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中华眼科医学杂志(电子版) ›› 2023, Vol. 13 ›› Issue (05) : 263 -267. doi: 10.3877/cma.j.issn.2095-2007.2023.05.002

论著

超声乳化白内障吸除联合后房型人工晶状体植入及前房角镜下前房角分离术治疗急性闭角型青光眼合并白内障的临床研究
张志宏, 吕爱国, 路平, 郭丽, 崔宏宇, 胡建华, 王立芳, 王延岭, 范肃洁()   
  1. 056001 邯郸市眼科医院(邯郸市第三医院)青光眼科
  • 收稿日期:2023-09-16 出版日期:2023-10-28
  • 通信作者: 范肃洁
  • 基金资助:
    河北省医学适用技术跟踪项目(GZ2022094)

Therapeutic effects of goniosynechialysis under the gonioscope and phacoemulsification cataract extraction combined with posterior chamber intraocular lens implantation on acute angle closure glaucoma complicated with cataract

Zhihong Zhang, Aiguo Lyn, Ping Lu, Li Guo, Hongyu Cui, Jianhua Hu, Lifang Wang, Yanling Wang, Sujie Fan()   

  1. Glaucoma Department, Handan City Eye Hospital The Third Hospital of Handan), Handan 056001, China
  • Received:2023-09-16 Published:2023-10-28
  • Corresponding author: Sujie Fan
引用本文:

张志宏, 吕爱国, 路平, 郭丽, 崔宏宇, 胡建华, 王立芳, 王延岭, 范肃洁. 超声乳化白内障吸除联合后房型人工晶状体植入及前房角镜下前房角分离术治疗急性闭角型青光眼合并白内障的临床研究[J/OL]. 中华眼科医学杂志(电子版), 2023, 13(05): 263-267.

Zhihong Zhang, Aiguo Lyn, Ping Lu, Li Guo, Hongyu Cui, Jianhua Hu, Lifang Wang, Yanling Wang, Sujie Fan. Therapeutic effects of goniosynechialysis under the gonioscope and phacoemulsification cataract extraction combined with posterior chamber intraocular lens implantation on acute angle closure glaucoma complicated with cataract[J/OL]. Chinese Journal of Ophthalmologic Medicine(Electronic Edition), 2023, 13(05): 263-267.

目的

观察超声乳化白内障吸除联合后房型人工晶状体植入及前房角镜下前房角分离术治疗急性闭角型青光眼(AACG)合并白内障的效果,并分析患者术后屈光误差的影响因素。

方法

选取2020年4月至2022年6月于邯郸市眼科医院就诊AACG合并白内障患者148例(148只眼)的临床资料。其中,男性40例(40只眼),女性108例(108只眼);年龄45~76岁,平均年龄(58.8±9.9)岁。所有患者均接受超声乳化白内障吸除联合后房型人工晶状体植入及前房角镜下前房角分离术治疗。检查并记录所有患者术前和术后3个月最佳矫正视力(BCVA)、眼压、降眼压药物使用种类、前房角开放距离(AOD)500、角膜曲率、眼轴长度、中央前房深度(ACD)及并发症的情况。BCVA、眼压、AOD500、角膜曲率、眼轴长度及ACD符合正态分布,采用±s表示,术前术后的比较采用配对样本t检验;降眼压药物使用种类和并发症情况不符合正态分布,采用中位数和四分位数表示,术前术后的比较采用Wilcoxon符号秩和检验。术后屈光误差与BCVA变化量、眼压变化量、AOD500、眼轴长度缩短量及ACD加深量的相关性采用Pearson相关分析。

结果

术前所有患者平均最小分辨率角的对数(logMAR)BCVA、眼压、降眼压药物使用种类、AOD500、角膜曲率、眼轴长度及ACD分别为(0.32±0.07)、(25.17±4.08)mmHg(1 mmHg=0.133 kPa)、3(3,4)种、(0.15±0.03)mm、(44.72±0.83)D、(21.69±0.55)mm及(1.91±0.43)mm;术后3个月分别为(0.06±0.02)、(16.34±3.19)mmHg、0(0,0)种、(0.57±0.12)mm、(44.69±0.85)D、(21.57±0.59)mm及(3.65±0.40)mm。术前与术后3个月患者BCVA、眼压、AOD500、眼轴长度及ACD的差异均有统计学意义(t=70.290,29.552,-68.127,2.561,-51.007;P<0.05);降眼压药物使用种类的差异有统计学意义(Z=-15.777,P<0.05)。术后发生一级前房出血者9例(9只眼),前房渗出者6例(6只眼),高眼压者9例(9只眼),均经药物控制治疗后恢复。术后屈光误差与术后眼轴长度缩短量及ACD加深量呈正相关,且有统计学意义(r=0.392,0.423;P<0.05)。

结论

超声乳化白内障吸除术联合后房型人工晶状体植入及前房角镜下前房角分离术,可有效地开放前房角,加深前房,降低眼压,提高BCVA,并且术后并发症轻微;术后眼轴长度缩短量和ACD加深量是术后屈光误差的影响因素。

Objective

The aim of this study is to observe the therapeutic effects of goniosynechialysis under gonioscope and phacoemulsification cataract extraction combined with posterior chamber intraocular lens implantation on acute angle-closure glaucoma (AACG) complicated with cataract, and analyze the influencing factors of postoperative refractive errors.

Methods

The clinical data of 148 patients (148 eyes) with AACG complicated with cataract treated in Handan Eye Hospital from April 2020 to June 2022 were selected. Among them, there were 40 males (40 eyes) and 108 females (108 eyes) ranged from 45 to 76 years with an average age of (58.8±9.9) years. All patients underwent phacoemulsification cataract extraction combined with posterior chamber intraocular lens implantation and goniosynechialysis under gonioscope. The best corrected visual acuity (BCVA), intraocular pressure, types of intraocular pressure-lowering drugs, angle opening distance (AOD)500, corneal curvature, axial length, central anterior chamber depth (ACD) and complications were recorded before and after surgery for 3 months. The BCVA, intraocular pressure, AOD500, corneal curvature, axial length and ACD followed a normal distribution and were expressed as ±s. Paired sample t test was used to compare the preoperative and postoperative data. The types of intraocular pressure-lowering drugs and complications did not meet the normal distribution and were expressed as median and interquartile range, compared by the Wilcoxon signed rank test before and after surgery. Pearson correlation analysis was used to analyze the correlation between postoperative refractive error and changes in BCVA, intraocular pressure, AOD500, shortening of axial length, and deepening of ACD.

Results

The preoperative logarithm of the mean minimum resolution angle (logMAR) BCVA, intraocular pressure, types of intraocular pressure-lowering drugs, AOD500, corneal curvature, axial length, and ACD of all patients were (0.32±0.07), (25.17±4.08) mmHg (1 mmHg=0.133 kPa), and 3 (3, 4)types, (0.15±0.03) mm, (44.72±0.83) mm, (21.69±0.55) mm and (1.91±0.43) mm. After operation for 3 months, they were (0.06±0.02), (16.34±3.19) mmHg, 0 (0, 0)type, (0.57±0.12) mm, (44.69±0.85) D, (21.57±0.59) mm and (3.65±0.40) mm, respectively. There were significant differences in BCVA, intraocular pressure, AOD500, axial length and ACD before and after surgery (t=70.290, 29.552, -68.127, 2.561, -51.007; P<0.05); the types of intraocular pressure-lowering drugs (Z=-15.777, P<0.05). There were 9 cases (9 eyes) of primary anterior chamber hemorrhage, 6 cases (6 eyes) of anterior chamber exudation, 9 cases (9 eyes) of high intraocular pressure, which were controlled by drug. The postoperative refractive error was positively correlated with the shortening of axial length and the deepening of ACD (r=0.392, 0.423; P<0.05).

Conclusions

Goniosynechialysis under the gonioscope and phacoemulsification cataract extraction combined with posterior chamber intraocular lens implantation can effectively open the chamber angle, deepen the anterior chamber, reduce the intraocular pressure level, improve BCVA, and the milder postoperative complications. The shortening of axial length and the deepening of ACD are the influencing factors of postoperative refractive error.

表1 手术前后急性闭角型青光眼合并白内障患者最佳矫正视力、眼压及降眼压药物使用种类的比较
图1 急性闭角型青光眼合并白内障患者术前和术后3个月裂隙灯显微镜下的眼前节彩色照像 图1A为术前,可见前房浅,晶状体混浊;图1B为术后3个月,可见前房较术前明显加深  图2 急性闭角型青光眼合并白内障患者术前的超声生物显微镜图像 图2A~图2D分别为0∶00、3∶00、6∶00及9∶00时钟位前房角图像,可见中央前房浅,全周前房角粘连关闭  图3 急性闭角型青光眼合并白内障患者术后3个月的超声生物显微镜检查图像 图2A~图2D分别为0∶00、3∶00、6∶00及9∶00时钟位前房角图像,可见中央及周边前房明显加深,0∶00时钟位前房角关闭,3∶00、6∶00及9∶00时钟位前房角开放
表2 手术前后急性闭角型青光眼合并白内障患者前房角开放距离500、角膜曲率、眼轴长度及中央前房深度的比较(±s)
表3 急性闭角型青光眼合并白内障患者术后屈光误差相关因素的检验结果
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