巩膜瓣下25G前段玻璃体切除术在超声乳化联合小梁切除术治疗极浅前房青光眼合并白内障中的有效性及安全性  

Efficacy and safety of 25G anterior segment vitrectomy under scleral flap in the treatment of superficial anterior chamber glaucoma complicated with cataract by phacoemulsification combined with trabeculectomy

作　　者：徐静 储昭节 范晶晶 王佳慧 XU Jing;CHU Zhao-jie;FAN Jing-jing(Department of Ophthalmology,Xi'an No.1 Hospital,Xi'an Shaanxi 710003,China.)

机构地区：[1]西安市第一医院眼科,陕西西安710003

出　　处：《临床和实验医学杂志》2022年第12期1307-1311,共5页Journal of Clinical and Experimental Medicine

基　　金：陕西省重点研发计划(编号:2021SF-335)。

摘　　要：目的探究巩膜瓣下25G前段玻璃体切除术在超声乳化联合小梁切除术治疗极浅前房青光眼合并白内障中的有效性及安全性。方法前瞻性选取2019年1月至2021年6月西安市第一医院60例极浅前房青光眼合并白内障患者作为研究对象,随机分为观察组(巩膜瓣下25G前段玻璃体切除术与超声乳化联合小梁切除术治疗)与对照组(超声乳化联合小梁切除术治疗),每组各30例。对比两组患者手术前后最佳矫正视力、眼压、前房深度及周边前房粘连范围,随访术后角膜内皮细胞丢失率、并发症发生率。结果两组患者术前眼压差异无统计学意义(P>0.05),术后1 d、1周、3个月观察组患者眼压为(12.32±3.14)、(13.12±3.23)、(13.05±3.01)mmHg,均明显低于对照组[(15.22±3.23)、(14.70±2.16)、(14.52±2.25)mmHg],差异均有统计学意义(P<0.05)。两组患者术前最佳矫正视力差异无统计学意义(P>0.05),术后1 d、1周及3个月观察组患者最佳矫正视力为(0.57±0.12),(0.67±0.15),(0.74±0.12)Log-MAR,均明显高于对照组[(0.38±0.15),(0.53±0.2),(0.62±0.18)Log-MAR],差异均有统计学意义(P<0.05);术前两组患者前房深度、周边前房粘连范围差异无统计学意义(P>0.05);术后3个月观察组患者前房深度为(3.23±0.24)μm,高于对照组[(2.70±0.21)μm],周边前房粘连范围为(85.32±25.74)°,低于对照组[(140.27±32.14)°],差异均有统计学意义(P<0.05)。随访患者术后3个月,观察组患者的角膜内皮细胞丢失率为(7.42±2.21)%,明显低于对照组[(14.26±3.54)%],差异有统计学意义(P<0.05);观察组患者并发症发生率(6.67%)明显低于对照组(26.67%),差异有统计学意义(P<0.05)。结论在超声乳化联合小梁切除术基础上联合巩膜瓣下25G前段玻璃体切除术,能够改善极浅前房青光眼合并白内障患者的眼压及视力指标,减少角膜内皮细胞的丢失,并发症少,值得推广。Objective To investigate the efficacy and safety of 25G anterior vitrectomy under scleral flap in the treatment of superficial anterior chamber glaucoma complicated with cataract by phacoemulsification combined with trabeculectomy.Methods From January 2019 to June 2021,60 patients with extremely shallow anterior chamber glaucoma combined with cataract in Xi'an No.1 Hospital were prospectively selected as the research subjects,and they were randomly divided into the observation group(25G anterior vitrectomy under the scleral flap and phacoemulsification combined with trabeculae).Resection treatment and control group(phacoemulsification combined with trabeculectomy treatment)two groups,30 cases in each group.The best corrected visual acuity,intraocular pressure,anterior chamber depth and peripheral anterior chamber adhesion range were compared between the two groups before and after surgery,and the postoperative corneal endothelial cell loss rate and complication rate were followed up.Results There was no significant difference in preoperative intraocular pressure between the two groups(P>0.05).The intraocular pressure of the observation group were(12.32±3.14)mmHg,(13.12±3.23)mmHg,(13.05±3.01)mmHg,which were significantly lower than those of the control group[(15.22±3.23)mmHg,(14.70±2.16)mmHg,(14.52±2.25)mmHg]at 1 day,1 week and 3 months after operation,and the differences were statistically significant(P<0.05).There was no significant difference in the best corrected visual acuity between the two groups before surgery(P>0.05).The best corrected visual acuity of the observation group were(0.57±0.12)Log-MAR,(0.67±0.15)Log-MAR,(0.74±0.12)Log-MAR,which were significantly higher than those of the control group[(0.38±0.15)Log-MAR,(0.53±0.2)Log-MAR,(0.62±0.18)Log-MAR]at 1 day,1 week and 3 months after the operation,and the differences were statistically significant(P<0.05).There was no significant difference in anterior chamber depth and peripheral anterior chamber adhesion between the two groups(P>0.05);3 mo

关 键 词：极浅前房青光眼 白内障 巩膜瓣 25G前段玻璃体切除术 超声乳化 小梁切除术 

分 类 号：R779.6[医药卫生—眼科]