AACG合并白内障患者急性发作期行超声乳化联合小梁切除手术后房角功能及临床疗效观察  

Observation on the chamber angle function and clinical efficacy of phacotrabeculectomy in the acute angle-closure glaucoma with cataract

作　　者：张进松[1] 刘少勤[1] 杨南 Zhang Jinsong;Liu Shaoqin;Yang Nan(Department of Ophthalmology.the Second People's Hospital of Anqing City,Anhui Province,China,246004)

机构地区：[1]安徽省安庆市第二人民医院眼科,246004

出　　处：《临床眼科杂志》2022年第2期138-142,共5页Journal of Clinical Ophthalmology

摘　　要：目的观察青光眼白内障联合手术治疗原发性急性闭角型青光眼(AACG)合并白内障的患者术后房角功能的变化及临床疗效。方法回顾性病例分析。收集2015年1月至2019年12月就诊于我院的急性闭角型青光眼合并白内障的患者53例(53只眼),患者为急性发作期经降眼压药物治疗后,房角关闭范围≥3个象限,超声生物显微镜(UBM)示前房变浅,周边虹膜与小梁网贴附范围>2个象限,晶状体核混浊度≥Ⅲ级。所有患者均行青白联合手术。术后随访6个月以上,比较术前、术后最佳矫正视力、平均眼压、平均前房深度、前房角开放程度及滤过泡形成情况。结果所有患者均顺利完成手术。术后1周、1个月及半年的平均BCVA较术前显著提高(P<0.01);而术后各组间的BCVA无统计学差异。术前患者的平均眼压(45.7±10.6)mmHg,术后各随访时间点的眼压较术前显著降低(P<0.01)。术后1周所有患眼滤过泡形成;术后1个月有45例患者存在功能性滤过泡;术后6个月39例患者术后功能性滤过泡形成。术前患者的平均房角关闭为3.4±0.3象限,术后明显改善;术后1周、1个月及6个月的房角关闭较术前明显改善(P<0.01)。术后半年时的眼压与术前房角关闭程度无相关性(r=0.12,P=0.79)。术后1周、1个月及6个月的平均中央前房深度较术前显著加深,差异有统计学意义(P<0.01)。术后患眼均无视网膜脱离、脉络膜出血等严重并发症发生。结论急性闭角型青光眼合并白内障的患者急性期行青光眼白内障联合手术是安全有效的,而且可以有效降低眼压,恢复房角功能,促进患者的视功能恢复。Objective To observe the chamber angle function and clinical efficacy of phacotrabeculectomy in patients with acute angle-closure glaucoma(AACG)with cataract.Methods A retrospective analysis was conducted based on 53 patients(53 eyes)who were diagnosed with acute angle-closure glaucoma combined with cataract from January 2015 to December 2019.All of the patients were treated with intraocular pressure-lowering drugs in acute stage,and their chamber angle was closed≥3 quadrants.Moreover,the ultrasound biomicroscopy(UBM)showed a shallow anterior chamber,the peripheral iris and trabecular meshwork attached range>2 quadrants and lens nucleus turbidity≥Ⅲgrades.All of the patients were treated with phacoemulsification and trabeculectomy.The follow-up duration was 6 months after operation.Statistical analyses were performed in terms of the best corrected visual acuity(BCVA),average intraocular pressure(IOP),average anterior chamber depth,anterior chamber angle opening and filtering bleb before and after surgery.Results All of the patients successfully finished the surgery.The mean BCVA at 1 week,1 month,and 6 months after surgery were significantly improved as compared to that before the surgery(P<0.01);whereas,there was not statistically different in BCVA between the postoperative groups.The postoperative mean IOP was(45.7±10.6)mmHg and was significantly lower than preoperative mean IOP at all postoperative follow-ups(P<0.01).All of the patients formed filtering blebs at 1 week after the surgery;45 patients had functional filtering blebs at 1 month after the surgery;and 39 patients remained at 6 months after the surgery.The preoperative mean atrial angle closure was 3.4±0.3 quadrants,and significantly improved at 1 week,1 month and 6 months after the surgery(P<0.01).The postoperative IOP at 6 months did not correlate with the degree of preoperative atrial angle closure(r=0.12,P=0.79).The postoperative mean central anterior chamber depth at 1 week,1 month and 6 months were statistically significant deeper than pr

关 键 词：急性闭角型青光眼 房角功能 青光眼白内障联合手术 小梁切除 

分 类 号：R779.6[医药卫生—眼科]