白内障超声乳化摘除术联合房角粘连分离术治疗慢性闭角型青光眼的临床疗效观察
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摘要
目的观察白内障超声乳化摘除术联合人工晶体植入联合房角粘连分离术治疗慢性闭角型青光眼的临床疗效。方法采取自身对照研究,对按照标准纳入我院的慢性闭角型青光眼患者30例(48眼),行白内障超声乳化摘除术联合房角粘连分离术,术前及术后1 d、1周、1个月、3个月进行最佳矫正视力、眼压、前方深度、视野、房角开放程度、神经上皮层厚度等结局指标检测。结果经治疗后,患者术前眼压(36.542±5.624)mmHg,术后3个月(13.958±1.821)mmHg,术后眼压均明显降低,达到正常范围(P<0.001);患者术前视力(0.391±0.258),术后3个月视力(0.730±0.198),术后视力均有提高(P<0.001);手术前患者前房深度(2.472±0.490)mm,术后前房深度(3.640±0.360)mm,差异有统计学意义(P<0.001);手术前视野平均缺损(-14.494±6.068)d B,术后视野平均缺损(-2.612±2.224)dB,差异有统计学意义(P<0.001);术后周边前房角粘连较术前减少47眼,粘连范围变化不明显者1眼。结论白内障超声乳化摘除术联合房角粘连分离术,可以有效地控制慢性闭角型青光眼患者眼压,提高视力,进一步减少视野损害。
Objective To observe the clinical efficacy of phacoemulsification combined with intraocular lens implantation combined with angle separation in the treatment of chronic angle-closure glaucoma. Methods A self-controlled study was performed to enroll 30 patients(48 eyes) with chronic angle-closure glaucoma in our hospital. The phacoemulsification combined with anterior chamber adhesions was performed before and 1 day,1 week, and 1 month after surgery. At 3 months, the best corrected visual acuity, intraocular pressure, anterior depth, visual field, open angle of the angle, and thickness of the neuroepithelial layer were measured. Results After treatment, the preoperative intraocular pressure(36.542±5.624) mmHg,postoperative 3 months(13.958 ±1.821) mmHg, postoperative intraocular pressure decreased significantly, reaching the normal range(P <0.001);preoperative visual acuity(0.391±0.258),After 3 months of visual acuity(0.730 ±0.198), postoperative visual acuity improved(P<0.001); preoperative anterior chamber depth(2.472 ±0.490) mm, postoperative anterior chamber depth(3.640 ±0.360) mm, the difference was statistical significant(P<0.001); mean visual field defect before operation(-14.494±6.068) dB, mean postoperative visual field defect(-2.612±2.224) d B, the difference was statistically significant(P<0.001);The postoperative anterior chamber angle adhesion was reduced by 47 eyes compared with preoperative, and there was 1 eye with no obvious change in adhesion range. Conclusion Phacoemulsification combined with anterior chamber adhesion separation can effectively control intraocular pressure in patients with chronic angle-closure glaucoma, improve vision and further reduce visual field damage.
Objective To observe the clinical efficacy of phacoemulsification combined with intraocular lens implantation combined with angle separation in the treatment of chronic angle-closure glaucoma. Methods A self-controlled study was performed to enroll 30 patients(48 eyes) with chronic angle-closure glaucoma in our hospital. The phacoemulsification combined with anterior chamber adhesions was performed before and 1 day,1 week, and 1 month after surgery. At 3 months, the best corrected visual acuity, intraocular pressure, anterior depth, visual field, open angle of the angle, and thickness of the neuroepithelial layer were measured. Results After treatment, the preoperative intraocular pressure(36.542±5.624) mmHg,postoperative 3 months(13.958 ±1.821) mmHg, postoperative intraocular pressure decreased significantly, reaching the normal range(P <0.001);preoperative visual acuity(0.391±0.258),After 3 months of visual acuity(0.730 ±0.198), postoperative visual acuity improved(P<0.001); preoperative anterior chamber depth(2.472 ±0.490) mm, postoperative anterior chamber depth(3.640 ±0.360) mm, the difference was statistical significant(P<0.001); mean visual field defect before operation(-14.494±6.068) dB, mean postoperative visual field defect(-2.612±2.224) d B, the difference was statistically significant(P<0.001);The postoperative anterior chamber angle adhesion was reduced by 47 eyes compared with preoperative, and there was 1 eye with no obvious change in adhesion range. Conclusion Phacoemulsification combined with anterior chamber adhesion separation can effectively control intraocular pressure in patients with chronic angle-closure glaucoma, improve vision and further reduce visual field damage.
引文
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[4]Zhang H,Tang J,Liu J.Effects of Phacoemulsification Combined With Goniosynechialysis on Primary Angle-closure Glaucoma[J].J Glaucoma,2016,25(5):e499-e503.
[5]Yazdani S,Akbarian S,Pakravan M,et al.Prevalence of angle closure in siblings of patients with primary angle-closure glaucoma[J].J Glaucoma,2015,24(2):149-153.
[6]Maeda M,Watanabe M,Ichikawa K.Goniosynechialysis Using an Ophthalmic Endoscope and Cataract Surgery for Primary Angle-closure Glaucoma[J].J Glaucoma,2014,23(3):174-178.
[7]裴锦云,林羽,杨海燕.超声乳化联合房角分离术治疗闭角型青光眼合并白内障的临床效果分析[J].天津医药,2016,44(7):906-909.
[8]Tiakumzuk Sangtam.Phacoemulsification versus trabeculectomy in medically uncontrolled chronic angle-closure glaucoma without cataract[J].Ophthalmology,2014,120(7):e45.
[9]Chen S,Lv J,Fan S,et al.Laser peripheral iridotomy versus laser peripheral iridotomy plus laser peripheral iridoplasty in the treatment of multi-mechanism angle closure:study protocol for a randomized controlled trial[J].Trials,2017,18(1):130.
[10]李景波,丁琪.超声乳化联合前房角分离术治疗闭角型青光眼伴白内障[J].中华眼外伤职业眼病杂志,2016,38(9):676-679.
[11]朱伟,王涛,沈祯.超声乳化联合前房角分离术治疗闭角型青光眼[J].中华眼外伤职业眼病杂志,2015,37(7):523-526.
[12]Tarongoy P,Ho CL,Walton DS.Angleclosure glaucoma:the role of the lens in the pathogenesis,prevention,and treatment[J].Surv Ophthalmol,2014,54(2):211-225.
[13]徐岬,康建芳.白内障超声乳化人工晶状体植入联合房角分离术治疗闭角型青光眼临床观察[J].中国实用眼科杂志,2011,29(3):247-249.
[14]刘晓静,郭淑玲,栗庆霞,等.超声乳化人工晶状体植入联合房角分离术治疗年龄相关性白内障合并PACG[J].国际眼科杂志,2017,17(10):1883-1885.
[15]姚克.青光眼白内障联合手术需重视的若干问题[J].中华眼科杂志,2013,49(5):385-388.
[16]侯宪如,秦佳音,任泽钦.青光眼视野指数与视野形态分期的关系及其诊断价值[J].中华眼科杂志,2017,53(2):92-97.
[17]Kameda T,Inoue T,Inatani M,et al.Long-term efficacy of goniosynechialysis combined with phacoemulsification for primary angle closure[J].Graefes Arch Clin Exp Ophthalmol,2013,251(3):825-830.
[2]Jiang Y,Chang DS,Zhu H,et al.Longitudinal changes of angle configuration in primary angle-closure suspects:the Zhongshan Angle-Closure Prevention Trial[J].Ophthalmology,2014,121(9)1699-1705.
[3]Wright C,Tawfik MA,Waisbourd M,et al.Primary angle-closure glaucoma:an update[J].Acta Ophthalmol,2016,94(3):217-225.
[4]Zhang H,Tang J,Liu J.Effects of Phacoemulsification Combined With Goniosynechialysis on Primary Angle-closure Glaucoma[J].J Glaucoma,2016,25(5):e499-e503.
[5]Yazdani S,Akbarian S,Pakravan M,et al.Prevalence of angle closure in siblings of patients with primary angle-closure glaucoma[J].J Glaucoma,2015,24(2):149-153.
[6]Maeda M,Watanabe M,Ichikawa K.Goniosynechialysis Using an Ophthalmic Endoscope and Cataract Surgery for Primary Angle-closure Glaucoma[J].J Glaucoma,2014,23(3):174-178.
[7]裴锦云,林羽,杨海燕.超声乳化联合房角分离术治疗闭角型青光眼合并白内障的临床效果分析[J].天津医药,2016,44(7):906-909.
[8]Tiakumzuk Sangtam.Phacoemulsification versus trabeculectomy in medically uncontrolled chronic angle-closure glaucoma without cataract[J].Ophthalmology,2014,120(7):e45.
[9]Chen S,Lv J,Fan S,et al.Laser peripheral iridotomy versus laser peripheral iridotomy plus laser peripheral iridoplasty in the treatment of multi-mechanism angle closure:study protocol for a randomized controlled trial[J].Trials,2017,18(1):130.
[10]李景波,丁琪.超声乳化联合前房角分离术治疗闭角型青光眼伴白内障[J].中华眼外伤职业眼病杂志,2016,38(9):676-679.
[11]朱伟,王涛,沈祯.超声乳化联合前房角分离术治疗闭角型青光眼[J].中华眼外伤职业眼病杂志,2015,37(7):523-526.
[12]Tarongoy P,Ho CL,Walton DS.Angleclosure glaucoma:the role of the lens in the pathogenesis,prevention,and treatment[J].Surv Ophthalmol,2014,54(2):211-225.
[13]徐岬,康建芳.白内障超声乳化人工晶状体植入联合房角分离术治疗闭角型青光眼临床观察[J].中国实用眼科杂志,2011,29(3):247-249.
[14]刘晓静,郭淑玲,栗庆霞,等.超声乳化人工晶状体植入联合房角分离术治疗年龄相关性白内障合并PACG[J].国际眼科杂志,2017,17(10):1883-1885.
[15]姚克.青光眼白内障联合手术需重视的若干问题[J].中华眼科杂志,2013,49(5):385-388.
[16]侯宪如,秦佳音,任泽钦.青光眼视野指数与视野形态分期的关系及其诊断价值[J].中华眼科杂志,2017,53(2):92-97.
[17]Kameda T,Inoue T,Inatani M,et al.Long-term efficacy of goniosynechialysis combined with phacoemulsification for primary angle closure[J].Graefes Arch Clin Exp Ophthalmol,2013,251(3):825-830.