白内障摘出联合睫状体光凝或小梁切除术治疗原发性闭角型青光眼效果及对眼表的影响  

Comparison of curative effect and ocular surface changes after cyclophotocoagulation or trabeculectomy combined with cataract surgery for primary angle closure glaucoma

作　　者：陈源[1] 陈海英[1] 项晓丽[1] 陈可 俞晶晶 黄正如[1] CHEN Yuan;CHEN Haiying;XIANG Xiaoli;CHEN Ke;YU Jingjing;HUANG Zhengru(Department of Opthalmology,Changshu No.2 People’s Hospital,Changshu 215500,Jiangsu Province,China)

机构地区：[1]常熟市第二人民医院眼科,江苏省常熟市215500

出　　处：《眼科新进展》2021年第7期660-663,共4页Recent Advances in Ophthalmology

基　　金：苏州市临床重点项目诊疗技术专项项目(编号LCZX201825)。

摘　　要：目的比较晶状体超声乳化术联合睫状体光凝术(CPC)或晶状体超声乳化术联合小梁切除术(CPT)治疗原发性闭角型青光眼(PACG)的效果及对眼表的影响。方法纳入合并白内障行手术治疗的PACG患者101例(101眼),并根据接受手术方式的不同分为两组CPC组患者接受CPC,共46例(46眼);CPT组接受CPT,共55例(55眼)。两组均以术眼的对侧眼为组内自身对照。收集入院时及术后1 d、4周时术眼眼压,并对入院时及术后4周抗青光眼药物的使用情况进行统计分析;对术眼及其对侧眼进行眼表疾病指数(OSDI)评估和泪河高度(TMH)、首次非侵入性泪膜破裂时间(NIBUTf)、平均泪膜破裂时间(NIBUTav)检测,组内对术眼与其对侧眼进行比较,组间对术眼与对侧眼的差值进行比较。结果术后1 d,CPC、CPT两组患者术眼眼压分别为(21.6±3.2)mmHg(1 kPa=7.5 mmHg)和(13.8±4.1)mmHg,差异有统计学意义(P=0.00);术后4周,CPC、CPT两组术眼眼压分别为(14.0±2.8)mmHg和(14.4±3.2)mmHg,差异无统计学意义(P=0.46)。术后4周CPC组和CPT组患者使用抗青光眼药物数量比较,差异无统计学意义(P=0.53)。术后4周,CPC组术眼与对侧眼OSDI评分为(35.52±11.54)分和(24.70±9.09)分,TMH为(0.28±0.11)mm和(0.37±0.14)mm,NIBUTf为(7.54±3.32)s和(13.77±4.05)s,NITBUTav为(10.77±3.10)s和(16.75±3.77)s,组内比较差异均有统计学意义(均为P=0.00);CPT组术眼与对侧眼OSDI评分为(42.02±10.55)分和22(18,27)分,TMH为(0.17±0.08)mm和(0.32±0.12)mm,NIBUTf为(5.13±2.00)s和(13.96±4.39)s,NITBUTav为(8.41±2.39)s和(16.33±4.83)s,组内比较差异均有统计学意义(均为P=0.00)。CPC组和CPT组术眼与对侧眼差值的组间比较,OSDI、TMH、NIBUTf、NITBUTav差异均有统计学意义(均为P<0.05)。结论CPC与CPT对PACG控制眼压效果相近,但CPC对眼表的损伤更轻,患者术后眼部自觉症状更少。Objective To compare the anti-glaucoma efficacy and ocular surface interference after combined phacoendoscopic cyclophotocoagulation(CPC)and combined phacotrabeculectomy(CPT)in the treatment of primary angle closure glaucoma(PACG).Methods A total of 101 patients(101 eyes)suffered from PACG complicated with cataract were divided into two groups according to surgical methods,and 46 patients(46 eyes)received CPC were in CPC group,and the other 55 patients(55 eyes)undergoing CPT were in CPT group.The contralateral eye of the surgery one was defined as self-control.Data related to anti-glaucoma effect,for example intraocular pressure(IOP)at entrance,on day 1 and the 4th week post-surgery,and anti-glaucoma drugs at entrance and 4th week post-surgery were collected for further comparison.In addition,ocular surface indexes including ocular surface disease index(OSDI),tear meniscus height(TMH),first noninvasive tear breakup time(NIBUTf)and average non-invasive tear film break-up time(NITBUTav)were applied to evaluate ocular surface status.The indexes were compared within group between surgical eyes and their contralateral ones while the deviations derived from surgical eyes and contralateral ones were compared between groups.Results On day 1 after surgery,the IOP of surgical eyes was(21.6±3.2)mmHg(1 kPa=7.5 mmHg)in the CPC group compared with(13.8±4.1)mmHg in CPT group(P=0.00).At the 4th week after surgery,the IOP of surgical eyes was(14.0±2.8)mmHg in CPC group and(14.4±3.2)mmHg in CPT,no statistically difference was found(P=0.46).In addition,the difference in quantity of anti-glaucoma drugs at 4th week post-surgery between the two groups was of no statistical significance(P=0.53).For ocular surface evaluation,the indexes of surgical eyes and contralateral ones in CPC group at 4th week post-surgery were shown as followsOSDI(35.52±11.54)points vs.(24.70±9.09)points,TMH(0.28±0.11)mm vs.(0.37±0.14)mm,NIBUTf(7.54±3.32)s vs.(13.77±4.05)s,NITBUTav(10.77±3.10)s vs.(16.75±3.77)s,and the differences were statistically

关 键 词：青光眼 白内障 白内障手术 小梁切除术 睫状体光凝术 眼压 眼表 

分 类 号：R775[医药卫生—眼科]