探讨23 G微创前段玻璃体切割及青光眼白内障联合手术对恶性青光眼患者眼压及前房结构的影响  

Effect of 23 G minimally invasive anterior vitrectomy combined with glaucoma and cataract surgery on intraocular pressure and anterior chamber structure in patients with malignant glaucoma.

作　　者：杨璐舟 王刚[1] 钱玖林 YANG Lu-zhou;WANG Gang;QIAN Jiu-lin(Department of Ophthalmology,Bazhong Central Hospital,Bazhong Sichuan 636000,China.)

机构地区：[1]巴中市中心医院眼科,四川巴中636000

出　　处：《临床和实验医学杂志》2022年第19期2103-2107,共5页Journal of Clinical and Experimental Medicine

基　　金：2019年度四川省医学科学研究重点课题(编号:20190112003)。

摘　　要：目的探讨23 G微创前段玻璃体切割及青光眼白内障联合手术在恶性青光眼治疗中的应用价值。方法采用前瞻性研究,选取2019年1月至2021年12月在巴中市中心医院眼科治疗的恶性青光眼患者115例,根据患者住院病历号末尾奇偶数分为实验组(n=60)和对照组(n=55),对照组给予青光眼滤过+虹膜周边切除+前房成形+白内障超声乳化吸出+人工晶状体植入术,实验组在对照组基础上给予23 G微创前段玻璃体切除手术。于手术后1周、1个月和3个月时随访,观察两组手术前后视力、眼压和前房结构差异,并填写美国国立眼科研究所视功能生存质量量表(NEI-VFQ-25)。结果手术后1周和1个月,实验组最佳矫正视力(BCVA)分别为0.32±0.11和0.49±0.12,明显高于对照组(0.27±0.10、0.40±0.13),而眼压分别为(25.51±6.03)、(18.65±4.55)mmHg,明显低于对照组[(30.03±5.88)、(21.17±4.80)mmHg],差异均有统计学意义(P<0.05)。手术后3个月,实验组中央前房深度(ACD)、前房容积(ACV)、房角开放距离(AOD)和小梁虹膜夹角(TIA)分别为(3.72±0.80)mm、(144.45±20.03)m^(3)、(0.57±0.13)mm和(33.45±5.69)°,明显高于对照组[(3.03±0.95)mm、(131.21±21.15)m^(3)、(0.50±0.12)mm和(28.89±6.10)°],差异均有统计学意义(P<0.05)。实验组视功能生存质量量表(NEI-VFQ-25)总体视力、周边视力、眼痛、近距离活动、远距离活动、精神健康评分分别为(62.26±8.16)、(80.03±9.10)、(80.87±8.87)、(77.46±9.93)、(78.89±8.45)和(68.89±6.65)分,明显高于对照组[(56.69±9.03)、(75.23±9.05)、(76.69±9.12)、(70.25±9.17)、(73.35±8.17)和(62.25±7.03)分],差异均有统计学意义(P<0.05)。结论23 G微创前段玻璃体切割及青光眼白内障联合手术治疗恶性青光眼有较好的效果,明显改善患者眼压、前房结构及生活质量。Objective To evaluate the value of 23 G minimally invasive anterior vitrectomy combined with glaucoma and cataract surgery in the treatment of malignant glaucoma.Methods Using prospective studies,115 patients with malignant glaucoma treated in the Department of Ophthalmology of Bazhong Central Hospital from January 2019 to December 2021 were enrolled and divided into experimental group(n=60)and control group(n=55)according to the parity of the number at the end of the medical record number.The control group was given glaucoma filtering combined with peripheral iridectomy,anterior chamber plasty,cataract phacoemulsification and intraocular lens implantation surgery,the experimental group was given 23 G minimally invasive anterior segment vitrectomy on the basis of the control group.At 1 week,1 month and 3 months after operation,the differences of visual acuity,intraocular pressure and anterior chamber structure between the two groups were compared,and the National Eye Institute Visual Function Questionnaire-25(NEI VFQ-25)was completed.Results One week and one month after operation,the best corrected visual acuity(BCVA)of the experimental group were 0.32±0.11 and 0.49±0.12,which were significantly higher than those in the control group(0.27±0.10,0.40±0.13),and the intraocular pressure in the experimental group were(25.51±6.03)and(18.65±4.55)mmHg,which were significantly lower than those in the control group[(30.03±5.88),(21.17±4.80)mmHg],the differences were statistically significant(P<0.05).Three months postoperatively,the central anterior chamber depth(ACD),anterior chamber volume(ACV),chamber angle opening distance(AOD)and trabecular iris angle(TIA)in the experimental group were(3.72±0.80)mm,(144.45±20.03)m^(3),(0.57±0.13)mm and(33.45±5.69)°respectively,which were significantly higher than those in the control group[(3.03±0.95)mm,(131.21±21.15)m^(3),(0.50±0.12)mm and(28.89±6.10)°],the differences were statistically significant(P<0.05).The scores of overall visual acuity,peripheral visual acuity

关 键 词：恶性青光眼 微创前段玻璃体切割 治疗效果 

分 类 号：R779.6[医药卫生—眼科]