关键词: 青光眼/外科学, 睫状环阻滞性青光眼, 白内障超声乳化吸出术, 激光后囊膜切开术

Abstract:  Objective To report the feasibility of the management model of malignant glaucoma with phacoemulsification cataract extraction. Design Retrospective case series. Participants 12 cases of malignant glaucoma with cataract after the filtration surgery which were invalid to medical treatment. Methods All 12 eyes were given priority to phacoemulsification cataract extraction and the implantation of posterior chamber foldable intraocular lens combined with goniosynechialysis and vitreous water pocket aspiration. Some relapse cases were performed Nd: YAG laser capsulotomy and hyaloidotomy or anterior vitrectomy. Ultrasound biomicroscopy (UBM) was examined at preoperation and 2 weeks of postoperation besides the routine examination. The mean following-up was 15.8±5.2 months. Main Outcome Measures Intraocular pressure (IOP), central anterior chamber depth (ACD) and visual acuity changes. Results The mean central ACD and IOP before surgery were 0.38±0.17 mm and 31.50±3.50 mm Hg. 5 eyes were cured after the surgery of phacoemulsification cataract extraction and the implantation of posterior chamber foldable intraocular lens combined with goniosynechialysis. Among the 7 relapsed eyes, 5 eyes underwent Nd: YAG laser capsulotomy and hyaloidotomy, and the other 2 eyes which relapsed again after laser treatment were performed anterior vitrectomy. The average central ACD was 2.31±0.37 mm at 2 weeks postoperatively and the mean IOP was 14.60±4.8 mm Hg at the last follow-up. The visual acuity increased or kept unchanged. Conclusions The small sample data in our study shows that the phacoemulsification cataract extraction and posterior chamber foldable intraocular lens implantation may be a first alternative in treating malignant glaucoma which is invalid to medical treatment. The Nd: YAG laser capsulotomy / hyaloidotomy and the anterior vitrectomy can be performed in the relapsed cases. This step by step treatment model is feasible. (Ophthalmol CHN, 2012, 21: 43-46)

Key words: glaucoma/surgery, malignant glaucoma, phacoemulsification, laser capsulotomy