Husain 等(Ophthalmology 2012 Aug 9)进行的一项分析表明，与激光虹膜周边切除术(LPI) 相比，起病1周内的急性原发性房角关闭 (APAC) 的患者，在药物控制后进行超声乳化人工晶体植入(phaco/IOL) 术后2年时眼压控制更好，并发症更少。这项随机对照研究纳入了37例患者，他们因APAC入院，药物治疗有效，有白内障，24 小时内眼压控制在 30mmHg 以内。作者随机选择了18 例接受LPI，19 例phaco/IOL。2 年后，LPI 组有 7 例失败 (即 2 次随访眼压 22~24mmHg，或1 次≥25mmHg)，而 phaco/IOL 组为 2 例。作者认为尽管还需要更大样本的研究，但早期 phaco/IOL 为这些患者提供了另一个选择，作者提醒，考虑到白内障的并发症如眼内炎和爆发性出血，只有有经验的手术者才可以这么做。

　　Initial Treatment Alternatives for Acute Primary Angle Closure Compared

　　An analysis by Husain et al (p. 2274) demonstrates that phacoemulsification and intraocular lens implant (phaco/IOL) performed within 1 week of medically controlled acute primary angle closure (APAC) presentation results in superior intraocular pressure (IOP) control at 2 years, compared with laser peripheral iridotomy (LPI), with few complications. This randomized, controlled trial included 37 patients with cataracts who presented with APAC who had responded to medical treatment, experiencing an IOP of ≤30 mmHg within 24 hours. The authors randomized 18 patients to LPI and 19 to phaco/IOL. Over a 2-year period, there were 7 failures in the LPI group (defined as IOP between 22 to 24 mmHg on 2 occasions or IOP ≥25 mmHg on 1 occasion) compared to 2 failures in the phaco/IOL group. The researchers, who call for a larger study, assert early phaco/IOL represents a viable option for these patients, but caution that only experienced surgeons should perform the surgery given the potential for cataract surgery complications such as endophthalmitis and expulsive hemorrhage.