摘要
目的探讨白内障超声乳化术联合房角分离术治疗原发性闭角型青光眼(PACG)合并白内障患者的临床效果及对患者房角开放状态、角膜内皮细胞的影响。方法回顾性分析2020年1月至2021年5月盐城市第一人民医院收治的100例PACG合并白内障患者的临床资料,根据手术方式的不同分为A组(50例,接受白内障超声乳化术联合小梁切除术治疗)与B组(50例,接受白内障超声乳化术联合房角分离术治疗),均于术后随访3个月。比较两组患者术前及术后1、3个月的最小分辨角对数(logMAR)视力、眼压、中央前房深度及房角开放状态,术前与术后3个月的角膜内皮细胞密度(ECD)、最大细胞面积(MAX)及平均细胞面积(AVE),以及随访期间并发症发生率。结果与术前比,术后1、3个月两组患者logMAR值、眼压均显著降低,但B组患者logMAR值显著低于A组,眼压显著高于A组;中央前房深度显著升高,且B组显著高于A组;A组患者术后3个月的窄房角Ⅱ级占比显著低于术后1个月,B组患者术后3个月宽房角占比显著高于术后1个月;与A组比,B组患者术后1、3个月宽房角患者占比均显著升高,术后1个月窄房角Ⅱ级患者及术后3个月窄房角Ⅰ级患者占比均显著降低;术后3个月两组患者MAX、AVE及A组患者ECD水平均显著降低,且B组患者MAX、AVE均显著低于A组,ECD显著高于A组;B组患者并发症总发生率显著低于A组(均P<0.05)。结论相比于白内障超声乳化联合小梁切除术,白内障超声乳化术联合房角分离术治疗PACG合并白内障可更有效地加大患者房角开放状态,改善视功能,减少角膜内皮细胞丢失,且具有更高的安全性。
Objective To investigate the clinical effect of cataract phacoemulsification combined with goniosynechialysis in the treatment of primary angle-closure glaucoma(PACG)patients combined with cataract and its effect on the open state of the angle of the patient's chamber and corneal endothelial cells.Methods The clinical data of 100 patients combined with PACG combined with cataract admitted to Yancheng NO.1 People's Hospital from January 2020 to May 2021 were retrospectively analyzed,they were divided into the group A(50 cases,receiving cataract phacoemulsification combined with trbecular ablation)and the group B(50 cases,receiving cataract phacoemulsification combined with goniosynechialysis)according to different surgical methods,all patients were followed up for 3 months.The minimum resolution angle logarithm(LogMAR),visual acuity,intraocular pressure,central anterior chamber depth and the open state of the angle before operation,1 and 3 months after operation,corneal endothelial cell density(ECD),maximum cell area(MAX)and average cell area(AVE)before and 3 months after operation,and the incidence of complications during follow-up were compared between the two groups.Results Compared with before operation,the LogMAR value and intraocular pressure of the two groups decreased significantly at 1 and 3 months after operation,but the LogMAR value of the group B was significantly lower than that of the group A,and the intraocular pressure was significantly higher than that of the group A;the depth of central anterior chamber of the two groups was significantly higher,and the group B was significantly higher than that of the group A;the proportion of narrow atrial angle grade Ⅱ in the group A at 3 months after operation was significantly lower than that at 1 month after operation,the proportion of wide atrial angle in the group B at 3 months after operation was significantly higher than that at 1 month after operation;compared with the group A,the proportion of patients with wide atrial angle in the group B increased significantly at 1 and 3 months after operation,and the proportion of patients with narrow atrial angle grade Ⅱ at 1 month after operation and patients with narrow atrial angle grade Ⅰ at 3 months after operation decreased significantly;3 months after operation,the levels of MAX,AVE in the two groups and ECD in the group A significantly decreased,and the levels of MAX,AVE in the group B were significantly lower than those in the group A,and ECD was significantly higher than that in the group A;the total incidence of complications in the group B was significantly lower than that in the group A(all P<0.05).Conclusion Compared with cataract phacoemulsification combined with trabecular ablatrow,cataract phacoemulsification combined goniosynechialysis in the treatment of PACG patients combined with cataract can more effectively increase the open state of the patient's angle,improve visual function,reduce the loss of corneal endothelial cells,and have higher safety.
作者
戴明
孙涛
徐晓融
邵成杰
朱姝
DAI Ming;SUN Tao;XU Xiaorong;SHAO Chengjie;ZHU Shu(Department of Ophthalmology,Yancheng NO.1 People's Hospital,Yancheng,Jiangsu 224001,China)
关键词
闭角型青光眼
白内障
白内障超声乳化术
房角分离术
小梁切除术
Primary angle-closure glaucoma
Cataract
Cataract phacoemulsification
Goniosynechialysis
Trabecular ablatrow
作者简介
戴明,硕士研究生,主治医师,研究方向:眼科;通信作者:朱姝,大学本科,主治医师,研究方向:眼科。E-mail:610131840@qq.com。
