激光虹膜成形术与超声乳化人工晶状体植入手术对闭角型青光眼合并白内障的临床观察  

Clinical Observation on Treatment of Cataract Accompanied by Angle-Closure Glaucoma with laser Irisplasty,Phacoemulsification and Intraocular Lens Implantation

作　　者：张健[1] 张帆[1] 任安娜 越海成 ZHANG Jian;ZHANG Fan;REN An-na;YUE Hai-cheng(Department of Ophthalmology,Beijing Pinggu District Hospital,Beijing 101200,China)

机构地区：[1]北京市平谷区医院眼科,北京市101200

出　　处：《中国激光医学杂志》2020年第4期213-218,共6页Chinese Journal of Laser Medicine & Surgery

摘　　要：目的观察激光虹膜成形术与超声乳化人工晶状体植入术对闭角型青光眼合并白内障患者近期视力矫正和安全性的影响。方法回顾性分析2016年5月至2018年5月,急性期闭角型青光眼合并白内障患者59例62只眼,按照双盲随机分成对照组和激光组两组。对照组患者29例30只眼,采用超声乳化人工晶状体植入治疗;观察组30例32只眼,采用激光虹膜成形术联合超声乳化人工晶状体植入手术治疗,激光治疗波长532 nm,光斑直径400μm,功率200~500 mW,曝光时间0.2 s。术后1个月,比较两组患者功能型滤泡形成情况;术后3个月,记录两组患者最佳矫正视力(best corrected visual acuity,BCVA)、裸眼视力(uncorrected visual acuity,UVA)和眼压变化(intraocular pressure,IP);术后7d,1和3个月,比较两组患者前房深度和房角开放度。并记录患者术后1个月并发症发生率。结果术后1个月,观察组功能型滤泡形成率(87.5%)高于对照组(66.7%),差异具有统计学意义(P<0.05);术后3个月,观察组BCVA、UVA和IP均优于对照组(P<0.05);术后7d,1和3个月,两组患者前房深度和房角开放度与术前比较,均不得增加,差异具有统计学意义(P<0.05);术后1个月,观察组并发症发生率(9.38%)显著低于对照组(30.0%),差异具有统计学意义(P<0.05)。结论激光虹膜成形术联合超声乳化人工晶状体植入治疗闭角型青光眼合并白内障,可有效缓解患者眼内压、恢复眼内生理形态、改善视力功能,并发症风险较低,值得临床推广。Objective To explore the effects of laser irisplasty phacoemulsification and intraocular lens implantation on the near-term vision correction,corneal endothelial cells,inflammatory factor levels and safety of cataract patients with angle-closure glaucoma.Methods Totally 59 patients(62 eyes)of acute angle-closure glaucoma accompanied by cataract from May 2016 to May 2018 were randomly divided into two groups:the control group and laser group.The 30 eyes of 29 patients in the control group were treated with phacoemulsification and intraocular lens implantation,and the 32 eyes of 30 patients in the observation group with laser irisplasty(power:200-500 mW,exposure time:0.2 s)One month after the surgery,the functional follicle formation,best corrected visual acuity(BCVA),uncorrected visual acuity(UVA)and intraocular pressure(IP)was compared between the two groups.The patient’s complication rate was calculated and recorded 1 month after the operation.Results One month after the operation,the rate(87.5%)of functional follicle formation in the observation group was significantly higher than that(66.7)in the control group,and the difference was statistically significant(P<0.05);As to 3 months postoperative BCVA,UVA and IP in both groups being significantly improved(P<0.05),.The incidence of complications in the observation group was 9.38%a month after the operation,which was much lower than that in the control group,namely,30.0%.The difference was statistically significant(P<0.05).Conclusions In the treatment of angle-closure glaucoma accompanying cataract,the combination of laser irisoplasty with phacoemulsification and intraocular lens implantation will effectively relieve the intraocular pressure,restore the intraocular physiology,improve the visual function,and reduce the risk of complications.It is hence worthy to be promoted.

关 键 词：激光虹膜成形术 闭角型青光眼 白内障 超声乳化 人工晶状体 

分 类 号：R616.4[医药卫生—外科学] R775[医药卫生—临床医学]