超声乳化联合房角镜直视下房角分离术治疗原发性慢性闭角型青光眼合并白内障的临床疗效  

Phacoemulsification combined with goniosynechialysis under gonioscopy in the treatment of chronic primary angle-closure glaucoma with cataract

作　　者：李维娜 李成茂 吴晓玉 Li Weina;Li Chengmao;Wu Xinoyu(Departnent of Ophthalmolog,the 910th Hospial of the Joint Serices Support Force,Quanzhou,Fuyian 362000,China)

机构地区：[1]联勤保障部队第910医院眼科,泉州362000

出　　处：《临床眼科杂志》2023年第1期40-43,共4页Journal of Clinical Ophthalmology

基　　金：泉州市科技计划项目(2019N078S)。

摘　　要：目的评价超声乳化联合房角镜直视下房角分离术治疗原发性慢性闭角型青光眼(CPACG)合并白内障的临床疗效。方法回顾性临床研究。选取2020年1月1日至2021年6月30日我院收治的CPACG合并白内障的患者54例(74只眼),患者入院后均行白内障超声乳化摘除联合后房型人工晶状体植入术及房角镜直视下360度房角分离术。比较患者术前、术后1周、1个月、3个月、末次随访时的BCVA和眼压;比较患者术前、术后1个月、末次随访时的中央前房深度、房角粘连性关闭(PAS)范围、中央角膜内皮细胞数,并记录术中并发症和后续治疗方案。结果术后1周、1个月、3个月及末次随访患者的BCVA分布等级与术前两两相比,差异均有统计学意义(均P<0.001),术后患者BCVA均较术前提高。术后各时间点患者眼压均较术前降低,差异均有统计学意义(均P<0.001);术前患者眼压最高,术后1周眼压下降最明显,之后缓慢升高。术后1个月和末次随访时患者中央前房深度较术前均明显增加(均P<0.001)。术后1个月和末次随访时患者的PAS范围均小于术前(均P<0.001)。术前、术后1个月和末次随访时患者的角膜内皮细胞数比较,差异无统计学意义(F=0.168,P=0.846)。末次随访时69只眼压正常,5只眼>21 mmHg,随访期间1只眼再行EXPRESS引流钉植入术,1只眼再行小梁切除术。结论超声乳化联合房角镜直视下房角分离术治疗CPACG合并白内障,可以提高患者视力,降低眼压,是安全有效的治疗手段。Objective To evaluate the clinical efficacy of phacoemulsification combined with goniosynechialysis under gonioscopy in the treatment of chronic primary angle closure glaucoma(CPACG)combined with cataract.Methods Retrospective clinical study.54 patients(74 eyes)with CPACG combined with cataract admitted to our hospital from January 1,2020 to June 30,2021 were selected,and phacoemulsification combined with goniosynechialysis under gonioscopywas performed in the operation.The best corrected visual acuity(BCVA)and intraocular pressure(IOP)were compared before surgery,at 1 week,1 month,3 months after surgery,and at the last follow-up.The depth of central anterior chamber,peripheral anterior synechia(PAS)range and central corneal endothelial cell number of patients were compared before surgery,at 1 month after surgery and at the last follow-up,and intraoperative complications and follow-up treatment plan were recorded.Results The BCVA distribution grades of patients at 1 week,1 month,3 months and the last follow-up showed statistically significant differences compared with those before surgery(all P<0.001),and the BCVA of patients after surgery was improved compared with that before surgery.The intraocular pressure at all postoperative time points was lower than that before surgery,with statistical significance(P<0.001).The IOP of the patient was the highest before surgery,and decreased most obviously at 1 week after surgery,then slowly increased.The central anterior chamber depth was significantly increased at 1 month after surgery and at the last follow-up(P<0.001).The range of PAS was smaller than that before surgery at 1 month postoperatively and at the last follow-up(P<0.001).There was no significant difference in the number of corneal endothelial cells before surgery,at 1 month after surgery and at the last follow-up(F=0.168,P=0.846).At the last follow-up,69 eyes had normal intraocular pressure,and 5 eyes more than 21 mmHg.During the follow-up period,EXPRESS drainage nail implantation and trabeculectomy were per

关 键 词：原发性慢性闭角型青光眼 白内障 超声乳化 房角分离 

分 类 号：R779.6[医药卫生—眼科]