持续高眼压对急性大发作期原发性闭角型青光眼行白内障手术的影响（英文）
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摘要
目的:研究持续高眼压对原发性闭角型青光眼急性大发作期行白内障手术的影响与其相关因素分析,并探讨持续高眼压状态下的治疗方案。方法:选取武汉同济医院眼科收治的284例293眼接受白内障手术治疗的原发性闭角型青光眼急性大发作期的病历资料。根据术前眼压,将病人分为三组,术前用全身及局部药物眼压可基本控制在正常范围内的(组1),共188例;术前眼压不能用药控制在正常范围,但行一次前房穿刺治疗后,眼压在用药物或不用药下可控制在正常范围的(组2),共61例;术前多次前房穿刺放液仍不能维持正常眼压(组3),共44例。组1行白内障摘除联合人工晶体植入术,组2和组3行白内障摘除和房角分离联合人工晶体植入术。分析手术前后视力、眼压、中央前房深度、黄斑中心凹下脉络膜厚度以及房角镜检查结果。术前及术后测量数据采用非参数检验。结果:各组术后一周眼压控制率分别为:组1(100%),组2(95%),组3 (82%)(组2眼压控制率高于组3,χ~2=4. 795,P<0. 05)。视力提高率分别为:组1 (92%),组2(84%);组3(52%)。各组术后中央前房深度均较术前明显加深,但组3中术后房角粘连范围显著高于组1和组2。组1和组2未出现术后前房积血,而组3中18%患者术后出现前房积血。结论:对于持续高眼压的原发性闭角型青光眼急性大发作术前各种措施将眼压降至正常后再行白内障手术有较好的疗效,但是术前多次前房穿刺放液仍不能维持正常眼压眼,术后存在较大的房角粘连和前房出血风险。
AIM: To explore the effect of persistent high intraocular pressure( IOP) on cataract surgery in eyes with acute primary angle-closure glaucoma( PACG) and its correlative factor,and to discuss the choice of treatment for persistent high IOP.METHODS: Totally 284 cases( 293 eyes) were diagnosed as acute PACG and underwent cataract surgery. According to preoperative IOP, these patients were divided into three groups: Group 1( 188 eyes),Group 2( 61 eyes) and Group 3( 44 eyes). Group 1 was defined that preoperative IOP can be controlled within the normal range under systemic and local drug. Group 2 was defined that preoperative IOP higher than 40 mmHg after drug therapy, which can be controlled after an anterior chamber puncture treatment. Group 3 was defined that preoperative IOP higher than 40 mmHg after multiple anterior chamber puncture. Group 1 underwent cataract extraction and intraocular lens( IOL) implantation. Group2 and Group 3 underwent cataract extraction and IOL implantation with goniosynechiolysis. The preoperative and postoperative visual acuity,IOP,anterior chamber depth( ACD) and subfoveal choroidal thickness were obtained,and gonioscopic measurement of chamber angle was recorded. Preoperative and postoperative measurements were compared using non-parametric tests. RESULTS: After surgical treatment, the rate of postoperative one-week IOP control rate was respectively: Group 1( 100%),Group 2( 95%),Group 3( 82%)( the rate of Group 2 is higher than Group 3,χ~2 =4. 795,P< 0. 05). The rate of the improved postoperative vision was respectively: Group 1( 92%),Group 2( 84%)and Group 3( 52%). Postoperative central anterior chamber depth of each group deepened obviously compared to preoperative, but the postoperative goniosynechia range of Group 3 was significantly wider than that of Group 1 and Group 2. Group 1 and Group 2did not record postoperative hyphema, while 18% of Group 3 had recorded hyphema.CONCLUSION: Acute PACG eyes with persistent high preoperative IOP had good effects after cataract surgery,but demonstrated wider goniosynechia range and higher risk of hyphema compared to eyes with normal preoperative IOP.
AIM: To explore the effect of persistent high intraocular pressure( IOP) on cataract surgery in eyes with acute primary angle-closure glaucoma( PACG) and its correlative factor,and to discuss the choice of treatment for persistent high IOP.METHODS: Totally 284 cases( 293 eyes) were diagnosed as acute PACG and underwent cataract surgery. According to preoperative IOP, these patients were divided into three groups: Group 1( 188 eyes),Group 2( 61 eyes) and Group 3( 44 eyes). Group 1 was defined that preoperative IOP can be controlled within the normal range under systemic and local drug. Group 2 was defined that preoperative IOP higher than 40 mmHg after drug therapy, which can be controlled after an anterior chamber puncture treatment. Group 3 was defined that preoperative IOP higher than 40 mmHg after multiple anterior chamber puncture. Group 1 underwent cataract extraction and intraocular lens( IOL) implantation. Group2 and Group 3 underwent cataract extraction and IOL implantation with goniosynechiolysis. The preoperative and postoperative visual acuity,IOP,anterior chamber depth( ACD) and subfoveal choroidal thickness were obtained,and gonioscopic measurement of chamber angle was recorded. Preoperative and postoperative measurements were compared using non-parametric tests. RESULTS: After surgical treatment, the rate of postoperative one-week IOP control rate was respectively: Group 1( 100%),Group 2( 95%),Group 3( 82%)( the rate of Group 2 is higher than Group 3,χ~2 =4. 795,P< 0. 05). The rate of the improved postoperative vision was respectively: Group 1( 92%),Group 2( 84%)and Group 3( 52%). Postoperative central anterior chamber depth of each group deepened obviously compared to preoperative, but the postoperative goniosynechia range of Group 3 was significantly wider than that of Group 1 and Group 2. Group 1 and Group 2did not record postoperative hyphema, while 18% of Group 3 had recorded hyphema.CONCLUSION: Acute PACG eyes with persistent high preoperative IOP had good effects after cataract surgery,but demonstrated wider goniosynechia range and higher risk of hyphema compared to eyes with normal preoperative IOP.
引文
1 Emanuel ME,Parrish RK 11,Gedde SJ. Evidence-based management of primary angle closure glaucoma. Curr Opin Ophthalmol 2014; 25(2):89-92
2 Hou X, Hu D, Cui ZL, Zhou J, Cai L, Wang YS. Small-incision phacotrabeculectomy versus phacoemulsification in refractory acute primary angle closure with cataract. BMC Ophthalmology 2015; 15:88
3 Gillan SN,Wilson PJ,Knight DS,Sanders R. Trends in acute primary angle-closure glaucoma,peripheral iridotomy and cataract surgery in scotland, 1998-2012. Ophthalmic Epidemiol 2016; 23(1):1-5
4 Sharma S,Tun TA,Baskaran M,Atalay E,Thakku SG,Liang Z,Milea D, Strouthidis NG, Aung T, Girard MJ. Effect of acute intraocular pressure elevation on the minimum rim width in normal, ocular hypertensive and glaucoma eyes. Br J Ophthalmol 2018; 102(1):131-135
5 Kim M, Park KH, Kim TW, Kim DM. Anterior chamber configuration changes after cataract surgery in eyes with glaucoma. Korean J Ophthalmol 2012; 26(2):97-103
6 Nolan WP, See JL, Aung T, Friedman DS, Chan YH, Smith SD,Zheng C, Huang D, Foster PJ, Chew PTK. Changes in angle configuration after phacoemulsification measured by anterior segment optical coherence tomography. J Glaucoma 2008; 17(6):455-459
7 Moghimi S, Bijani F, Chen R, Yasseri M, He MG, Lin SC, Weinreb RN. Anterior segment dimensions following laser iridotomy in acute primary angle closure and fellow eyes. Am J Ophthalmol 2018; 186:59-68
8 Lin Z, Liang YB, Wang NL, Li SZ, Mou DP, Fan SJ, Sun S, Tang X,Thomas R. Peripheral anterior synechia reduce extent of angle widening after laser peripheral iridotomy in eyes with primary angle closure. Journal of Glaucoma 2013; 22(5):374-379
9 Suwan YN, Jiamsawad S, Tantraworasin A, Gey man L,Supakontanasan W, Teekhasaenee C. Qualitative and quantitative evaluation of acute angle-closure mechanisms. BMC Ophthalmol 2017; 17(1):246
10 Chen MJ,Liu CJ,Cheng CY,Lee SM. Corneal status in primary angle-closure glaucoma with a history of acute attack. J Glaucoma 2012;21(1):12-16
11 Nongpiur ME, Png O, Chiew JW, Fan KR, Girard MJA, Wong T,Goh D,Perera SA,Aung T. Lack of association between corneal hysteresis and corneal resistance factor with glaucoma severity in primary angle closure glaucoma. Invest Opthalmol Vis Sci 2015; 56(11):6879-6885
12 Zhang XL, Liu YM, Wang W, Chen SD, Li F, Huang WB, Aung T,Wang NL. Why does acute primary angle closure happen? Potential risk factors for acute primary angle closure. Surv Ophthalmol 2017; 62(5):635-647
13 Liu LF, Liu XN, Huang CK, Wang G, Ma D, Zhang WQ, Zheng C,Zhang MZ. Associated factors of acute primary angle closure glaucoma in a sub-group of Chinese people:comparison between attack eyes and normal controls. Sci Rep 2017;7(1):14885
14 Wang W, Zhou MW, Huang WB, Chen SD, Ding XY, Zhang XL.Does acute primary angle-closure cause an increased choroidal thickness? Invest Opthalmol Vis Sci 2013; 54(5):3538-3545
15 Zhang XL, Wang W,Aung T,Jonas JB,Wang NL. Choroidal physiology and primary angle closure disease. Surv Ophthalmol 2015; 60(6):547-556
16 Chen SD, Wang W, Gao XB, Li Z, Huang WB, Li XY, Zhou MW,Zhang XL. Changes in choroidal thickness after trabeculectomy in primary angle closure glaucoma. Invest Opthalmol Vis Sci 2014; 55(4):2608-2613
17 Zhou MW, Wang W, Huang WB, Gao XB, Li Z, Li XY, Zhang XL.Is increased choroidal thickness association with primary angle closure?Acta Ophthalmol 2014;92(7):e514-e520
18 He M, Huang W. Changes of choroidal thickness after phacoemulsification. Invest Ophthalmol Vis Sci 2015; 56(2):1118
19 Yuan JS, Wang YW, Wang PY, Ma R. Safety in treating primary acute angle-closure glaucoma under high intraocular pressure by compound trabeculectomy. Pak J Pharm Sci 2016; 29(6 Spec):2217-2220
20 Cash well LF,Croyle T A. Acute primary closed-angle glaucoma associated with hyphema. Am J Ophthalmol 1988; 106(3):353-354
21 Fakhraie G, Vahedian Z,Moghimi S,Eslami Y,Zarei R,Oskouee JF. Phacoemulsification and goniosynechialysis for the management of refractory acute angle closure. Eur J Ophthalmol 2012; 22(5):714-718
22 Lu DW, Tai MC, Chang YH, Liang CM, Chen CL, Chien KH, Chen JT,Chen YH. Anterior chamber paracentesis and PH values in patients with acute primary angle closure. Graefes Arch Clin Exp Ophthalmol2013;251(4):1229-1234
2 Hou X, Hu D, Cui ZL, Zhou J, Cai L, Wang YS. Small-incision phacotrabeculectomy versus phacoemulsification in refractory acute primary angle closure with cataract. BMC Ophthalmology 2015; 15:88
3 Gillan SN,Wilson PJ,Knight DS,Sanders R. Trends in acute primary angle-closure glaucoma,peripheral iridotomy and cataract surgery in scotland, 1998-2012. Ophthalmic Epidemiol 2016; 23(1):1-5
4 Sharma S,Tun TA,Baskaran M,Atalay E,Thakku SG,Liang Z,Milea D, Strouthidis NG, Aung T, Girard MJ. Effect of acute intraocular pressure elevation on the minimum rim width in normal, ocular hypertensive and glaucoma eyes. Br J Ophthalmol 2018; 102(1):131-135
5 Kim M, Park KH, Kim TW, Kim DM. Anterior chamber configuration changes after cataract surgery in eyes with glaucoma. Korean J Ophthalmol 2012; 26(2):97-103
6 Nolan WP, See JL, Aung T, Friedman DS, Chan YH, Smith SD,Zheng C, Huang D, Foster PJ, Chew PTK. Changes in angle configuration after phacoemulsification measured by anterior segment optical coherence tomography. J Glaucoma 2008; 17(6):455-459
7 Moghimi S, Bijani F, Chen R, Yasseri M, He MG, Lin SC, Weinreb RN. Anterior segment dimensions following laser iridotomy in acute primary angle closure and fellow eyes. Am J Ophthalmol 2018; 186:59-68
8 Lin Z, Liang YB, Wang NL, Li SZ, Mou DP, Fan SJ, Sun S, Tang X,Thomas R. Peripheral anterior synechia reduce extent of angle widening after laser peripheral iridotomy in eyes with primary angle closure. Journal of Glaucoma 2013; 22(5):374-379
9 Suwan YN, Jiamsawad S, Tantraworasin A, Gey man L,Supakontanasan W, Teekhasaenee C. Qualitative and quantitative evaluation of acute angle-closure mechanisms. BMC Ophthalmol 2017; 17(1):246
10 Chen MJ,Liu CJ,Cheng CY,Lee SM. Corneal status in primary angle-closure glaucoma with a history of acute attack. J Glaucoma 2012;21(1):12-16
11 Nongpiur ME, Png O, Chiew JW, Fan KR, Girard MJA, Wong T,Goh D,Perera SA,Aung T. Lack of association between corneal hysteresis and corneal resistance factor with glaucoma severity in primary angle closure glaucoma. Invest Opthalmol Vis Sci 2015; 56(11):6879-6885
12 Zhang XL, Liu YM, Wang W, Chen SD, Li F, Huang WB, Aung T,Wang NL. Why does acute primary angle closure happen? Potential risk factors for acute primary angle closure. Surv Ophthalmol 2017; 62(5):635-647
13 Liu LF, Liu XN, Huang CK, Wang G, Ma D, Zhang WQ, Zheng C,Zhang MZ. Associated factors of acute primary angle closure glaucoma in a sub-group of Chinese people:comparison between attack eyes and normal controls. Sci Rep 2017;7(1):14885
14 Wang W, Zhou MW, Huang WB, Chen SD, Ding XY, Zhang XL.Does acute primary angle-closure cause an increased choroidal thickness? Invest Opthalmol Vis Sci 2013; 54(5):3538-3545
15 Zhang XL, Wang W,Aung T,Jonas JB,Wang NL. Choroidal physiology and primary angle closure disease. Surv Ophthalmol 2015; 60(6):547-556
16 Chen SD, Wang W, Gao XB, Li Z, Huang WB, Li XY, Zhou MW,Zhang XL. Changes in choroidal thickness after trabeculectomy in primary angle closure glaucoma. Invest Opthalmol Vis Sci 2014; 55(4):2608-2613
17 Zhou MW, Wang W, Huang WB, Gao XB, Li Z, Li XY, Zhang XL.Is increased choroidal thickness association with primary angle closure?Acta Ophthalmol 2014;92(7):e514-e520
18 He M, Huang W. Changes of choroidal thickness after phacoemulsification. Invest Ophthalmol Vis Sci 2015; 56(2):1118
19 Yuan JS, Wang YW, Wang PY, Ma R. Safety in treating primary acute angle-closure glaucoma under high intraocular pressure by compound trabeculectomy. Pak J Pharm Sci 2016; 29(6 Spec):2217-2220
20 Cash well LF,Croyle T A. Acute primary closed-angle glaucoma associated with hyphema. Am J Ophthalmol 1988; 106(3):353-354
21 Fakhraie G, Vahedian Z,Moghimi S,Eslami Y,Zarei R,Oskouee JF. Phacoemulsification and goniosynechialysis for the management of refractory acute angle closure. Eur J Ophthalmol 2012; 22(5):714-718
22 Lu DW, Tai MC, Chang YH, Liang CM, Chen CL, Chien KH, Chen JT,Chen YH. Anterior chamber paracentesis and PH values in patients with acute primary angle closure. Graefes Arch Clin Exp Ophthalmol2013;251(4):1229-1234