目的：总结新型冠状病毒肺炎(COVID-19)疫区原发性急性闭角型青光眼患者的特点和救治方法。

方法：回顾性分析2020-03-02/20疫情期间我院治疗的原发性急性闭角型青光眼患者5例9眼的病历资料，慢性进展期8眼施行白内障超声乳化人工晶状体植入联合房角分离术，临床前期1眼施行激光虹膜周切术。分析手术前后眼压、视力及并发症等情况，总结患者特点及诊治体会。

结果：原发性急性闭角型青光眼患者5例中3例为双眼发病，发病时间12～40(25.)d；白内障超声乳化人工晶状体植入联合房角分离术后眼压(12.)较术前(48.)明显下降(t=12.192，P<0.01)；住院天数2～6(平均3.)d。5例患者均未发现感染及手术相关并发症。

结论：在COVID-19疫情期间，疫区原发性急性闭角型青光眼慢性进展期患者发作时间长、病情重，双眼发作比例高；白内障超声乳化人工晶状体植入联合房角分离术可以安全、有效地降低原发性急性闭角型青光眼患者的眼压；疫情期间规范的防控措施可有效保障医患安全，但加大手术难度。

?AIM: To summarize the characteristics and treatment of primary acute angle-closure glaucoma during the outbreak of corona virus disease 2019 (COVID-19) in Wuhan.

?METHODS: Five patients (9 eyes) with primary acute angle-closure glaucoma (APACG) of our hospital were enrolled. Eight eyes with sustained high intraocular pressure (IOP) were given phacoemulsification with goniosynechialysis and one eye in preclinical phase was given YAG laser iridectomy from March 3-20, 2020. The preoperative and postoperative IOP, visual acuity, hospitalization days and complications were reviewed and analyzed.

?RESULTS: Three out of five APACG cases were binocular attack. The onset time was 12-40 (25.)d. The IOP(48.) of eight eyes decreased significantly after surgeries(12.), the difference was statistically significant (t=12.192,P<0.01). The hospitalization time was 2-6 (3.)d. No COVID-19 infection or severe complications were observed.

?CONCLUSION:During the epidemic of COVID-19, phacoemulsification with goniosynechialysis is able to reduce IOP of APACG patients who suffered from longer, heavier and binocular attack in the epidemic area effectively and safely. Strict prevention management can effectively ensure the safety of medical staff and patients, but also increase the difficulty of the surgeries meanwhile.

?KEYWORDS:corona virus disease 2019; ophthalmology; acute primary angle-closure glaucoma; phacoemulsification with goniosynechialysis; Wuhan

0引言

原发性急性闭角型青光眼(acute primary angle-closure glaucoma，APACG)是眼科常见疾病，临床主要表现为突发视力下降伴剧烈眼胀、头痛甚至恶心、呕吐等[1]。

部分药物治疗效果不佳的患者需要采取手术治疗，延误手术时机将导致患者严重的不可逆性视神经损伤，甚至失明[2]。2019-12，新型冠状病毒肺炎(corona virus disease 2019，COVID-19)在武汉暴发，中国人民解放军中部战区总医院是位于湖北省武汉市武昌区的一所大型综合三级甲等部队医院，自2020-01起成为COVID-19患者诊疗定点医院。疫情期间，我院眼科针对急症患者开展手术治疗。本研究回顾2020-03-02/20我院眼科为APACG患者5例9眼实施手术治疗情况，展现“封城”情况下APACG患者的特殊表现，同时为未来特殊情况下APACG的救治提供经验，现报告如下。

1对象和方法

1.1对象回顾性分析2020-03-02/20期间我科收治的APACG患者5例9眼的病历资料，其中男1例，女4例；年龄56～87(平均)岁；双眼发作3例，单眼发作、对侧眼临床前期1例，单眼发作、对侧眼白内障术后1例；4例患者来自武汉，1例患者来自武汉周边地区；发病时间12～40(平均25.)d，住院2～6(平均3.)d。1例患者在手术前1mo，因确诊COVID-19收治武汉“方舱”医院的同时，双眼青光眼急性发作，持续使用降眼压药物，眼压控制不佳，转入我院。1例患者单眼发作发病5d后门诊就诊，经药物治疗后眼压下降，2wk后再次发作。结合患者病史及专科检查，5例患者APACG均诊断明确，术前向患者及家属详细说明病情，签署知情同意书。纳入患者基本信息见表1。

表1 手术患者信息病例性别年龄(岁)居住地主要诊断发病时间(d)住院时间(d)1男56武汉左眼原发性急性闭角型青光眼(慢性进展期)右眼原发性急性闭角型青光眼(临床前期)左眼年龄相关性白内障2122女58湖北公安双眼原发性急性闭角型青光眼(慢性进展期)双眼年龄相关性白内障1233女64武汉双眼原发性急性闭角型青光眼(慢性进展期)双眼年龄相关性白内障3564女87武汉双眼原发性急性闭角型青光眼(慢性进展期)双眼年龄相关性白内障1845女75武汉右眼原发性急性闭角型青光眼(慢性进展期)右眼年龄相关性白内障左眼白内障术后404

文章来源：《武汉冶金管理干部学院学报》 网址: http://www.whyjglgbxyxb.cn/qikandaodu/2021/0310/820.html