摘要
目的:探讨青光眼白内障联合手术治疗急性闭角型青光眼慢性期合并白内障患者术后房角功能。方法:回顾性系列病例分析。2017年11月至2018年3月在河南省人民医院青光眼中心收治的急性闭角型青光眼慢性期合并白内障患者37例(37眼)。患者为青光眼急性期发作后经药物治疗3~14 d,术前眼压高于21 mmHg(1 mmHg=0.133 kPa);房角关闭范围>2个象限;超声生物显微镜(UBM)示前房变浅,周边虹膜根部与小梁网贴附范围>2个象限;晶状体核混浊度≥Ⅲ级。所有患眼均行常规双切口小梁切除+超声乳化白内障吸除+人工晶状体植入+房角分离术,术中均未使用抗代谢药物,巩膜瓣常规可调节缝线密闭缝合。术前术后观察患者的最佳矫正视力(BCVA)、眼压、中央前房深度、前房角开放程度及滤过泡形成情况。采用Wilcoxon符号秩和检验、方差分析、配对t检验及Pearson相关分析对各项观察指标进行分析。结果:术后7 d时眼压为(18.8±1.7)mmHg,较术前明显下降(t=16.562,P<0.001),15例患者形成滤过泡。术后1个月眼压为(15.5±1.8)mmHg,较术前明显下降(t=20.529,P<0.001),仅有5例患者存在功能性滤过泡。术后半年,眼压为(14.9±2.4)mmHg,23例患者术后眼压<16 mmHg,14例患者术后眼压介于16~20 mmHg之间,较术前眼压明显下降(t=24.458,P<0.001);UBM示所有患者术后房角重新开放范围>2个象限,术后眼压与术前房角粘连程度无相关关系(r=0.016,P=0.926);术后中央前房深度较术前加深(t=-25.195,P<0.001);33例患者术后BCVA较术前提高,4例患者术后BCVA较前无改善,术前术后BCVA差异具有统计学意义(Z=-5.017,P<0.001);5例患者术后上方结膜可见功能性滤过泡形成,32例患者术后未见明显滤过泡,UBM也证实结膜下无有效滤过泡形成。结论:对于急性闭角型青光眼慢性期合并白内障患者,行双切口小梁切除+超声乳化白内障吸除+人工晶状体植入+房角分离术可有效降低眼压。眼压的下降很可能是房角区小梁网功能的恢复,而不是依赖于外滤过通道的建立。
Objective:To investigate the functioning of the anterior chamber angle after combined surgery in the treatment of the chronic phase of acute angle-closure glaucoma with cataract.Methods:A retrospective analysis was performed on 37 patients(37 eyes)in the chronic phase of acute angle-closure glaucoma with cataract who were treated in the glaucoma center of Henan Provincial People's Hospital from November 2017 to March 2018:All patients were treated with drugs after an acute attack for 3-14 days;preoperative intraocular pressure(IOP)was higher than 21 mmHg;gonioscopic examination:angle closure>2 quadrant;ultrasound biomicroscopy(UBM):Anterior chamber shallow,peripheral iris root and trabecular meshwork attachment range>2 quadrant;lens nuclear turbidity≥Ⅲ.All patients underwent conventional double-incision surgery combined with trabeculectomy,phacoemulsi fication cataract extraction,intraocular lens implantation,and angle separation.No anti-metabolite drugs were used during the surgery.The scleral flap was tightly closed with an adjustable suture.The best corrected visual acuity(BCVA),IOP,central anterior chamber depth,angle opening range and filtration bleb formation were observed before and after surgery.The Wilcoxon test,analysis of variance,paired t test and Pearson correlation were used to analyze the observation index.Results:At 7 days after surgery:The mean IOP was 18.8±1.7 mmHg,which was signi ficantly lower than IOP before surgery(t=16.562,P<0.001);filtration blebs were observed in 15 patients.At 1 month after surgery:The mean IOP was 15.5±1.8 mmHg,which was significantly lower than IOP before surgery(t=20.529,P<0.001);only 5 patients had functional filtering blebs.A half year after surgery:The average IOP was 14.9±2.4 mmHg,the IOP of 23 patients was<16 mmHg,and 14 patients were between 16-20 mmHg,which was statistically signi ficant compared with preoperative IOP(t=24.458,P<0.001);UBM:All patients had a reopening range of>2 quadrants after surgery,and there was no correlation between postoperative IOP and preoperative anterior angle(r=0.016,P=0.926);the depth of the central anterior chamber was deeper than before surgery(t=-25.195,P<0.001);the postoperative BCVA of 33 patients was improved compared with BCVA before surgery,the BCVA of 4 patients did not improve,the difference in BCVA before and after surgery was statistically signi ficant(Z=-5.017,P<0.001);5 patients had functional filtering blebs formation in the upper conjunctiva,32 patients had no obvious filtering blebs after surgery,ultrasound biomicroscopy also con firmed that no effective filtering blebs formed under the conjunctiva.Conclusions:For patients in the chronic phase of acute angle-closure glaucoma with cataract,combined trabeculectomy plus cataract surgery plus angle separation can effectively reduce intraocular pressure.The decrease in intraocular pressure is likely to depend on the recovery of the function of the trabecular meshwork,rather than to rely on the establishment of an external filtration channel.
作者
楚莹莹
杨潇远
朱海燕
李海军
董仰曾
Yingying Chu;Xiaoyuan Yang;Haiyan Zhu;Haijun Li;Yangzeng Dong(Department of Ophthalmology,Zhengzhou Children's Hospital,Henan Children's Hospital,Zhengzhou University Affiliated Children's Hospital,Zhengzhou 450000,China;Henan Eye Hospital,Henan Eye Institute,the People's Hospital of Henan Province,Zhengzhou 450003,China)
出处
《中华眼视光学与视觉科学杂志》
CAS
CSCD
2020年第1期8-13,共6页
Chinese Journal Of Optometry Ophthalmology And Visual Science
关键词
急性闭角型青光眼
慢性期
青光眼白内障联合手术
房角功能
acute angle-closure glaucoma
chronic phase
glaucoma and cataract combined surgery
the function of anterior chamber angle
