改良的扁平部玻璃体放液用于青光眼白内障联合手术治疗伴晶状体悬韧带异常的闭角型青光眼的疗效观察  

Efficacy of improved pars plana vitreous drainage in the combined surgery of glaucoma and cataract for angle closure glaucoma with abnormal lens suspensory ligament

作　　者：尹瑞梅 陈琳[2] 王涛[2] Yin Ruimei;Chen Lin;Wang Tao(Department of Ophthalmology,Liaocheng People’s Hospital,Liaocheng,Shandong 252000,China;Beijing Tongren Eye Center,Beijing Tongren Hospital,Capital Medical University,Beijing Key Laboratory of Ophthalmology and Visual Science,Beijing 100730,China)

机构地区：[1]聊城市人民医院眼科,山东聊城252000 [2]首都医科大学附属北京同仁医院、北京同仁眼科中心眼科学与视觉科学北京市重点实验室,北京100730

出　　处：《眼科》2023年第5期403-408,共6页Ophthalmology in China

摘　　要：目的分析改良的扁平部玻璃体放液用于青光眼白内障联合手术治疗伴晶状体悬韧带异常的闭角型青光眼的效果。设计回顾性病例系列。研究对象2021年1月至2023年2月北京同仁医院伴有晶状体悬韧带异常的闭角型青光眼,经多种药物治疗后仍持续高眼压状态,术中应用改良扁平部玻璃体放液的青光眼患者18例(18眼)。方法所有患者均施行术中改良的扁平部玻璃体放液、超声乳化白内障摘除、一期囊袋内植入IOL、宽基底的虹膜周边切除。联合张力环植入者11例,联合小梁切除术5例,联合内窥镜下睫状体光凝术3例。术后平均随访(8.3±3.6)个月。主要指标前房深度、视力、眼压、抗青光眼药物数量及手术并发症情况。结果最后一次随访时,所有患者视力均较术前提高,平均提高(3.7±2.2)行。16/18眼在未使用降眼压药物情况下,眼压7~21 mmHg,2/18眼在术后6个月时用一种局部降眼压药物下眼压正常。术中放液后所有患者眼压下降、前房较穿刺前加深。术中、术后均无严重并发症发生。结论改良的扁平部玻璃体放液是青光眼白内障联合手术治疗伴晶状体悬韧带异常的闭角型青光眼安全有效的手段。Objective To analyze the therapeutic effect of improved pars plana vitreous drainage in the combined surgery of glaucoma and cataract for angle closure glaucoma with abnormal lens suspensory ligament.Design Retrospective case series.Participants 18 patients(18 eyes)with angle closure glaucoma with abnormal lens suspension ligament were reviewed from January 2021 to February 2023 in Beijing Tongren Hospital.Methods All patients were treated with improved pars plana vitreous drainage,phacoemulsification and cataract extraction.All patients were implanted with intraocular lens(IOL)in the bag at the first stage.All patients were treated with wide base peripheral iridectomy.11 patients were implanted with capsular tension ring,5 patients with trabeculectomy,and 3 patients with ciliary body photocoagulation under endoscope.The average postoperative follow-up was(8.3±3.6)months.Main Outcome Measures Anterior chamber depth(ACD),visual acuity(VA),intraocular pressure(IOP),number of anti glaucoma drugs used,and surgical complications.Result At the last follow-up,all patients'VA improved compared to before surgery,with an average improvement of(3.7±2.2)lines on the standard VA chart.16/18 eyes maintained 7~21 mmHg without the use of IOP lowering drugs and 2/18 eyes maintained normal IOP 6 months after surgery with the addition of a local IOP lowering drug.After the improved pars plana vitreous drainage,all patients had a decrease in IOP during surgery,and the ACD deepened compared to before drainage.No serious complications occurred during or after the surgery in all patients.Conclusion The improved pars plana vitreous drainage is a safe and effective method for the combined surgery of glaucoma and cataract in the treatment of angle closure glaucoma with abnormal lens suspensory ligament.

关 键 词：青光眼/外科学 晶状体悬韧带 扁平部玻璃体放液 

分 类 号：R779.6[医药卫生—眼科]