目的

观察激光虹膜周边切开术（LPI）联合囊袋张力环（CTR）植入对原发性闭角型青光眼（PACG）伴白内障治疗的远期效果。

方法

收集2019年6—12月期间于上海新视界眼科医院白内障青光眼科就诊的合并PACG老年性白内障患者100例（100只眼）的临床资料。其中，男性52例（52只眼），女性48例（48只眼）；年龄54～90岁，平均（71.7±8.3）岁。根据患者术中是否植入CTR将患者分为研究组和对照组。两组患者均行LPI联合白内障手术，研究组术中植入CTR，对照组未植入CTR。比较两组患者术前、LPI术后、白内障术后1 d、1个月及4年的视力、眼压、角膜内皮细胞密度及前房深度。性别和眼别等计数资料，以［例（%）］表示，组间比较采用卡方检验。视力、眼压、角膜内皮细胞密度及前房深度等计量资料，符合正态分布的以表示，组间比较采用独立样本t检验，组内比较采用配对t检验；不符合正态分布的以M（Q1，Q3）表示，组间比较采用Mann-Whitney U检验，组内比较采用Wilcoxon符号秩和检验。

结果

研究组患者54例（54眼）。其中，男性26例（26只眼），女性28例（28只眼）；右眼31例（31只眼），左眼23例（23只眼）；年龄54～90岁，平均（71.3±8.5）岁；白内障超声乳化手术时间17.00～39.00 s，平均（27.76±5.30）s；人工晶状体（IOL）屈光度9.00～30.00 D，平均（21.25±4.13）D。对照组患者46例（46只眼）。其中，男性26例（26只眼），女性20例（20只眼）；右眼23例（23只眼），左眼23例（23只眼）；年龄54～87岁，平均（72.1±8.0）岁；白内障超声乳化手术时间21.00～43.00 s，平均（29.72±4.99）s；IOL屈光度10.00～30.00 D，平均（21.43±4.20）D。两组性别和眼别分布的比较，差异均无统计学意义（χ²=0.70，0.55；P＞0.05）；两组年龄和白内障超声乳化手术时间的比较，差异无统计学意义（t=-0.45，-1.89；P＞0.05）；两组IOL屈光度的比较，差异无统计学意义（Z=-0.052，P＞0.05）。研究组和对照组患者白内障术后1 d及4年的裸眼远视力分别为0.20（0.10，0.30）最小分辨视角的对数（logMAR）、0.20（0.10，0.30）logMAR、0.30（0.20，0.30）logMAR及0.30（0.20，0.40）logMAR，差异均有统计学意义（Z=-2.672，-3.562；P＜0.05）；术后4年，两组患者裸眼远视力均优于术前，差异均有统计学意义（Z=-6.359，-5.829；P＜0.05）。研究组和对照组患者白内障术后4年眼压分别为16.50（13.75，18.00）mmHg（1 mmHg=0.133 kPa）和18.00（15.00，20.00）mmHg，差异有统计学意义（Z=-2.873，P＜0.05）；术后4年，两组患者眼压均低于术前，差异均有统计学意义（Z=-5.893，-4.512；P＜0.05）。研究组患者白内障术后4年眼压低于LPI术后，差异有统计学意义（Z=-4.124，P＜0.05）。研究组和对照组患者白内障术后4年前房深度分别为（2.75±0.28）mm和（2.65±0.22）mm，差异无统计学意义（t=1.955，P＞0.05）。两组患者白内障术后4年前房深度均大于术前，差异均有统计学意义（t=-28.106，-29.694；P＜0.05）。研究组和对照组患者白内障术后4年前房深度与LPI术后的比较，差异均有统计学意义（t=-25.933，-26.930；P＜0.05）。研究组和对照组患者白内障术后4年的角膜内皮细胞密度分别为（2095.50±312.81）个/mm²和（1977.15±251.12）个/mm²，差异有统计学意义（t=2.061，P＜0.05）。研究组患者白内障术后4年的角膜内皮细胞密度较术前降低10.79%，差异有统计学意义（Z=-6.393，P＜0.05）；对照组较术前降低15.57%，差异有统计学意义（t=13.959，P＜0.05）。两组患者白内障术后4年IOL未发生异常，长期安全性良好。

结论

对PACG合并白内障患者行LPI联合超声乳化吸除后房型IOL植入术，可显著地改善患者的视力，降低眼压，增加前房深度，且角膜安全性良好。同时，在白内障手术中联合植入CTR，可显著地改善眼压，且对角膜内皮细胞的损伤小，值得推荐。

Objective

The aim of this study is to observe the long-term clinical effect of laser peripheral iridotomy（LPI）combined with capsule tension ring（CTR）implantation in cataract patients with primary angle closure glaucoma（PACG）.

Methods

A total of 100 patients（100 eyes）with senile cataract complicated with PACG were retrospectively collected from Cataract Glaucoma Department of Shanghai Xinshijie Eye Hospital from June to December 2019.There were 52 males（52 eyes）and 48 females（48 eyes）with an average age of（71.7±8.3）years（ranged from 54 to 90 years）.Patients were divided into study group and control group according to with or without CTR.Both groups of patients underwent LPI combined with cataract surgery，and CTR was implanted in the study group，while not implanted in the control group.The visual acuity，intraocular pressure（IOP），corneal endothelial cell density，and anterior chamber depth of two groups of patients before surgery，after LPI treatment，and after cataract surgery for 1 day，1 month，and 4 years were compared.Gender and ocular data were presented as cases and percentage and used for comparison between groups by chi-square test.Count data such as visual acuity，IOP，corneal endothelial cell count，and anterior chamber depth were described as for data consistent with normal distribution.Independent sample t test was used for inter-group comparison，and paired t test was used for intra-group comparison.Data that did not conform to normal distribution were described by M（Q1，Q3），and used for inter-group comparison by Mann-Whitney U test，and for intra-group comparison was used by Wilcoxon signed rank test.

Results

There were 54 patients（54 eyes）in the study group.Among them，there were 26 males（26 eyes）and 28 females（28 eyes）with an average of（71.3±8.5）years old（ranged from 54 to 90 years old）；there were 31 cases（31 eyes）in the right eye and 23 cases（23 eyes）in the left eye.The phacoemulsification surgery time for cataracts was 17.00 to 39.00 seconds，with an average of（27.76±5.30）seconds.The refractive error of artificial intraocular lens（IOL）ranged from 9.00 to 30.00 D，with an average of（21.25±4.13）D.There were 46 patients（46 eyes）in the control group.Among of them，there were 26 males（26 eyes）and 20 females（20 eyes）；there were 23 cases（23 eyes）in the right eye and 23 cases（23 eyes）in the left eye.The age range was 54 to 87 years old，with an average of（72.1±8.0）years old.The phacoemulsification surgery time for cataracts was 21.00 to 43.00 seconds，with an average of（29.72±4.99）seconds.The IOL refractive power was 10.00 to 30.00 D，with an average of（21.43±4.20）D.There was no statistically significant difference in gender and eye distribution between the study group and the control group（χ²=0.70，0.55；P＞0.05）.There was no statistically significant difference in age and phacoemulsification surgery time between the study group and the control group（t=-0.45，-1.89；P＞0.05）.There was no statistically significant difference in IOL refractive power comparison（Z=-0.052，P＞0.05）.The uncorrected distance visual acuity of the study group and the control group after surgery for 1 day and 4 years was0.20（0.10，0.30）logarithm of the minimum angle of resolution（logMAR），0.20（0.10，0.30）logMAR，0.30（0.20，0.30）logMAR，0.30（0.20，0.40）logMAR，respectively.The differences were statistically significant（Z=-2.672，-3.562；P＜0.05）.At 4 years after surgery，uncorrected distance visual acuity in both groups was better than the baseline，and the differences were statistically significant（Z=-6.359，-5.829；P＜0.05）.The IOPof the study group and the control group at 4 years after surgery was 16.50（13.75，18.00）mmHg（1 mmHg=0.133 kPa）and 18.00（15.00，20.00）mmHg，respectively，and the difference was statistically significant（Z=-2.873，P＜0.05）.At 4 years after surgery，IOP of both groups was lower than the baseline，and the differences were statistically significant（Z=-5.893，-4.512；P＜0.05）.The IOP of the study group at 4 years after cataract surgery was significantly lower than that after LPI treatment，and the difference was statistically significant（Z=-4.124，P＜0.05）.The anterior chamber depth was（2.75±0.28）mm and（2.65±0.22）mm respectively in the study group and the control group after cataract surgery for 4 years，and the difference was not statistically significant（t=1.955，P＞0.05）.After surgery for 4 years，the anterior chamber depth in both groups was greater than the baseline，with statistical significance（t=-28.106，-29.694；P＜0.05）.Compared with LPI treatment，there were significant differences in anterior chamber depth between the study group and the control group at 4 years after cataract surgery（t=-25.933，-26.930；P＜0.05）.The corneal endothelial cell count after cataract operation for 4 years was（2095.50±312.81）/mm² and（1977.15±251.12）/mm²，respectively，and the difference was statistically significant（t=2.061，P＜0.05）.The corneal endothelial cell count in the study group after cataract surgery for 4 years was lower 10.79% than the baseline，and the difference was statistically significant（Z=-6.393，P＜0.05）. The control group reduction was 15.57%， and the difference was statistically significant（t=13.959，P＜0.05）.There were no abnormal IOL between the study group and the control group after cataract surgery for 4 years in two groups，and the long-term safety of IOL between the study group and the control group was good.

Conclusions

LPI combined with phacoemulsification and IOL the study group and the control group implantation for cataracts patients with PACG can significantly improve the visual acuity，reduce IOP，increase anterior chamber depth，and have good corneal safety.At the same time，the application of CTR in cataract surgery can significantly reduce the IOP，and has less impact on corneal endothelial cells.