房角粘连分离联合Phaco与单纯Phaco治疗小范围房角粘连的CPACG伴白内障疗效比较  

A comparison study on goniosynechialysis+ phacoemulsification versus simple phacoemulsification for CPACG with PAS≤180° combined cataract

作　　者：陈瑶 程钢炜[1] Chen Yao;Cheng Gangwei(Department of Ophthalmology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Ophthalmology,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China)

机构地区：[1]中国医学科学院北京协和医院眼科,100730 [2]首都医科大学附属北京天坛医院眼科,100070

出　　处：《中华实验眼科杂志》2021年第10期885-891,共7页Chinese Journal Of Experimental Ophthalmology

摘　　要：目的比较房角粘连分离联合白内障超声乳化术(Phaco-GSL)与单纯Phaco治疗周边虹膜前粘连(PAS)≤180°慢性原发性闭角型青光眼(CPACG)伴白内障患者的疗效。方法采用队列研究方法,收集2014年2月至2018年10月在北京协和医院接受Phaco-GSL和单纯Phaco的CPACG伴白内障患者40例52眼。根据患者手术方式不同分为Phaco-GSL组22例29眼和单纯Phaco组18例23眼。于术前和术后1 d,1周,1、3、6、12、18个月分别采用Goldmann压平眼压计测量术眼眼压,采用标准对数视力表测量术眼最佳矫正视力(BCVA),计算患者所用降眼压药物数量的变化,采用超声生物显微镜和四面压陷式房角镜观察术眼PAS变化,对术中、术后并发症及其处理进行分析和比较。结果Phaco-GSL组和单纯Phaco组眼压组间总体比较差异无统计学意义(F_(组别)=1.569,P=0.223),2个组术眼手术前后不同时间点眼压总体比较,差异有统计学意义(F_(时间)=7.762,P<0.01),其中2个组术后1周及以后各时间点眼压均较各自组内术前值显著下降,差异均有统计学意义(均P<0.001)。Phaco-GSL组和单纯Phaco组术眼BCVA组间总体比较差异无统计学意义(F_(组别)=1.996,P=0.172),2个组术眼手术前后BCVA总体比较差异有统计学意义(F_(时间)=95.737,P<0.01),其中2个组术后6个月和18个月BCVA较各自组内术前值均显著提高,差异均有统计学意义(均P<0.001)。与术前比较,2个组术后降眼压药物使用数量均减少,差异均有统计学意义(均P<0.05);Phaco-GSL组术后降眼压药物使用数量明显少于单纯Phaco组,2个组间降眼压药物使用数量术后6、12、18个月比较差异均有统计学意义(均P<0.05)。与术前比较,Phaco-GSL组术后各时间点PAS程度均明显减轻,差异均有统计学意义(均P<0.05);术后18个月,Phaco-GSL组和单纯Phaco组PAS程度分别为45(0,90)°和100(90,140)°,术后各时间点Phaco-GSL组的PAS程度均低于单纯Phaco组,差异均有统计学意义(均PObjective To compare the efficacy of phacoemulsification+goniosynechialysis(Phaco-GSL)and Phaco alone for chronic primary angle-closure glaucoma(CPACG)patients with peripheral anterior synechia(PAS)≤180°combined cataract.Methods A cohort study was performed.Fifty-two eyes with CPACG in 40 patients who underwent Phaco-GSL and Phaco-alone in Peking Union Medical College Hospital from February 2014 to October 2018 were enrolled.The patients were divided into Phaco-GSL group(22 cases,29 eyes)and Phaco-alone group(18 cases,23 eyes)according to different surgeries.Goldmann applanation tonometer was used to measure intraocular pressure(IOP)before operation and 1 day,1 week and 1,3,6,12,18 months after operation.Best corrected visual acuity(BCVA)was examined with a standard logarithmic visual acuity chart.The number of anti-glaucoma drugs was calculated in the follow-up duration.The change of PAS was observed by ultrasound biomicroscopy and indentation gonioscopy.The intra-and post-operative complications and their management were analyzed and compared.This research protocol adhered to the Declaration of Helsinki and was approved by an Ethics Committee of Peking Union Medical College Hospital(No.S-K1352).Written informed consent was obtained from each subject prior to any medical examination.Results There was no significant difference in IOP between the Phaco-GSL group and the Phaco-alone group(F_(group)=1.569,P=0.223).A significant difference was found in IOP among various time points in different groups(F_(time)=7.762,P<0.01).The IOP of the eyes were significantly reduced at various time points postoperatively in comparison with the preoperative IOP in each group(all at P<0.001).There was no significant intergroup difference in BCVA(F_(group)=1.996,P=0.172),however,a significant difference was found in BCVA among different time points in both groups(F_(time)=95.737,P<0.01).The postoperative 6-and 18-month BCVA was significantly improved in comparison with before surgery in both groups(all at P<0.001).The number of a

关 键 词：房角粘连分离术 白内障超声乳化术 慢性原发性闭角型青光眼 周边前粘连 

分 类 号：R779.6[医药卫生—眼科]