年轻原发性慢性闭角型青光眼周边虹膜切除术与小梁切除术的疗效比较  

Comparison of peripheral iridectomy and trabeculectomy in younger patients with chronic primary angle-closure glaucoma

作　　者：林树芬 苏毅华[2] 钟毅敏[1] 肖辉[1] 朱颖婷[1] 方蕾 陈立明 刘杏[1] Lin Shufen;Su Yihua;Zhong Yimin;Xiao Hui;Zhu Yingting;Fang Lei;Chen Liming;Liu Xing(State Key Laboratory of Ophthalmology,Zhongshan Ophthalmic Center,Sun Yat-sen University,Guangdong Provincial Key Laboratory of Ophthalmology Visual Science,Guangdong Provincial Clinical Research Center for Ocular Diseases,Guangzhou 510060,China;Ophthalmology Department of the First Affiliated Hospital,Sun Yat-sen University,Guangzhou 510080)

机构地区：[1]中山大学中山眼科中心眼病防治全国重点实验室/广东省眼科视觉科学重点实验室/广东省眼部疾病临床医学研究中心,广州510060 [2]中山大学附属第一医院眼科,广州510080

出　　处：《眼科》2024年第4期261-266,共6页Ophthalmology in China

基　　金：广东省自然科学基金(2022A1515011469);广东省医学科学技术研究基金(20201127141137226)。

摘　　要：目的比较周边虹膜切除术(surgical peripheral iridectomy,SPI)与小梁切除术(trabeculectomy,Trab)治疗进展期和晚期年轻原发性慢性闭角型青光眼(chronic primary angle-closure glaucoma,CPACG)的疗效与安全性。设计回顾性比较性病例系列。研究对象2012年1月至2022年12月首次在中山大学中山眼科中心行Trab或SPI、年龄≤40岁的进展期或晚期CPACG连续病例48例(67眼)。方法按手术方式分为Trab组与SPI组,其中Trab组15例(22眼),SPI组33例(45眼)。记录视力、Goldmann眼压、影像学及视野检查的结果,比较两组手术成功率及手术并发症发生率、术前与术后的眼部参数情况。主要指标最佳矫正视力、眼压、中央前房深度、降眼压药物种类、房角开放距离、前房夹角、手术成功率。结果48例CPACG患者中位数年龄为32.0(24.3,36.0)岁。Trab组术后平均随访19.6±22.2月;SPI组术后平均随访39.1±20.9个月。Trab组手术成功率为45.5%(10/22眼);SPI组手术成功率80.0%(36/45眼)。SPI组的手术成功率高于Trab组(χ^(2)=15.528,P<0.001)。Trab组与SPI组的术前最佳矫正视力、眼压、中央前房深度、降眼压药物种类无统计学差异,而Trab组的房角开放距离和前房夹角较SPI组小(Z=-2.174,P=0.030;Z=-2.107,P=0.035)。末次随访时,与Trab组相比,SPI组最佳矫正视力较好(Z=-2.310,P=0.021)、中央前房深度较深(Z=-4.615,P<0.001)、房角开放距离与前房夹角较大(均Z=-3.924,P<0.001),而眼压较高(Z=-2.455,P=0.014)、降眼压药物种类较多(Z=-5.721,P<0.001)。Trab组术后并发症发生率59.1%(13/22眼),包括浅前房11眼,恶性青光眼2眼;SPI组术后并发症发生率6.7%(3/45眼),均为伤口渗漏;Trab组的术后并发症发生率高于SPI组(P<0.001)。结论≤40岁CPACG患者行Trab手术成功率较低且手术并发症较多;SPI联合降眼压药物治疗成功率较高且手术并发症较少。对≤40岁的CPACG患者即使是进展期或晚期患者,首次手术可以考虑Objective To compare the efficacy and safety of surgical peripheral iridectomy and trabeculectomy for young patients with chronic primary angle-closure glaucoma(CPACG).Design Retrospective comparative case series.Participants Consecutive cases of intermediate and advanced-staged CPACG,aged 40 years or younger,who underwent either trabeculectomy(Trab)or surgical peripheral iridectomy(SPI)as an initial treatment at Zhongshan Ophthalmic Center between January 2012 and December 2022 were enrolled,including 48 patients(67 eyes).Methods The patients were divided into two groups:the Trab group and the SPI group.There were 15 cases(22 eyes)in Trab group and 33 cases(45 eyes)in SPI group.The results of ocular examinations were recorded,including visual acuity,intraocular pressure(IOP),slit-lamp microscopy,fundus examination,gonioscopy,A-scan ultrasonography,ultrasound biomicroscopy,spectral domain optical coherence tomography,and visual field test.Ocular parameters before and after the operation,success rate and incidence of complication were compared between groups.Main Outcome Measures Best corrected visual acuity(BCVA),IOP,anterior chamber depth(ACD),the number of glaucoma medications,the angle opening distance 500μm from the scleral spur(AOD500),anterior chamber angle(ACA)and surgical success rate.Results A total of 48 PACG patients(67 eyes)were enrolled,including 10 males and 38 females.The median age was 32.0(24.3-36.0)years old.The mean duration of follow up for Trab group and SPI group was 19.6±22.2 months and 39.1±20.9 months,respectively.The success rate of Trab group was 45.5%(10/22).The success rate of SPI group was 80.0%(36/45),which was higher than that of Trab group(χ2=15.528,P<0.001).No difference was found in BCVA,IOP,ACD and the number of glaucoma medications between Trab group and SPI group before surgery,and AOD500 and ACA were wider in SPI group(Z=-2.174,P=0.030;and Z=-2.107,P=0.035).At the last visit,BCVA was better(Z=-2.310,P=0.021),ACD was deeper(Z=-4.615,P<0.001),AOD500 and ACA was wider(both

关 键 词：闭角型青光眼 小梁切除术 周边虹膜切除术 

分 类 号：R779.6[医药卫生—眼科]