摘要
目的应用超声生物显微镜（UBM）观察原发性闭角型青光眼合并自内障患者超声乳化联合人工晶状体植入术前、后的眼前节结构变化及临床效果。方法前瞻性系列病例研究。对合并有自内障的20例（24只眼）原发性闭角型青光眼患者行白内障超声乳化吸除联合人工晶体植入术。术后随访6—23个月。记录术前及术后不同时间点最佳矫正视力（BCVA）、眼压、角膜内皮计数、抗青光眼药物数目及并发症情况。并分别于术前及术后6个月行UBM检查，测量前房深度（ACD）、房角开放距离500（AOD500）、小梁虹膜夹角（TIA）、房角隐窝面积（ARA）及小梁睫状体距离（TCPD）。采用重复测量资料的方差分析、Wilcoxon秩和检验以及配对设计的t检验对数据进行统计分析。结果24只眼术后1周、1个月、3个月及6个月的BCVA（0．83±0．25、0．85±0．19、0．84±0．20、0．81±0．21）分别与术前（0．42±0．21）相比，差异均有统计学意义（F=113．85，P=0．000）；术后1周、1个月、3个月、6个月及末次随访平均眼压[（13．88±3．64）mmHg、（13．35±2．93）mmHg、（13．32±3．02）mmHg、（13．61±3．61）mmHg和（13．53±3．58）mmHg]均低于术前（16．03±4．27）mmHg，其差异均有统计学意义（F=6．67，P=0．000）。24只眼中，术后6个月时平均ACD、AOD500、TIA及ARA分别[（3．32±0．75）mm、（0．23±0．13）mm、（24．93±11．76）及（0．17±0．22）mm^2]与术前[（1．90±0．84）mm、（0．11±0．13）mm、（11．61±11．42）及（0．07±0．08）mm^2]相比，差异均有统计学意义（z=-3．980，t=-3．43，t=-3．33，Z=-3．123，P=0．000，0．003，0．004，0．001）；平均TCPD（0．79±0．15）mm与术前（0．77±0．22）mm相比，差异无统计学意义（t=-0．29，P=0．776）。术后6个月平均角膜内皮计数（2189．75±518．21）个／mm^2与术前（2405．46±624．42）个／mm^2相比，差异无统计学意义（z=1．907，P=0．057），平均抗青光眼药物由术前的（2．21±0．61）种降至术后的（0．25±0．61种），差异有统计学意义（z=5．790，P=0．000）。术后早期10只眼发生轻、中度角膜水肿，1只眼瞳孔区纤维渗出膜形成。结论合并白内障的原发性闭角型青光眼患者行超声乳化白内障吸除联合人工晶体植入术，术后前房深度明显增加，房角解剖结构得到改善，房水流出通畅，能够起到有效降低眼压的作用。
Objective To evaluate the ultrasound biomicroscopic changes of the anterior chamber and the clinical outcome after phacoemulsiftcation and intraocular lens implantation in patients with primary angle closure glaucoma （PACG） and co-existing cataract. Methods Phacoemulsification and intraocular lens implantation were performed on 20 patients （24 eyes） with PACG and co-existing cat- aract in this retrospective study. Best-corrected visual acuity （BCVA）, intraocular pressure （IOP）, cor- neal endothelial cell density, and the number of the antiglaucomatous mediation were documented preoperatively and postoperatively respectively, as well as the main complications in the early period after surgery. UBM was performed preoperatively and 6 months after surgery, and anterior chamber distance （ACD）, angle opening distances00 （AOD500）, trabecular iris angle （TIA）, angle recess area （ARA） and trabecular ciliary processes distance （TCPD） were compared preoperatively and postoperatively respectively. Variance analysis of repeated measured data, Wilcoxon rank sum test and paired t test were used to analyze the data. Results The mean follow-up period was （7.92±4.06） months. In 24 eyes, the mean BCVA improved at lweek （0.83±0.25）, 1 month （0.85±0.19）, 3 months （0.84±0.20） and 6 months （0.81±0.21） postoperatively than preoperatively （0.42±0.21） （F =113.85, P =0.000）.The mean IOP at 1 week, 1 month, 3 months, 6 months and final follow-up postoperatively were （13.88±3.64）mmHg, （13.35±2.93：）mmHg, （13.32±3.02）mmHg, （13.61±3.61） mmHg, and （13.53±3.58）mmHg respectively, which were significant lower than preoperatively （16.03±4.27）mmHg （F =6.67, P =0.000）. The mean ACD, AOD500, TIA and ARA at 6 months postopera- tively were （3.32±0.75）mm, （0.23±0.13）mm, （24.93±11.76）0, （0.17±0.22）mm2 respectively, which were significantly different from preoperatively [（1.90±0.84）mm, （0.11±0.13）mm, （11,61±11.42）° and （0.07±0.08）mm2] （Z =-3.980, t =-3.43, t =-3.33, Z =-3：123, P =0.000, 0.003, 0.004, 0.001）, while the mean TCPD （0.79±0.15）mm had not a significant difference from pre- operatively （0.77±0.22） mm （t =-0.29, P =0.776）. The mean corneal endothelial cell at 6 months postoperatively was （2189.75±518.21） cell/mm2, which had not a significant difference from that preoperatively （2405.46±624.42）cell/mm2 （Z = 1.907, P =0.057）, the mean kinds of antiglaucomatous medication decreased from （2.21±0.61） preoperatively to （0.25±0.61） 6 months postoperatively （Z =5.790, P =0.000）. The main complications in the early period after surgery were found that 10 eyes had mild and moderate corneal edema, 1 eye exudative membrane in pupil. Conclusions Phacoemulsification and ir^traocular lens implantation combined with trabeculectomy performed on the patients with PACG and co-existing cata- ract can effectively deepen the anterior chamber, and remain the configuration of the anterior chamber angle, the drainage of the aqueous humor reopen, as well, the IOP is well controlled postoperatively.
出处
《中国实用眼科杂志》
CSCD
北大核心
2012年第5期566-570,共5页
Chinese Journal of Practical Ophthalmology
