PEI联合房角分离术及房角切开术治疗中晚期PACG疗效及安全性评估  

Outcomes and safety of phacoemulsification combined with intraocular lens implantation plus goniosynechialysis and goniotomy for advanced primary angle-closure glaucoma

作　　者：宋云河 张英哲 林凤彬 聂昕 施继光 陈太峰[4,5] 梁小红 王贞玉 魏孟欢 陈姝宇 张秀兰 Song Yunhe;Zhang Yingzhe;Lin Fengbin;Nie Xin;Shi Jiguang;Chen Taifeng;Liang Xiaohong;Wang Zhenyu;Wei Menghuan;Chen Shuyu;Zhang Xiulan(State Key Laboratory of Ophthalmology,Zhongshan Ophthalmic Center,Sun Yat-sen University,Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science,Guangdong Provincial Clinical Research Center for Ocular Diseases,Guangzhou 510060,China;Department of Ophthalmology,Chongqing General Hospital,Chongqing 400014,China;Enshi Huiyi Eye Hospital,Enshi 445000,China;Department of Ophthalmology,The First People's Hospital of Pingdingshan,Pingdingshan 467000,China;Zhongshan Ophthalmic Center for advanced study)

机构地区：[1]中山大学中山眼科中心,眼科学国家重点实验室,广东省眼科视觉科学重点实验室,广东省眼部疾病临床研究中心,广州510060 [2]重庆市人民医院眼科,重庆400014 [3]恩施慧宜眼科医院,恩施445000 [4]平顶山市第一人民医院眼科,平顶山467000 [5]中山大学中山眼科中心

出　　处：《中华实验眼科杂志》2022年第4期334-339,共6页Chinese Journal Of Experimental Ophthalmology

摘　　要：目的评估超声乳化白内障摘出人工晶状体植入术(PEI)联合房角分离术(GSL)及房角切开术(GT)治疗中晚期原发性闭角型青光眼(PACG)的有效性和安全性。方法采用系列病例观察性研究方法,于2020年8月至2021年6月在中山大学中山眼科中心连续纳入中晚期PACG患者50例50眼,所有患眼均接受PEI+GSL+GT,随访时间至少6个月,平均随访7.5(6,10)个月。采用Goldmann压平眼压计测定患者手术前后眼压;采用ETDRS视力表测定患眼最佳矫正视力(BCVA),并转换为LogMAR视力分析;收集抗青光眼用药种类及数量信息和手术并发症资料。计算患眼手术成功率,完全成功定义为术后不使用任何抗青光眼药物眼压为5~18 mmHg(1 mmHg=0.133 kPa)且眼压较基线下降20%,无威胁视力的并发症,无需接受额外的抗青光眼手术,无光感丢失;条件成功定义为使用或不使用抗青光眼药物达到上述条件。结果术眼术前平均眼压为(28.81±7.81)mmHg,末次随访平均眼压为(13.41±4.10)mmHg,术后眼压较术前显著下降,差异有统计学意义(t=12.260,P<0.001);与术前比较,术后眼压平均降低13.80(9.10,19.40)mmHg,降幅为51.1%(38.6%,67.1%)。术前平均BCVA为(0.92±0.11)LogMAR,术后末次随访时为(0.88±0.10)LogMAR,手术前后BCVA比较差异无统计学意义(t=-0.560,P=0.580)。术前平均使用降眼压药物2(1,3)种,术后为0(0,0)种。手术完全成功率为80%(40/50),条件成功率为94%(47/50)。术中和术后并发症主要包括前房积血7眼,一过性眼压升高7眼,角膜水肿3眼,未出现威胁视力的并发症。结论PEI+GSL+GT治疗中晚期PACG能够有效降低眼压、减少降眼压药物的使用种类和数量,手术安全性好。Objective To evaluate the effectiveness and safety of phacoemulsification cataract extraction combined with intraocular lens implantation(PEI)plus goniosynechilysis(GSL)and goniotomy(GT)for advanced primary angle-closure glaucoma(PACG).Methods An observational case series study was performed.Fifty eyes of 50 patients with advanced PACG were enrolled in Zhongshan Ophthalmic Center from August 2020 to June 2021.All the patients received PEI+GSL+GT and were followed up for over 6 months,with a mean follow-up of 7.5(6,10)months.Intraocular pressure(IOP)was measured with a Goldmann applanation tonometer.Best corrected visual acuity(BCVA)was examined with an ETDRS chart and converted to logarithm of the minimum angle of resolution(LogMAR)units for analysis.Types and number of anti-glaucoma medications applied before and after surgery,and the surgical complications were collected.Success rate of surgery was calculated.Complete surgical success was defined as an IOP of 5-18 mmHg(1 mmHg=0.133 kPa)with a reduction of 20%from baseline without anti-glaucoma medication,no vision-threatening complications,no loss of light perception,and no reoperation.Qualified success was defined as an IOP of 5-18 mmHg with a reduction of 20%from baseline with or without anti-glaucoma medication,no vision-threatening complications,no loss of light perception,and no reoperation.This study adhered to the Declaration of Helsinki.This research protocol was approved by an Ethics Committee of Zhongshan Ophthalmic Center(No.2021KYPJ177).Written informed consent was obtained from each subject before entering the cohort.Results The mean preoperative IOP was(28.81±7.81)mmHg,and the IOP at the end of follow-up was(13.41±4.10)mmHg,showing a statistically significant decrease(t=12.260,P<0.001).The postoperative IOP was decreased by 13.80(9.10,19.40)mmHg,with a percentage decrease of 51.1%(38.6%,67.1%).The mean preoperative and postoperative BCVA was(0.92±0.11)LogMAR and(0.88±0.10)LogMAR,respectively,and no significant difference was found(t=-0.560,P=0

关 键 词：青光眼/手术疗法 疗效 安全性 闭角型青光眼 微创青光眼手术 房角切开术 超声乳化白内障摘出术 

分 类 号：R779.6[医药卫生—眼科]