前房穿刺术联合激光周边虹膜切除术治疗急性原发性闭角型青光眼的效果观察  

Observation on the effect of anterior chamber puncture combined with laser peripheral iridectomy in the treatment of acute primary angle closure glaucoma

作　　者：王亚明 赵雯 唐凯[2] Wang Yaming;Zhao Wen;Tang Kai(Department of Ophthalmology,Qingdao Huangdao District Traditional Chinese Medicine Hospital,Qingdao 266500,China;Department of Ophthalmology,Affiliated Eye Hospital of Shandong University of Traditional Chinese Medicine,Jinan 250001,China)

机构地区：[1]青岛市黄岛区中医医院眼科,青岛266500 [2]山东中医药大学附属眼科医院眼科,济南250001

出　　处：《中国医师进修杂志》2025年第4期378-382,共5页Chinese Journal of Postgraduates of Medicine

摘　　要：目的探讨急性原发性闭角型青光眼(PACG)患者采用前房穿刺术联合激光周边虹膜切除术(LPI)治疗的疗效。方法前瞻性选取青岛市黄岛区中医医院2019年1月至2022年12月治疗的85例(85眼)急性PACG患者,采用随机数字表法分为研究组(43例,采用前房穿刺术联合LPI治疗)和对照组(42例,采用药物降压联合LPI治疗),比较两组手术前后最佳矫正视力、眼压、角膜水肿分级、中央前房深度、房角开放范围及手术并发症发生情况。结果两组术前最佳矫正视力、眼压比较差异无统计学意义(P>0.05);两组术后3、6、12个月最佳矫正视力、眼压与本组术前比较均显著降低,且研究组低于对照组[(0.41±0.09)logMAR比(0.47±0.10)logMAR、(0.26±0.05)logMAR比(0.31±0.06)logMAR、(0.30±0.07)logMAR比(0.34±0.08)logMAR,(14.3±3.6)mmHg(1 mmHg=0.133 kPa)比(16.5±3.2)mmHg、(15.0±3.9)mmHg比(17.6±3.6)mmHg、(17.4±3.5)mmHg比(20.0±3.8)mmHg],差异有统计学意义(P<0.05)。两组术前中央前房深度、房角开放范围比较差异无统计学意义(P>0.05);两组术后3、6、12个月中央前房深度、房角开放范围均较术前升高,并且研究组高于对照组[(2.94±0.46)mm比(2.72±0.45)mm、(3.01±0.50)mm比(2.89±0.48)mm、(2.93±0.44)mm比(2.81±0.47)mm,(244.0±26.0)°比(236.1±29.5)°、(256.5±27.4)°比(248.3±30.3)°、(250.7±29.0)°比(241.5±25.4)°],差异有统计学意义(P<0.05)。两组术前角膜水肿程度分级比较差异无统计学意义(P>0.05);研究组在术后3 d角膜水肿程度分级低于对照组,差异有统计学意义(P<0.05)。研究组术后并发生发生率为4.65%(2/43),对照组为14.29%(6/42),两组并发症发生率比较差异无统计学意义(χ^(2)=2.31,P>0.05)。结论急性PACG患者采用前房穿刺术联合LPI治疗更有利于控制患者的眼压、改善视力、恢复前房深度,临床疗效肯定。ObjectiveTo explore the therapeutic effect of anterior chamber puncture combined with laser peripheral iridectomy(LPI)on patients with acute primary angle closure glaucoma(PACG).MethodsA total of 85 patients(85 eyes)with acute PACG treated in the Qingdao Huangdao District Traditional Chinese Medicine Hospital from January 2019 to December 2022 were selected and divided into the study group(43 cases,treated with anterior chamber puncture combined with LPI)and the control group(42 cases,treated with drug antihypertensive combined with LPI)by random number table method.The best corrected visual acuity,intraocular pressure,corneal edema grade,central anterior chamber depth,angle opening range and postoperative complications were compared between the two groups.ResultsBefore surgery,there were no statistical differences in the best corrected visual acuity and intraocular pressure between the two groups(P>0.05),and at 3,6 and 12 months after surgery,the best corrected visual acuity and intraocular pressure in the two groups were significantly lower than those before surgery,and the study group were lower than those in the control group:(0.41±0.09)logMAR vs.(0.47±0.10)logMAR,(0.26±0.05)logMAR vs.(0.31±0.06)logMAR,(0.30±0.07)logMAR vs.(0.34±0.08)logMAR;(14.3±3.6)mmHg(1 mmHg=0.133 kPa)vs.(16.5±3.2)mmHg,(15.0±3.9)mmHg vs.(17.6±3.6)mmHg,(17.4±3.5)mmHg vs.(20.0±3.8)mmHg,there were statistical differences(P<0.05).Before surgery,there were no statistical differences between the two groups in central anterior chamber depth and angle opening range(P>0.05),and at 3,6 and 12 months after surgery,the central anterior chamber depth and angle opening range were higher in the both groups and the study group were higher than those in the control group:(2.94±0.46)mm vs.(2.72±0.45)mm,(3.01±0.50)mm vs.(2.89±0.48)mm,(2.93±0.44)mm vs.(2.81±0.47)mm;(244.0±26.0)°vs.(236.1±29.5)°,(256.5±27.4)°vs.(248.3±30.3)°,(250.7±29.0)°vs.(241.5±25.4)°,there were statistical differences(P<0.05).There was no significant differen

关 键 词：青光眼 闭角型 前房穿刺术 激光周边虹膜切除术 角膜水肿 最佳矫正视力 

分 类 号：R779.6[医药卫生—眼科]