单纯房角分离术和超声乳化联合房角分离术治疗慢性闭角型青光眼远期疗效比较  

Long-term efficacy comparison between goniosynechialysis and combination of phacoemulsification with goniosynechialysis for the management of chronic angle closure glaucoma

作　　者：朱靖[1] 赵伟[1] 邵珺[1] 鲍迅[1] 林菁[1] 傅东红[1] 姚勇[1] 

机构地区：[1]南京医科大学附属无锡人民医院眼科,无锡214023

出　　处：《中华实验眼科杂志》2013年第10期964-967,共4页Chinese Journal Of Experimental Ophthalmology

基　　金：基金项目：江苏省眼病研究一无锡市眼病流行病学调查基金项目（WKF0811）

摘　　要：背景 原发性闭角型青光眼（PACG）的主要病理基础是周边虹膜粘连所致的房水排出受阻,眼压升高.近年来,房角分离术和超声乳化联合房角分离术治疗PACG的方法已逐渐用于临床,但手术方式的选择对手术的成功率有明显影响. 目的 探讨单纯房角分离术和超声乳化联合房角分离术治疗慢性PACG的长期疗效及手术方式的选择.方法 采取非随机对照的临床研究设计,纳入2008年3月至2011年2月在南京医科大学附属无锡人民医院眼科治疗的慢性PACG患者110例,按照手术适应证的不同分为两组,其中78例78眼行晶状体超声乳化摘出术±人工晶状体（IOL）植入联合房角分离术为联合手术组,34例34眼接受单纯180°房角分离术为单纯房角分离组.所有患者均随访2年,记录并比较患者术眼手术前后视力、眼压、前房深度、超声生物显微镜（UBM）检查及视野的改变.患者手术前后视力、眼压和房角深度的差异比较均采用配对t检验. 结果 单纯房角分离组患者术后2年的视力为0.45±0.15,与术前的0.65±0.15比较差异无统计学意义（t=1.57,P＞0.05）；而联合手术组患者术后视力为0.85±0.05,明显高于术前的0.25±0.15,差异有统计学意义（t=9.12,P＜0.001）.单纯房角分离组术眼术后2年的眼压为（14.2±4.1）mmHg（1 mmHg=0.133 kPa）,联合手术组术眼为（13.7±4.8） mmHg,分别低于术前的（47.2±6.3） mmHg和（46.9±7.0）mmHg,差异均有统计学意义（t=4.95,P＜O.001；t=5.03,P＜0.001）.单纯房角分离组和联合手术组术前房角深度分别为（1.33±0.24） mm和（1.56±0.37）mm,术后分别增加至（3.38-0.02） mm和（3.54±0.03）mm,差异均有统计学意义（t=7.65,P＜0.001；t=6.76,P＜0.001）. 结论 单纯180°房角分离术和晶状体超声乳化摘出术＋IOL植入联合房角分离术治疗慢性PACG均能有效控制眼压,但临床上手术方式的选择应充分考虑适应证.Background One of the features of the pathogenesis of primary angle-closure glaucoma（PACG） is anterior synechia of peripheral iris.Goniosynechialysis and combination of phacoemulsification and goniosynechialysis have been applied for the treatment of the disease recently,but the selection of operative types has great impact on clinical efficacy.Objective This study was to investigate the long-term efficacy of goniosynechialysis and combination of phacoemulsification and goniosynechialysis for the management of chronic PACG.Methods A non-randomized clinical controlled trial was designed.This clinical trial complied with Declaration of Helsinki and was approved by Medical Ethic Committee of Nanjing Medical University.Written informed consent was obtained from each patient.One hundred and ten eyes of 110 patients with chronic PACG were assigned to the goniosynechialysis group and combined operative group from March,2008 to February,2011 in Wuxi People＇s Hospital.180° goniosynechialysis was performed on 34 patients in the goniosynechialysis group,and phacoemulsifieation ＋intraocular lens （IOL） implantation ＋ goniosynechialysis were carried out in 78 patients of the combination operative group.All the patients were followed-up for 2 years.Vision acuity,intraocular pressure （IOP）,anterior chamber depth（ACD）,unltrasound biomicroscopy and perimetry were recorded and compared between before and after operation.Results No significant difference was found in vision acuity between preoperation and postoperative 2 years in the goniosynechialysis group （[0.65 ± 0.15] vs.[0.45 ± 0.15]） （t =1.57,P〉0.05）,but in the combination operative group,the vision acuity was significantly different between the before and after operation （[0.25±0.15] vs.[0.85 ±0.05]） （t =9.12,P〈0.001）.The lOPs at 2 years after operation were （14.2±4.1） mmHgand（13.7±4.8） mmHg,respectively in the goniosynechialysis group and combination operative group and were significantly lower than（47.2 ±6.3） mm

关 键 词：房角分离术 闭角型青光眼 白内障 晶状体超声乳化摘出术 

分 类 号：R775[医药卫生—眼科]