior chamber intraocular lens implantation.Ophthalmic SurgLasers.1998,29:639～642
24.Suzuki R,Kuraki S,Fujiwara N.Ten-year follow-up of intraocular pressure after phacoemulsification and aspiration with intraocular lens implantation performed by the same surgeon.Ophthalmologica.1997:211:79～83
25.Tong JT,Miller KM.Intraocular pressure change after sutureless phacoemulsification and foldable posterior chamber lens implantation.J Cataract Refract Surg.1998,24:256～262
26.Sacc S,Marletta A,Pascotto A,et al.Daily tonometric curves after cataract surgery.Br J Ophthalmol.2001,85:24～29
27.Merkur A,Damji KF,Mintsioulis G,et al.Intraocular pressure decrease after phacoemulsification in patients with pseudoexfoliation syndrome.J Cataract Refract Surg.2001,27: 528～532
28.Shingleton BJ,Wadhwani RA,O'Donoghue MW,et al.Evaluation of intraocular pressure in the immediate period after phacoemulsification.J Cataract Refract Surg.2001,27: 524～527
29.Cekic O,Batman C.Effect of capsulorhexis size on postoperative intraocular pressure.J Cataract Refract Surg.1999,25:416～419
30.Radius RL,Schultz K,Sobocinski K,et al.Pseudophakia. and intraocular pressure.Am J Ophthalmol.1984,97:738～42
31.Rhee DJ,Deramo VA,Connolly BP,et al.Intraocular pressure trends after supranormal pressurization to aid closure of sutureless cataractwounds.J Cataract Refract Surg.1999,25:546～549
32.周 健,张丰菊,史跃武. 超声乳化人工晶状体植入术后眼压的观察.眼外伤职业眼病杂志.2005,27(11):816～818
33.王少华,黄振平,陈银.白内障超声乳化人工晶状体植入后的房角和眼压改变.医学研究生学报.2004,17(11)
34.Cigdem A,Sukru B,Tugrul A.Anterior chamber depth,iridocorneal angle width,and intraocular pressure changes after uneventful phacoemulsification in eyes without glaucoma and with open iridocorneal angles.Journal of Cataract & Refractive Surgery.2004,30(4):832～838
35.Altan C,Bayraktar S,Altan T,et al.Anterior chamber depth,iridocorneal angle width, and intraocular pressure changes after uneventful phacoemulsification in eyes without glaucoma and with open iridocorneal angles.J Cataract Refract Surg.2004,30(4):832～838
36.Congdon N,Wang F,Tielsch JM. Issues in the epidemiology and population based screening of primary angle closure glaucoma. Survey Ophthalmol 1992,36:411～423
37.Congdon NG, Quigley HA, Hung PT, et al.Screening techniques for angle-closure glaucoma in rural Taiwan.Acta Ophthalmol Scand 1996,74(2):113～9
38.Aung T,Ang LP,Chan S,et al.Acute primary angle-closure: long-term intraocular pressure outcome in Asian eyes. Am JOphthalmol.2001,131:7～12
39.Hoh ST,Gazzard GA,Oen FTS,et al.Laser iridotomy versus primary phacoemulsification.Asia-Pacific Journal of Ophthalmology.2001,13(4):22～23
40.Steuhl KP,Marahrens P,Frohn C,et al.Intraocular pressure and anterior chamber depth before and after extracapsular cataract extraction with posterior chamber lens implantation. Ophthalmic Surg.1992,23:233～237
41.Pereira FA,Cronemberger S.Ultrasound biomicroscopic study of anterior segment changes after phacoemulsification and foldable intraocular lens implantation.Ophthalmology.2003,110:1799～1806
42.Nonaka A,Kondo T,Kikuchi M,et al.Angle widening and alteration of ciliary process configuration after cataract surgery for primary angle closure.Ophthalmology.2006,113(3):437～41
43.Wong TY,Foster PJ,Seah SK,et al.Rates of hospitalization for angle closure glaucoma in Chinese, Malay, and Indian residents in Singapore.Br J Ophthalmol.2000,84:990～992
44.Action J, Salmon JF, Scheltz R. J Cataract Refract Surg 1997,23: 930～934
45.Noben K, Linsen MC, Zeyen TG. Is combined phacoemulsification and trabeculectomy as effective as trabeculectomy alone. Bull Soc Belge Ophtalmol,1998;270:85～90
46.Tham CC,Leung DY,Lai JS.et al.Letter Unusual presentation of angle-closure glaucoma treated by phacoemulsification.J Cataract Refract Surg.2005,31(8):1477～1478
47.Bobrow JC. Cataract extraction and lens implantation with and without trabeculectomy: an intrapatient comparison. Trans Am Ophthalmol Soc 1998;96:521～556.
48.Smith MF,Doyle JW.Cataract surgery in the glaucoma patient:Advances and modifications.Semin Ophthalmol.1999;14(3):124～9
1.黄焕光.超声生物显微镜在闭角型青光眼诊断和治疗中的应用.医学文选.2005,24(3):435～437
2.Davwid TL, Vincent VW. Thomas YH. et al. Long-term intraocular pressure control after clear corneal phacoemulsification in glaucoma patients. Journal of Cataract & Refractive Surgery.2006,32:183
3.Steuhl KP, Marahrens P, Frohn C, et al. Intraocular pressure and anterior chamber depth before and after extracapsular cataract extraction with posterior chamber lens implantation. Ophthalmic Surg,1992,23:233～237
4.Lyle W A,Jin J C. Comparison of a 3 and 6mm incision in combined phacoemulisification and trabeculectomy. Am J Ophthalmol,1991,111:189～196
5.Kosmin A S,Wishart P K. Long-term intraocular pressure control after cataract extraction with trabeculectomy:phacoemulsification versus extracapsular technique. Cataract Refract Surg,1998,24:249～255
6.Timothy V, Ian C, Sam L, et al. Primary phacoemulsification for uncontrolled angle-closure glaucoma. Journal of Cataract & Refractive Surgery.2000,26(7):1012～1016
7.Kubota , Toguri I , Onizuka N , et al. Phacoemulsification and intraocular lens implantation for angle closure glaucoma after the relief of pupillary block.Ophthalmologica.2003,217(5):325～328
8.Hayashi K,Hayashi H,Nakao F,et al. Effect of cataract surgery on intraocular pressure control in glaucoma patients. J Cataract Refract Surg.2001,27(11):1779～1786
9.Altan C, Bayraktar S, Altan T, et al. Anterior chamber depth, iridocorneal angle width, and intraocular pressure changes after uneventful phacoemulsification in eyes without glaucoma and with open iridocorneal angles. J Cataract Refract Surg.2004,30(4):832～838
10.Ge J, Guo Y, Liu Y. Preliminary clinical study on the management of angle-closure glaucoma by phacoemulsification with foldable posterior chamber intraocular lens implantation.Zhonghua-Yan-Ke-Za-Zhi.2001,37(5):355～358
11.Kurimoto Y,Park M,Sakaue H,et a1.Changes in the anterior chamber configuration after small-incision cataract surgery with posterior chamber intraocular lens implantation. Am J Ophthalmol.1997,124:775～780
12.Frederico A S, Pereira, Sebastiao C. Ultrasound biomicroscopic study of anterior segment changes after phacoemulsification and foldable intraocular lens implantation.Ophthalmology.2003,110(9):1799～1806
13.Nonaka A, Kondo T, Kikuchi M, et al. Angle widening and alteration of ciliary process configuration after cataract surgery for primary angle closure.Ophthalmology.2006 Mar,113(3):437～41
14.Jahn CE. Reduced intraocular pressure after phacoemulsification and posterior chamber intraocular lens implantation.J Cataract Refract Surg,1997,23:1260～1264
15.Kubota T, Toguri I, Onizuka N, et al. Phacomulsification and intraocular lens implantation after the relief of papillary block.Ophthalmologica.2003,217(5):325～328
16.Hayashi K, Hayashi H, Nakao F, et al. Changes in anterior chamber angle width after intraocular lens implantation in eyes with glaucoma.Ophthalmology.2000,107(4):698～703
17.Tin A, Winifred P, David M, et al. Anterior Chamber Depth and the risk of Primary Angle Closure in 2 East Asian Populations. Arch Ophthalmol.2005,123:527～532
18.杨春燕,裴颖,凡文博,等.超声乳化晶状体吸除术及人工晶体植入术后房水肿瘤坏死因子、白细胞介素1和过氧化脂质含量的研究.中华眼科杂志,1999,35(1):63
19.Diestelhorst M , Krieglstein GK. Influence of cataract and posterior chamber lens implantation on the dynamics of the aqueous humor:prospective study in fluorophotometry. J FrOphthalmol,1991,14(4):255～259
20.周文炳.临床青光眼.北京:人民卫生出版社,20OO,l75-l76
21.Camille Hylton. Cataract After Glaucoma Filtration Surgery. Am J Ophthalmol,2003,135:231～232
22.Henry D, Jampel. Effect of technique on intraocular pressure after combined cataract and glaucoma surgery.Ophthalmology.2002,109(12):2215～2224
23.Jacobi,P C. Primary phacoemulsification following acute primary angle closure glaucoma.Ophthalmologe.2005,102(12):1207-1211;quiz 1212～1213
24.Ferrari E, Bandello F, Roman P, et al. Combined clear corneal phacoemulsification and ab interno trabeculectomy: Three-year case series. Journal of Cataract & Refractive Surgery.2005,31(9):1783～1788
25.David S. Friedman. Surgical strategies for coexisting glaucoma and cataract.Ophthalmology.2002(10):1902～19132
26.Jia-Kang Wang. Unusual presentation of angle-closure glaucoma treated by phacoemulsification. J Cataract Refract Surg.2004,30:1371～1373
27.La J, Tham C, Chan J, et al. Phacotrabeculectomy in treatment of primary angle-closure glaucoma and primary open-angle glaucoma.Jpn-J-Ophthalmol.2004,48(4): 408～411
28.Beckers H, De-Kroon, Nuijts R, et al.Phacotrabeculectomy.Doc-Ophthalmol.2000,100(1):43～47
29.Gimbel HV,Penno EE,Ferensowicz M.Combined cataract surgery intraocular lens implantation and viscocanalostomy . J CataractRefract Surg,1999,25:l370～l375
30.Gianoli F,Schnyder CC,Bovey E,et a1.Combined surgery for cataract and gaucoma:phacoemulslfication and deep scleretomy compared with phacoemulsification and trabeculectomy.J Cataract Refract Surg,1999,25:340～346
31.Tanito M,Park M,Nishikawa M,et a1.Comparison of surgical outcomes of combined vicocanalostomy and cataract surgery with combined trabeculotomy and cataract surgery.Am J Ophthalmol,2002,134:513～520
32 . Wishart MS . Shergill T . Porooshani H . Viscocanalostomy and phacoviscocanalostomy:long-term results.J cataract Refract Surg,2002,28:745～751
33.姚克,申屠形超,徐雯,等.超声乳化白内障吸除联合青光眼粘弹剂小管扩张术的临床疗效观察.中华眼科杂志.2004,40(5):291～294
34.Renard J, Giraud J, Oubaaz A,et al. Treatment of acute angle-closure glaucoma. J Fr Ophtalmol.2004,27(6 Pt 2):701～705
35.Dermot McGrath.眼前段的动态成像——先进的成像技术开启秘密之室.EUROTIMES.2006,1:12～16