PEI联合术中房角镜下房角分离及房角切开术治疗中晚期PACG合并白内障  

Phacoemulsification with intraocular lens implantation plus goniosynechialysis and goniotomy under intraoperative gonioscope for the treatment of advanced primary angle-closure glaucoma with cataract

作　　者：高思佳 闻郁 万茜茜[1] 刘贺婷[1] 陶黎明[1] Gao Sijia;Wen Yu;Wan Qianqian;Liu Heting;Tao Liming(Department of Ophthalmology,the Second Hospital of Anhui Medical University,Hefei 230601,Anhui Province,China)

机构地区：[1]安徽医科大学第二附属医院眼科,安徽省合肥市230601

出　　处：《国际眼科杂志》2024年第6期864-869,共6页International Eye Science

基　　金：安徽医科大学校自然科学基金项目(No.2020xkj202)。

摘　　要：目的:评价超声乳化白内障吸除人工晶状体植入术(PEI)联合术中房角镜直视下房角分离术(GSL)及房角切开术(GT)治疗中晚期原发性闭角型青光眼(PACG)合并白内障的效果。方法:回顾性病例系列研究方法。收集2021-12-01/2023-03-31在安徽医科大学第二附属医院手术的中晚期PACG合并白内障患者62例65眼,根据手术方式不同分为两组:观察组30例32眼行PEI+GSL+GT,对照组32例33眼行PEI+GSL。评估两组患者术前,术后1 d, 1 wk, 1、3、6 mo眼压、最佳矫正视力(BCVA)和抗青光眼药物使用数量。术前和术后6 mo时分别评估视野、杯盘比、前房角开放范围、前房深度、RNFL平均厚度。结果:PEI+GSL+GT组术后6 mo眼压和平均眼压降幅(16.68±2.65、11.12±8.53 mmHg)与PEI+GSL组(18.71±2.51、8.32±4.17 mmHg)有显著差异(P<0.05),眼压降幅率无差异(44.57%±21.79%和35.20%±17.94%,P>0.05)。术后6 mo两组抗青光眼药物使用数量、BCVA、前房深度、房角关闭范围均较术前改善(均P<0.01),PEI+GSL+GT组术后6 mo的药物减少数量和房角开放范围均大于PEI+GSL组(P<0.05),其余指标两组间比较均无差异(均P>0.05)。两组术后6 mo的视野平均偏差、杯盘比及RNFL平均厚度较术前均无差异(均P>0.05)。PEI+GSL+GT组手术完全成功率为81%(26/32),手术条件成功率为94%(30/32);PEI+GSL组手术完全成功率为58%(19/33),手术条件成功率为76%(25/33)。两组间手术成功率均有差异(完全成功率χ^(2)=4.275,P=0.039;条件成功率χ^(2)=4.040,P=0.044)。两组患者均未见危及视力的并发症及再次手术。结论:对于中晚期原发性闭角型青光眼合并白内障患者,采用PEI+GSL+GT治疗比PEI+GSL治疗更有效。AIM:To evaluate the efficacy of phacoemulsification with intraocular lens implantation(PEI)combined with goniosynechialysis(GSL)and goniotomy(GT)under direct vision with gonioscope in the treatment of advanced primary angle-closure glaucoma(PACG)combined with cataract.METHODS:Retrospective case series study.A total of 62 patients(65 eyes)with advanced PACG combined with cataract who were treated in the Second Hospital of Anhui Medical University from December 1,2021 to March 31,2023 were enrolled,and they were divided into two groups according to different surgical methods.The control group(32 cases,33 eyes)received PEI+GSL,whereas the observation group(30 cases,32 eyes)received PEI+GSL+GT.The intraocular pressure(IOP),best corrected visual acuity(BCVA)and the number of anti-glaucoma medications of the two groups before surgery and at 1 d,1 wk,1,3,and 6 mo after surgery were evaluated.In addition,the visual field,cup-to-disc ratio(C/D),angle open range,anterior chamber depth,and average thickness of retinal nerve fiber layer(RNFL)were evaluated before and 6 mo after surgery.RESULTS:There were significant differences in IOP and lowering range of average IOP at 6 mo between the PEI+GSL+GT group(16.68±2.65,11.12±8.53 mmHg)and the PEI+GSL group(18.71±2.51,8.32±4.17 mmHg;P<0.05),and there was no difference in the rate of IOP reduction(44.57%±21.79%and 35.20%±17.94%,P>0.05).The number of anti-glaucoma medications,BCVA,anterior chamber depth,and angle closure range were improved in the two groups at 6 mo after operation(all P<0.01).The number of medication reductions and the range of angle opening at 6 mo after surgery in the PEI+GSL+GT group were significantly higher than those in the PEI+GSL group(P<0.05),and there was no difference in the other indicators between the two groups(all P>0.05).There was no difference in the mean deviation of visual field,C/D and average thickness of RNFL between the two groups at 6 mo after operation compared with those before operation(all P>0.05).The complete surgery success rate

关 键 词：原发性闭角型青光眼(PACG) 白内障 房角切开术 房角分离术 微创青光眼手术 超声乳化白内障吸除人工晶状体植入(PEI) 前房角镜检查 

分 类 号：R779.6[医药卫生—眼科]