白内障合并浅前房患者的手术治疗相关研究

Study of treatment on patients with cataract and shallow anterior chamber

目的:对白内障合并浅前房的患者,前瞻性的采用非接触光学相干生物测量仪(IOLmaster)联合晶状体混浊测量仪(OLM)检查进行分型,观察并研究手术及激光治疗的干预性效果及时机。方法:随机收集白内障合并浅前房患者106例128眼。根据前房深浅分为轻度浅前房和高危浅前房。依据晶状体混浊程度分为轻度混浊、中度混浊、重度混浊。部分患者接受了白内障超声乳化吸出联合人工晶状体植入手术,或激光周边虹膜成形术治疗。观察所有患者随访2a的眼部情况、最佳矫正视力(BCVA)、眼压情况等。结果:未手术组轻度浅前房和高危浅前房患者随访2a内的前房深度进行性变浅,眼压进行性升高(P<0.05);随访2a内,随着晶状体混浊程度进行性加重,晶状体重度混浊患者的中央前房深度浅于晶状体轻、中度混浊的患者(P<0.05),同时,眼压高于晶状体轻、中度混浊的患者(P<0.05)。接受手术治疗的患者随访2a内的高眼压发生率(4.9%)低于未接受手术治疗的患者(41.3%)(P<0.05);接受白内障手术的患者术后的中央前房深度深于术前(P<0.05),也深于未接受手术者(P<0.05);接受白内障手术的患者术后的眼压低于术前(P<0.05),也低于未接受手术者(P<0.05);手术后不同程度浅前房患者的视力都明显高于术前(P<0.05),但术后高危浅前房组患者的视力低于轻度浅前房组患者(P<0.05)。轻度浅前房患者,激光治疗后1a的眼压与术前相比无显著性差异(P>0.05);高危浅前房患者,激光治疗后1a的眼压高于术前(P<0.05)。结论:IOLmaster联合OLM检查能够客观评估白内障合并浅前房的患者的病情变化,确定手术时机。及早进行白内障手术是治疗此类患者的关键所在,但对术者要求较高,激光治疗远期疗效不确切。

AIM： To study the effect of operation and laser and application of IOLmaster and OLM（opacity lensmeter） on patients with cataract and shallow anterior chamber. METHODS： Totally 106 patients 128 eyes with cataract and shallow anterior chamber were divided into mild and severe groups by anterior chamber depth, mild, moderate and severe groups by lens density. Some patients received phacoemulsification or laser treatment. They were observed and analyzed for 2 years. ~ RESULTS： No operation group： The conditions of anterior chamber and intraocular pressure（IOP~） are more serious than before in mild and severe anterior chamber groups during 2 years（P〈 0.05）; With the worsening of lens density, the conditions of anterior chamber and lOP in severe lens density group were more serious than that in other two groups during 2 years（P〈 0.05）. Operation group： After 2 years the high lOP rate of patients with operation was lower than that without surgery treatment （P〈 0.05） ; The conditions of anterior chamber and lOP of patients with operation was better than before and that without surgery treatment（ P 〈 0.05 ） ; The best-corrected visual acuity （BCVA~） of all patients is improved after surgery than before（ P〈 0.05）, while the BCVA of patients in severe anterior chamber group after operation was lower than that in mild anterior chamber（P〈0.05）. Laser treatment group： 1 years later, lOP of patients with laser treatment in mild anterior chamber group was not significantly improved than before（ P〉 0.05）, while lOP of patients with laser treatment in severe anterior chamber group was more worse than before（ P〈 0.05） though laser treated successfully. CONCLUSION. IOLmaster and OLM can offer the assessing of progression of the patients with cataract and shallow anterior chamber. Earlier surgery of cataract is more effective than laser treatment though with a little difficuty.