谷户钩Schlemm管切开联合白内障手术治疗原发性闭角型青光眼的效果  

Efficacy of Phaco-Tanito microhook ab-interno trabeculotomy for primary angle-closure glaucoma

作　　者：陈洁 黄正如[1] 项晓丽[1] Chen Jie;Huang Zhengru;Xiang Xiaoli(Department of Ophthalmology,Changshu NO.2 People’s Hospital,Affiliated Changshu Hospital of Nantong University,Changshu 215500,China)

机构地区：[1]常熟市第二人民医院眼科、南通大学附属常熟医院,常熟215500

出　　处：《中华眼外伤职业眼病杂志》2023年第10期767-772,共6页Chinese Journal of Ocular Trauma and Occupational Eye Disease

摘　　要：目的观察谷户钩Schlemm管切开联合白内障手术治疗原发性闭角型青光眼的短期效果。方法回顾性病例系列研究。分析常熟市第二人民医院2021年12月至2022年12月伴有白内障的原发性闭角型青光眼21例(21眼)的临床资料。所有患者均接受白内障超声乳化、前房角分离及谷户钩Schlemm管切开三联手术治疗。术后随访至少6个月,观察眼压、最佳矫正视力(BCVA,logMAR)及前房角开放距离(AOD500)、视网膜神经纤维层厚度及并发症情况。结果患者术前眼压为26.00(23.50,29.50)mmHg(1 mmHg=0.133 kPa),术后各时间点眼压明显降低(χ^(2)=16.38,df=5,P=0.006):术后1 d、1周、1个月、3个月及末次随访眼压依次为17.00(14.00,21.50)mmHg、18.00(15.25,23.00)mmHg、16.50(14.00,18.00)mmHg、15.50(13.75,18.25)mmHg以及15.00(13.25,19.50)mmHg。末次随访BCVA 0.22(0.10,0.35)较术前0.82(0.35,1.00)提高,差异有统计学意义(χ^(2)=20.19,df=2,P<0.001)。术前AOD500为0.16(0.09,0.36)mm,术后加深至0.63(0.52,0.66)mm,差异有统计学意义(Z=-2.67,P=0.008)。术后有4例出现前房积血,其中1例在术后6 d进行前房冲洗后视力及眼压平稳,无活动性前房积血发生。结论谷户钩Schlemm管切开联合白内障手术在短期内可降低原发性闭角型青光眼患者的眼压,并改善视力。Objective To observe the efficacy of Phaco-Tanito microhook ab-interno trabeculotomy for the treatment of primary angle-closure glaucoma.Methods This was a retrospective case series study.From Dec.2021 to Dec.2022,the clinical data of 21 eyes of 21 cases with primary angle-closure glaucoma with cataract in Changshu No.2 People’s Hospital were analyzed retrospectively.All cases underwent Phaco-Tanito microhook ab-interno trabeculotomy.Best corrected visual acuity(BCVA,logMAR),intraocular pressure(IOP),angle-opening distance at 500μm(ADD500),retina nerve fiber layer and complications were observed.The follow-up time was 6 months.Result sIn all patients,preoperative IOP was 26.00(23.50,29.50)mmHg,and IOP was 17.00(14.00,21.50)mmHg at 1 day postoperatively,18.00(15.25,23.00)mmHg at 7 days after operation,16.50(14.00,18.00)mmHg at 1 month after operation,15.50(13.75,18.25)mmHg at 3 months after operation and 15.00(13.25,19.50)mmHg at the last follow-up,respectively(1 mmHg=0.133 kPa).Postoperative IOP decreased at each time point after operation(χ^(2)=16.38,df=5,P<0.006).BCVA improved from 0.82(0.35,1.00)preoperatively to 0.22(0.10,0.35)postoperatively at the final examination(χ^(2)=20.19,df=2,P<0.001).AOD500 was 0.16(0.09,0.36)mm preoperatively and 0.63(0.52,0.66)mm at the final examination(Z=-2.67,P=0.008).There were 4 patients with hyphema after operation,and 1 patient received anterior chamber irrigation.Conclusion Phaco-Tanito microhook ab-interno trabeculotomy is effective for primary angle closure glaucoma with cataract.It helps to control the intraocular pressure,to relieve retinal nerve fiber layer,and to improve visual function.

关 键 词：青光眼 闭角型 原发性 白内障 晶状体乳化术 超声 粘小管切开术 

分 类 号：R779.6[医药卫生—眼科]