白内障术中房角镜指导下房角成形术治疗原发性闭角型青光眼合并白内障疗效评价  

Evaluation of clinical efficacy and safety on phacoemulsification combined with gonioscopy-assisted angle plasty for primary angle-closure glaucoma with cataract

作　　者：王瑾[1] 牟大鹏[1] 张烨[1] 王悦 孙云晓[1] 唐炘[1] 王宁利[1] Wang Jin;Mou Dapeng;Zhang Ye;Wang Yue;Sun Yunxiao;Tang Xin;Wang Ningli(Beijing Ophthalmology&Visual Science Key Laboratory,Beijing Institute of Ophthalmology,Beijing Tongren Eye Center,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China)

机构地区：[1]首都医科大学附属北京同仁医院眼科、北京同仁眼科中心、北京市眼科研究所北京市眼科与视觉科学重点实验室,北京100730

出　　处：《中华实验眼科杂志》2023年第1期47-53,共7页Chinese Journal Of Experimental Ophthalmology

基　　金：国家自然科学基金项目(82130029)。

摘　　要：目的评估超声乳化白内障吸除术中房角镜指导下房角成形术(Phaco-GAAP)治疗原发性闭角型青光眼(PACG)合并白内障的疗效及安全性。方法采用系列病例观察研究方法,于2022年4月至2022年8月在首都医科大学附属北京同仁医院纳入PACG合并白内障患者22例25眼。所有患眼均接受Phaco-GAAP手术,术中先进行黏弹剂辅助下房角成形操作,再用房角镜观察并记录术眼360°房角周边前粘连(PAS)部位及范围,对未完全开放处的房角行二次房角成形操作,记录房角PAS范围。若2次房角成形后房角PAS范围依然>180°,则术中联合内窥镜下睫状体光凝术。分别于术后1 d、1周、1个月及3个月进行随访,主要效应指标包括眼压、房角PAS范围、降眼压药物使用数量和手术并发症,计算手术成功率。手术条件成功定义为术后联合药物应用眼压可控制到≤21 mmHg,完全成功定义为术后未使用降眼压药物眼压≤21 mmHg。术后1个月、3个月评估房角PAS范围。结果25眼术前、Phaco-GAAP术中第1次和第2次房角成形后房角PAS范围分别为[270(225,360)°]、[165(110,215)°]和[100(35,175)°],总体比较差异有统计学意义(χ^(2)=40.742,P<0.001),其中术中第1次房角成形后PAS范围小于术前,第2次房角成形后PAS范围小于第1次房角成形后,差异均有统计学意义(均P<0.001)。2次房角成形后房角PAS范围≥180°的比例由48%下降到24%。随访末期完成房角镜检查的13眼术前、术毕、术后1个月及术后3个月房角PAS范围分别为[240(195,305)°]、[60(25,182.5)°]、[170(120,275)°]和[180(140,280)°],总体比较差异有统计学意义(χ^(2)=23.631,P<0.001),术后1个月、3个月术眼PAS范围明显小于术前,但均大于术毕时房角PAS范围,差异均有统计学意义(P=0.004、0.004、0.011、0.003)。术眼手术前及术后1 d、1周、1个月和3个月眼压值分别为(40.19±17.23)、(15.80±7.98)、(13.89±5.09)、(12.80±3.79)和(13.24±2.78)mmObjective To evaluate the efficacy and safety of phacoemulsification combined with gonioscopy-assisted angle plasty(Phaco-GAAP)for primary angle closure glaucoma(PACG)with cataract.Methods A case series study was carried out.Twenty-five eyes of 22 patients with PACG and cataract were enrolled in Beijing Tongren Hospital from April 2022 to August 2022.All of the patients received Phaco-GAAP surgery.During the operation,viscoelastic-assisted goniosynechialysis was performed at first,followed by a secondary angle plasty for residual peripheral anterior synechiae(PAS)based on the quantified assessment by gonioscopy,and the extent of PAS was recorded intraoperatively.The operated eyes were followed at 1 day,1 week,1 month and 3 months after surgery to evaluate intraocular pressure(IOP),PAS range,the number of anti-glaucoma drugs application,operation-related complications,and success rate.The qualified success rate was defined as medicine-controlled IOP≤21 mmHg after surgery,and complete success rate was defined as IOP≤21 mmHg without any anti-glaucoma medication.This study complied with the Declaration of Helsinki and was approved by the Ethics Committee of Beijing Tongren Hospital(TRECKY2021-136).Written informed consent was obtained from each patient prior to entering the research cohort.Results The extent of PAS was[270(225,360)°],[165(110,215)°]and[100(35,175)°]at preoperation,first and secondary angle plasty,respectively,showing a significant difference among them(χ^(2)=40.742,P<0.001).The PAS range was significantly reduced at first angle plasty in comparison with preoperation and was significantly reduced at secondary angle plasty in comparison with at first angle plasty(both at P<0.001),and the proportion of the angle PAS range≥180°decreased from 48%to 24%after second angle plasty.In 13 eyes finished gonioscopy,the PAS range was[240(195,305)°],[60(25,182.5)°],[170(120,275)°]and[180(140,280)°]at preoperation,at the end of operation,postoperative 1 month and 3 months,respectively,with a significa

关 键 词：原发性闭角型青光眼 房角成形术 周边前粘连 疗效 安全性 

分 类 号：R779.6[医药卫生—眼科]