急性闭角型青光眼高眼压状态下行个体化超声乳化白内障吸除联合房角分离术的远期效果  

Long-term efficacy of individualized phacoemulsifcation combined with goniosynechialysis under high intraocular pressure in acute angle-closure glaucoma

作　　者：傅亚博 蔡雅静 吴文捷[1,3] 刘晓宝 黄煜龙 吴鑫娜 Fu Yabo;Cai Yajing;Wu Wenjie;Liu Xiaobao;Huang Yulong;Wu Xinna(Department of Ophthalmology,Fujian Provincial Hospital,Fuzhou 350000,China;Department of Ophthalmology,Longyan People′s Hospital,Longyan 364000,China;Provincial Clinical Medical College of Fujian Medical University,Fujian Medical University,Fuzhou 350000,China;Department of Ophthalmology,Zhangzhou Municipal Hospital,Zhangzhou 363000,China)

机构地区：[1]福建省立医院眼科,福州350000 [2]龙岩人民医院眼科,龙岩364000 [3]福建医科大学省立临床医学院,福州350000 [4]漳州市医院眼科,漳州363000

出　　处：《中华眼外伤职业眼病杂志》2024年第6期409-416,共8页Chinese Journal of Ocular Trauma and Occupational Eye Disease

基　　金：福建省自然科学基金(2022J011006);福建省医学创新课题(2023CXA001)。

摘　　要：目的观察个体化超声乳化白内障吸除联合房角分离术(GSL)治疗高眼压状态急性闭角型青光眼(AACG)的远期临床效果。方法前瞻性病例系列研究。连续纳入2014至2023年福建省立医院收治的抗青光眼治疗后仍处于高眼压状态的AACG患者57例(69只眼),所有患者行个体化白内障超声乳化联合GSL手术治疗。记录矫正远视力(CDVA,logMAR)、术后眼部屈光状态(以等效球镜度数表示)、角膜内皮细胞密度(CECD)、眼压、术中及术后并发症情况,并分析远期临床效果。结果本研究患者随访时长为2.5(1.3,4.0)年。CDVA术前为1.54(0.82,2.30),术后末次随访时为0.26(0.05,0.70),差异具有统计学意义(Z=-5.30,P<0.001);术后等效球镜度数为(-0.52±0.92)D;术前18只眼因术前角膜水肿严重而无法进行测量,余51只眼的CECD为(2329.39±541.03)个/mm^(2),末次随访时CECD为(1823.50±533.40)个/mm^(2)(Z=-4.20,P<0.001),眼压由术前(48.51±6.25)mmHg(1 mmHg=0.133 kPa)降至末次随访的(15.66±2.27)mmHg(Z=-5.16,P<0.001)。AACG中,针对具体眼部复杂情况分别个体化地对42只眼行角膜按压术,9只眼行角膜上皮刮除术,4只眼合并角膜上皮大泡行角膜大泡切开及层间分离处理,3只眼行前部玻璃体穿刺抽吸术,7只眼行二期人工晶状体植入术。所有患眼术后末次随访眼压控制理想,其中65只眼(94.20%)经个体化白内障超声乳化联合GSL手术治疗后无需使用任何降眼压药物,1只眼二期植入青光眼引流阀,4只眼需局部联合降眼压药控制眼压。术中、术后均无明显并发症。结论对于高眼压状态AACG患者,个体化白内障超声乳化联合GSL手术是一种安全、有效的治疗方法。ObjectiveTo observe long-term clinical efficacy of individualized phacoemulsifcation combined with goniosynechialysis(GSL)under high intraocular pressure(IOP)in acute angle-closure glaucoma(AACG).MethodsThis was a prospective case series study.Sixty-nine eyes of 57 consecutive patients with refractory AACG with high IOP treated with individualized phacoemulsifcation combined with GSL in Fujian Provincial Hospital from 2014 to 2023 were included.Preoperative and postoperative IOP,corrected distant visual acuity(CDVA,logMAR),postoperative spherical equivalent,corneal endothelial cell density(CECD),and intraoperative/postoperative complications were recorded.Long-term clinical efficacy were analyzed.ResultsThe follow-up period was 2.5(1.3,4.0)years in this study.The CDVA improved from 1.54(0.82,2.30)preoperatively to 0.26(0.05,0.70)at the last follow-up postoperatively,and the difference was statistically significant(Z=-5.30,P<0.001).Postoperative spherical equivalent was(-0.52±0.92)D.Preoperative CECD was(2309.39±541.03)cells/mm^(2)in 51 eyes,and the mean CECD of all patients was(1823.50±533.40)cells/mm^(2)(Z=-4.20,P<0.001)at the final follow-up.CECD was inaccessible in 18 eyes due to severe corneal edema.IOP decreased from(48.51±6.25)mmHg(1 mmHg=0.133 kPa)preoperatively to(15.66±2.27)mmHg at the final follow-up(Z=-5.16,P<0.001).Among the 69 eyes,additional customized procedures performed were corneal indentation in 42 eyes,epithelial debridement in 9 eyes,giant epithelial bullae view in 4 eyes,pars-plana fluid aspiration in 3 eyes,and secondary intraocular lens implantation in 7 eyes.The IOP of all eyes was well controlled eventually and 65 eyes(94.20%)were successfully treated by customized phacoemulsifcation and GSL without medicine.One eye underwent secondary implantation of glaucoma drainage valve,while 4 eyes required local combination of IOP lowering drugs to control IOP.No significant intraoperative or postoperative complications were observed.ConclusionCustomized phacoemulsifcation combined with GSL i

关 键 词：急性闭角型青光眼 角膜内皮细胞 超声乳化白内障吸除术 房角分离 眼压 

分 类 号：R779.6[医药卫生—眼科]