现阶段对青光眼白内障联合手术的认识-张秀兰

2012211OphthalmolCHN2012Vol.21No．1··【】、、、。。、、。、。。。。2012213-6【】/CommentoncombinedsurgeryoncoexistingcataractandglaucomaZHANGXiu-lan.StateKeyLaboratoryofOphthalmology,ZhongshanOphthalmicCenter,SunYat-SenUniversity,Guangzhou510060,China.Email:[e-mail]【Abstract】Theadvanceofphacoemulsificationhasbeenmakinghugesignificantcontributiontothemanagementofglaucoma.However,managementofglaucomawithcoexistingcataracthasraisedmanydiscussionsinrecentyearsincludingcurrenttreatmentstrategies,indications,surgicalprocedure,timingandoutcomes.Thisshortpaperwilldiscusstheseissues.Surgicalstrategyofprimaryangle-closureglaucoma(PACG)shouldbedeterminedwithanindividualizedapproachbasedonthedegreeofperipheralanteriorsynechiae,thenumberofglaucomamedications,theopacityoflensandvisualfunctions.Proficientoperationskillsareneededforchoosingcombinedsurgery.CataractextractionshouldbegreatlyavoidedduringacuteattackstageofPACG.Theeffectofcataractex－tractioninprimaryopenangelglaucoma(POAG)stillneedsfurtherstudytoclarify.Forothertypesofglaucomasuchasmalignantglau－coma,aggressivelensextractionisofcontroversial.(OphthalmolCHN,2012,21:3-6)【Keywords】glaucoma/surgery;cataract;[e-mail]。、、、。、。。“”。2008《》1“”“”。“”。/。2-3。4。。EC－CE、ICCE、32012211OphthalmolCHN2012Vol.21No．15-7。ECCE3.2mm1.8mm8。。、、、、7,9-10、11-12、、11,13-15。11,16。Lai1790°270°。。、、。、。2-3、。20055-6、、CUBM。5-71≥180°≥3≥0.52≥180°≥30.53180°30.5。“”“180°”。180°。、、、。。、、。。。、。。。。。。、。Lam10、。18、、、、。47,10。12、、“”34、。42012211OphthalmolCHN2012Vol.21No．119。。2~4mmHg6~8mmHg12。、1～23“”。。。。、、、、、。、、、。、、6-8。。。、、、2I-sent、Ex-PRESS。“”—。。。UBM、OCT。、、。“3A”accountable、accessible、affordable20。1..,2008,44:862-863.2CrichtonA.Managementofcoexistingcataractandglaucoma.CurrOpinOphthalmol,2010,21:129-134.3VizzeriG,WeinrebRN.Cataractsurgeryandglaucoma.CurrOpinOphthalmol,2010,21:20-24.4LiuHN,ChenXL,LiX,etal.Efficacyandtolerabilityofone-siteversustwo-sitephaco-trabeculectomy:ameta-analysisofrandom－izedcontrolledclinicaltrials.ChinMedJ(Engl),2010,123:2111-2115.5,,,..,2006,24:695-699.6ZhangX,TengL,LiA,etal.Theclinicaloutcomesofthreesur－gicalmanagementsonprimaryangle-closureglaucoma.YanKeXueBao,2007,23:65-74.7GeJ,ZhangX.Angle-ClosureGlaucoma:SurgicalManagementofAcuteAngle-ClosureGlaucoma.PearlsofGlaucomaManagement,1st.ed;GiaconiJA,LawSK,ColemanAL,etal,BerlinHeidel－berg:Springer-Verlag,2010:439-444.8,,,.1.8mm.,2011,47:903-907.9TarongoyP,HoCL,WaltonDS.Angle-closureglaucoma:therole52012211OphthalmolCHN2012Vol.21No．1··[e-mail]。。3~4cm1cm。。1.4cm×1.8cm。““、。3-0、2。320cm3-0、3。。。3。3-0。6。。1、2、4。1999-20115926251153324~78。3~10。625621、31。、、、、、、。。2011-12-16ofthelensinthepathogenesis,prevention,andtreatment.SurvOphthalmol,2009,54:211-225.10LamDS,LeungDY,ThamCC,etal.Randomizedtrialofearlyphacoemulsificationversusperipheraliridotomytopreventin－traocularpressureriseafteracuteprimaryangleclosure.Oph－thalmology,2008,115:1134-1140.11ShamsPN,FosterPJ.Clinicaloutcomesafterlensextractionforvisuallysignificantcataractineyeswithprimaryangleclosure.JGlaucoma,2011.May26.Epubaheadofprint12ShrivastavaA,SinghK.Theeffectofcataractextractiononin－traocularpressure.CurrOpinOphthalmol,2010,21:118-122.13PachimkulP,IntajakY.EffectoflensextractiononprimaryangleclosureinaThaipopulation.JMedAssocThai,2008,91:303-308.14,..,2011,20:5-8.15,,,..,2011,20:28-33.16LeeYH,YunYM,KimSH,etal.Factorsthatinfluenceintraocu－larpressureaftercataractsurgeryinprimaryglaucoma.CanJOphthalmol,2009,44:705-710.17LaiJS,ThamCC,ChanJC.Theclinicaloutcomesofcataractex－tractionbyphacoemulsificationineyeswithprimaryangle-clo－sureglaucoma(PACG)andco-existingcataract:aprospectivecaseseries.JGlaucoma,2006,15:47-52.18KeenanTD,SalmonJF,YeatesD,etal.Trendsinratesofprima－ryangleclosureglaucomaandcataractsurgeryinEnglandfrom1968to2004.JGlaucoma,2009,18:201-205.19WallandMJ,ParikhRS,ThomasR.Thereisinsufficientevidencetorecommendlensextractionasatreatmentforprimaryopenan－gleglaucoma:anevidence-basedperspective.ClinExpOphthal－mol,2011,Jun13.doi:10.1111/j.1442-9071.2011.02617.x.20.“”“”.,2008,17:4-5.2011-10-086