原发性急性闭角型青光眼前房穿刺降压对角膜内皮细胞的影响  

Impact of Anterior Chamber Paracentesis on Corneal Endothelial Cells in Acute Primary Angle-Closure Glaucoma

作　　者：刘歆 沈嘉琪 邵玉婷 林慧 毕燕龙[2] Xin Liu;Jiaqi Shen;Yuting Shao;Hui Lin;Yanlong Bi(Department of Ophthalmology,Guizhou Provincial People's Hospital,Guiyang 550000,China;Department of Ophthalmology,Tongji Hospital,School of Medicine,Tongji University,Shanghai 200092,China)

机构地区：[1]贵州省人民医院眼科,贵阳550000 [2]同济大学附属同济医院眼科,上海200092

出　　处：《中华眼视光学与视觉科学杂志》2024年第12期928-934,共7页Chinese Journal Of Optometry Ophthalmology And Visual Science

基　　金：贵州省科技计划项目(黔科合基础-(2024)青年302)

摘　　要：目的:探讨急性高眼压下反复前房穿刺降压对角膜内皮细胞的影响。方法:回顾性病例对照研究。随机选取2021年1月至2023年12月同济大学附属同济医院眼科原发性闭角型青光眼急性发作合并白内障并行白内障超声乳化吸除联合人工晶状体植入联合房角分离的患者35例(35眼)。根据术前是否进行过前房穿刺放液将患者分为单纯药物组和药物+前房穿刺组。收集患者术前最高眼压和穿刺前后眼压以及眼压降低幅度、眼轴长度(AL)、前房深度(ACD)、穿刺次数;术中超声乳化累计释放能量(CDE);术前和术后1、3个月患者的最佳矫正视力(BCVA)、眼压、角膜内皮细胞密度(ECD)、术后抗青光眼药物使用数量等数据。使用重复测量方差分析、独立样本t检验及Mann Whitney非参数检验进行数据分析。结果:2组患者在年龄、性别、发病到就诊时间和术前抗青光眼药物使用、BCVA、AL、ACD、术前ECD以及术中超声乳化CDE、最高眼压和眼压降低幅度等方面差异均无统计学意义(均P>0.05)。药物+前房穿刺组术前眼压高于单纯药物组[(25.4±3.9)mmHgvs.(20.0±6.0)mmHg,t=3.05,P=0.005]。药物+前房穿刺组术前穿刺(1.7±0.8)次。与术前比较,术后2组BCVA均显著升高(均P<0.001),组间BCVA差异无统计学意义;术后2组抗青光眼药物使用数量明显减少(均P<0.001),组间差异无统计学意义;术后2组患者眼压控制良好,组间眼压差异无统计学意义;术后2组ECD均显著下降(P<0.001),且药物+前房穿刺组ECD在术后1、3个月时均显著低于单纯药物组(均P<0.05)。前房穿刺次数与术后1个月(r=-0.52,P=0.001)及术后3个月(r=-0.65,P<0.001)ECD呈负相关;术前最高眼压与术后1个月ECD呈负相关(r=-0.35,P=0.041);术前眼压与术后ECD无相关性。结论:急性高眼压下反复前房穿刺可能会对角膜内皮细胞造成损伤。Objective:To investigate the impact of anterior chamber paracentesis(ACP)on corneal endothelial cells(CECs)under acute elevated intraocular pressure(IOP).Methods:A retrospective case-control study was conducted.From January 2021 to December 2023,35 eyes with acute primary angle-closure glaucoma undergoing phacoemulsification,intraocular lens implantation,and goniosynechialysis at Tongji Hospital were randomly selected.Patients were divided into two groups:a simple medication group and a medication+ACP group based on whether ACP was performed before surgery.Preoperative data including the highest IOP,IOP before paracentesis,IOP after paracentesis,IOP reduction,axial length(AL),anterior chamber depth(ACD),and the number of ACPs were collected.Intraoperative data including cumulative dissipated energy(CDE)were also collected.Preoperative and postoperative best corrected visual acuity(BCVA),IOP,endothelial cell density(ECD),and antiglaucoma medication usage were recorded.Data were analyzed using repeated measures analysis of variance,independent sample t-test and Mann-Whitney U test for nonparametric data.Results:There were no significant differences between the two groups in age,gender,time from onset to treatment,preoperative use of antiglaucoma medication,preoperative BCVA,preoperative AL,preoperative ACD,preoperative ECD,CDE,preoperative highest IOP,or IOP reduction.The preoperative IOP in the medication+ACP group was significantly higher than that in the simple medication group[(25.4±3.9)mmHg vs.(20.0±6.0)mmHg,t=3.05,P=0.005].The average number of preoperative ACPs was 1.7±0.8.After surgery,BCVA improved significantly in both groups compared to preoperative values(all P<0.001),with no significant difference between the groups.Antiglaucoma medication usage was significantly reduced(all P<0.001)postoperatively,but there was no statistically significant difference between the two groups.Both groups showed good control of IOP after surgery with no significant difference.After surgery,both groups showed a signific

关 键 词：原发性急性闭角型青光眼 前房穿刺 角膜内皮细胞 眼压 

分 类 号：R779.6[医药卫生—眼科]