单纯超声乳化白内障吸除联合后房型人工晶状体植入术治疗原发性闭角型青光眼疗效的临床观察
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摘要
目的观察单纯超声乳化白内障吸除联合后房型人工晶状体植入术治疗原发性闭角型青光眼的疗效。方法收集2013年8月至2015年1月武警总医院眼科收治的原发性闭角型青光眼合并白内障患者48例(60只眼)进行研究。其中,男性20例(28只眼),女性28例(32只眼)。年龄在57～82岁,平均年龄为(69. 20±7. 32)岁。按照起病缓急,将急性闭角型青光眼者32例(34只眼)分为A_1组;将慢性闭角型青光眼者16例(26只眼)分为A_2组。按照前房角粘连范围,将<180°者22例(28只眼)分为B_1组;将≥180°者26例(32只眼)分为B_2组。按照两种局部降压药物是否能控制眼压在正常范围,将控制良好者18例(21只眼)分为C_1组;将控制不佳者30例(39只眼)分为C_2组。所有患者均行单纯超声乳化白内障吸除联合后房型人工晶状体植入术。术后3个月对受试者进行随访,记录眼压、最佳矫正视力、中央前房深度、前房角开放距离、前房角开放度数、前房角粘连范围、术中术后并发症及药物使用情况。对所得数据采用独立样本t检验进行组间比较。结果 A_1组和A_2组术前眼压分别为(30. 52±8. 29) mm Hg(1 mm Hg=0. 133 k Pa)和(23. 91±8. 12) mm Hg,术后3个月眼压分别为(12. 3±4. 21) mm Hg和(17. 7±4. 13) mm Hg,经独立样本t检验,其差异具有统计学意义(t=3. 09,4. 96; P <0. 05); B_1组和B_2组术前眼压分别为(20. 8±4. 45) mm Hg和(32. 59±8. 16)mm Hg,术后3个月眼压分别为(14. 04±3. 19) mm Hg和(16. 38±4. 80) mm Hg,经独立样本t检验,其差异具有统计学意义(t=-6. 81,2. 19; P <0. 05); C_1组和C_2组术前眼压分别为(19. 8±1. 05) mm Hg和(34. 59±7. 26) mm Hg,术后3个月眼压分别为(12. 04±2. 19) mm Hg和(18. 98±2. 65) mm Hg,经独立样本t检验,其差异具有统计学意义(t=9. 25,-10. 25; P <0. 05);所有受试者,术前中央前房深度、前房角开放距离、前房角开放度数分别为(2. 01±0. 31) mm、(0. 14±0. 05) mm及(15. 6±5. 36) mm;术后3个月中央前房深度、前房角开放距离、前房角开放度数分别(3. 60±0. 15) mm、(0. 34±0. 04)mm及(34. 3±3. 42) mm。术后3个月与术前相比,中央前房加深,前房角开放距离增大、开放度数增加,差异有统计学意义(t=-35. 76,-24. 19,-22. 78; P <0. 05)。术后3个月与术前相比,前房角粘连范围差异有统计学意义(χ~2=33. 39,P <0. 05)。术后3个月与术前相比,最佳矫正视力差异有统计学意义(χ~2=16. 88; P <0. 05)。术后随访3个月,A_1、A_2、B_1、B_2、C_1及C_2组患者的眼压控制率分别为97%、88%、96%、91%、100%及91%。此外,术前眼压小于30 mm Hg的原发性闭角型青光眼患者,术后眼压下降程度与术前眼压以及晶体拱高之间存在着一定的相关性,相应的函数关系为Y=-0. 854+0. 813X_1-1. 648X_2(X_1为术前眼压,X_2为晶体拱高)。结论单纯超声乳化白内障吸除联合后房型人工晶状体植入术能有效降低术前应用两种或两种以内降眼压药物能有效控制眼压或前房角粘连范围<180°的原发性闭角型青光眼患者的眼压。对于术前眼压小于30 mm Hg的原发性闭角型青光眼患者,术后眼压下降程度与术前眼压以及晶状体拱高密切相关。单纯超声乳化白内障吸除联合后房型人工晶状体植入术可使原发性闭角型青光眼患者前房加深、前房角开放、最佳矫正视力提高。
Objective The aim of this study was to observe the clinical effect of phacoemulsification combined with posterior chamberintraocularlens implantation in primary angle closure glaucoma.Methods A total of 48 cases(60 eyes)with primary angle closure glaucoma and cataract admitted to the ophthalmology department of the General Hospital of Armed Police from August 2013 to January 2015 were studied.Among them,there were 20 males(28 eyes)and 28 females(32 eyes).The age ranged from 57 to82 years,with an average age of(69.20±7.32)years.Patients with acute angle-closure glaucoma(34 eyes)were divided into A_1group and chronic angle-closure glaucoma(26 eyes)into A_2group according to the onset time.According to the range of angle adhesion,28 eyes were divided into B_1group and 32 eyes were divided into B_2group.According to whether two local antihypertensive drugs can control(intraocular pressure,IOP)in normal range,21 eyes with good control were divided into C_1group and 39 eyes with poor control were divided into C_2group.All patients underwent phacoemulsification combined with posterior chamber intraocular lens implantation.Three months after operation,the subjects were followed up to record intraocular pressure,best corrected visual acuity,central anterior chamber depth,angle opening distance,angle opening degree,angle adhesion range,intraoperative and postoperative complications and drug use.The data were compared by independent sample t test.Results The intraocular pressure of group A_1and group A_2were(30.52±8.29)mmH g(1 mmH g=0.133 kP a)and(23.91±8.12)mmH g respectively before operation,and(12.3±4.21)mmH g and(17.7±4.13)mmH g 3 months after operation.After independent sample t test,the difference was statistically significant(t=3.09,4.96;P<0.05);preoperative intraocular pressure of group B_1and group B_2were(20.8±4.45)mmH g and(32.59±8.16)mmH g,respectively,and intraocular pressure of group B_1and group B_2were(14.04±3.19)mmH g and(16.38±4.80)mmH g three months after operation.After independent sample t test,the difference was statistically significant(t=-6.81,2.19;P<0.05);preoperative intraocular pressure in C_1group and C_2group were(19.8±1.05)mmH g and(34.59±7.26)mmH g respectively,and intraocular pressure in3 months after operation were(12.04±2.19)mmH g and(18.98±2.65)mmH g respectively.The difference was statistically significant(t=9.25,-10.25;P<0.05)by independent sample t test.The preoperative central anterior chamber depth,angle opening distance and angle opening degree were(2.01±0.31)mm,(0.14±0.05)mm and(15.6±5.36)mm for all subjects,respectively.The central anterior chamber depth,angle opening distance and angle opening degree were(3.60±0.15)mm,(0.34±0.04)mm and(34.3±3.42)mm,respectively three months after operation.Three months after operation,the central anterior chamber deepened,the angle opened distance increased and the degree of opening increased.The difference was statistically significant(t=-35.76,-24.19,-22.78;P<0.05).There was a significant difference in the angle adhesion range between the three months after operation and before operation(χ~2=33.39,P<0.05).There was significant difference in the best corrected visual acuity(χ~2=16.88;P<0.05)between 3 months after operation and before operation.After 3 months follow-up,the IOPcontrol rates of A_1,A_2,B_1,B_2,C_1and C_2groups were 97%,88%,96%,91%,100%and 91%,respectively.In addition,in patients with primary angle closure glaucoma whose intraocular pressure was less than 30 mmH g before surgery,there is a certain correlation between the degree of intraocular pressure decline after surgery and preoperative intraocular pressure and lens arch height.The corresponding functional relationship is Y=-0.854+0.813X_1-1.648X_2(X_1is preoperative intraocular pressure,X_2is lens arch height).Conclusions Phacoemulsification and intraocular lens implantation could reduce the IOP of primary angle-closure glaucoma(PACG)patients with goniosynechia<180°and with whose two kinds of drugscould get IOP well controlled.Preoperative IOP and lens vault are significant correlated with the degree of IOP decline,for PACG patients with preoperative IOP of less than 30 mmH g.What's more,phacoemulsification and intraocular lens implantation can improve the anterior chamber,angle and visual acuity of PACG.
Objective The aim of this study was to observe the clinical effect of phacoemulsification combined with posterior chamberintraocularlens implantation in primary angle closure glaucoma.Methods A total of 48 cases(60 eyes)with primary angle closure glaucoma and cataract admitted to the ophthalmology department of the General Hospital of Armed Police from August 2013 to January 2015 were studied.Among them,there were 20 males(28 eyes)and 28 females(32 eyes).The age ranged from 57 to82 years,with an average age of(69.20±7.32)years.Patients with acute angle-closure glaucoma(34 eyes)were divided into A_1group and chronic angle-closure glaucoma(26 eyes)into A_2group according to the onset time.According to the range of angle adhesion,28 eyes were divided into B_1group and 32 eyes were divided into B_2group.According to whether two local antihypertensive drugs can control(intraocular pressure,IOP)in normal range,21 eyes with good control were divided into C_1group and 39 eyes with poor control were divided into C_2group.All patients underwent phacoemulsification combined with posterior chamber intraocular lens implantation.Three months after operation,the subjects were followed up to record intraocular pressure,best corrected visual acuity,central anterior chamber depth,angle opening distance,angle opening degree,angle adhesion range,intraoperative and postoperative complications and drug use.The data were compared by independent sample t test.Results The intraocular pressure of group A_1and group A_2were(30.52±8.29)mmH g(1 mmH g=0.133 kP a)and(23.91±8.12)mmH g respectively before operation,and(12.3±4.21)mmH g and(17.7±4.13)mmH g 3 months after operation.After independent sample t test,the difference was statistically significant(t=3.09,4.96;P<0.05);preoperative intraocular pressure of group B_1and group B_2were(20.8±4.45)mmH g and(32.59±8.16)mmH g,respectively,and intraocular pressure of group B_1and group B_2were(14.04±3.19)mmH g and(16.38±4.80)mmH g three months after operation.After independent sample t test,the difference was statistically significant(t=-6.81,2.19;P<0.05);preoperative intraocular pressure in C_1group and C_2group were(19.8±1.05)mmH g and(34.59±7.26)mmH g respectively,and intraocular pressure in3 months after operation were(12.04±2.19)mmH g and(18.98±2.65)mmH g respectively.The difference was statistically significant(t=9.25,-10.25;P<0.05)by independent sample t test.The preoperative central anterior chamber depth,angle opening distance and angle opening degree were(2.01±0.31)mm,(0.14±0.05)mm and(15.6±5.36)mm for all subjects,respectively.The central anterior chamber depth,angle opening distance and angle opening degree were(3.60±0.15)mm,(0.34±0.04)mm and(34.3±3.42)mm,respectively three months after operation.Three months after operation,the central anterior chamber deepened,the angle opened distance increased and the degree of opening increased.The difference was statistically significant(t=-35.76,-24.19,-22.78;P<0.05).There was a significant difference in the angle adhesion range between the three months after operation and before operation(χ~2=33.39,P<0.05).There was significant difference in the best corrected visual acuity(χ~2=16.88;P<0.05)between 3 months after operation and before operation.After 3 months follow-up,the IOPcontrol rates of A_1,A_2,B_1,B_2,C_1and C_2groups were 97%,88%,96%,91%,100%and 91%,respectively.In addition,in patients with primary angle closure glaucoma whose intraocular pressure was less than 30 mmH g before surgery,there is a certain correlation between the degree of intraocular pressure decline after surgery and preoperative intraocular pressure and lens arch height.The corresponding functional relationship is Y=-0.854+0.813X_1-1.648X_2(X_1is preoperative intraocular pressure,X_2is lens arch height).Conclusions Phacoemulsification and intraocular lens implantation could reduce the IOP of primary angle-closure glaucoma(PACG)patients with goniosynechia<180°and with whose two kinds of drugscould get IOP well controlled.Preoperative IOP and lens vault are significant correlated with the degree of IOP decline,for PACG patients with preoperative IOP of less than 30 mmH g.What's more,phacoemulsification and intraocular lens implantation can improve the anterior chamber,angle and visual acuity of PACG.
引文
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[3]王芳.超声乳化人工晶状体植入治疗原发性闭角型青光眼合并白内障研究进展[J].中国实用眼科杂志,2014,32(8),930-933.
[4]葛坚,郭彦,刘奕志,等.超声乳化白内障吸除术治疗闭角型青光眼的初步临床观察[J].中华眼科杂志,2001,37(5):355-358.
[5]王宁利.目前青光眼防治工作中存在的问题与解决对策[J].中华眼科杂志,2002,2(38):705-708.
[6]乔利亚,梁远波,王宁利,等.晶状体摘除术治疗原发性闭角型青光眼合并白内障的循证评价[J].眼科,2005,14(2):93-98.
[7]宋旭东,王宁利,唐广贤,等.超声乳化手术治疗原发性闭角型青光眼合并白内障的多中心试验[J].医学研究杂志,2010,39(3):17-22.
[8]刘杏,李媚.眼前节相干光断层扫描在原发性闭角型青光眼诊治中的应用[J].眼科,2013(1):1-5.
[9]Lam DS,Leung DY,Tham CC,etal.Randomized trial of early phacoemulsification versus peripheral to prevent intraocular pressure rise after acute primary angle closure[J].Ophthalmology,2008,115(7):1134-1140.
[10]梁远波,王宁利,乔利亚,等.对单纯白内障手术治疗合并白内障的闭角型青光眼的疗效评价[J].中华眼科杂志,2004,40(11):723-725.
[11]Teekhasaenee C,Ritch R.Combined phacoemulsmcation and goniosynechialysis for uncontrolled chronic angle-closure glaucoma after acute angle-closure glaucoma[J].Ophthalmolgy,1999,106(4):669-674.
[12]贾乃伟,丁亚丽,李兵,等.超声乳化人工晶体植入联合小梁切除术治疗青光眼合并白内障临床观察[J].中国实用医药,2009,27(4):17-29.
[13]Wang N,Chintala SK,Fini ME,et a1.Ultrasound activates the TM ELAM-1/IL-1/NF-kappaBresponse:a potential mechanism for intraocular pressure reduction after phacoemulsification[J].Invest Ophthalmol Vis Sci,2003,44(5):1977-1981.
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