应用UBM观察闭角型青光眼合并白内障超声乳化术后眼前节变化  

Changes of the structure of the anterior chamber after phacoemulsification in primary angle closure glaucoma with cataract by ultrasound biomicroscopy

作　　者：李世玮[1] 吴强[1] 陆斌[1] 王文清[1] 方健[1] 

机构地区：[1]上海交通大学附属第六人民医院眼科,上海200233

出　　处：《中国实用眼科杂志》2012年第5期566-570,共5页Chinese Journal of Practical Ophthalmology

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�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）° an

关 键 词：超声生物显微镜 超声乳化术 青光眼 白内障 

分 类 号：R779.66[医药卫生—眼科]