白内障超声乳化人工晶状体植入术对早期原发性青光眼眼压控制效果分析

Effects ofphacoemulsification and intraocular lens implantation for early control ofintraocular pressure of primary glaucoma

目的观察早期原发性青光眼行超声乳化联合人工晶状体植入术后眼内压（10P）控制情况，分析与术后IOP控制效果相关的影响因素。方法回顾性选择原发性闭角型青光眼（PACG）43例（43只眼）和原发性开角型青光眼（POAG）早期患者32例（32只眼），均行标准3．2mm透明角膜切口白内障超声乳化联合折叠人工晶状体植入术，术后2年定期随访。手术成功标准为：术后IOP保持在6-21mmHg，青光眼神经病变及相应视野缺损无明显进展，无需再行抗青光眼手术治疗。结果白内障超声乳化联合人工晶状体植入术后，PACG组有28例（65．1％）、POAG组有12例（37．5％）术后IOP控制良好，2年累计生存率之间存在差异（P〈O．05）。PACG组成功与失败病例在术前IOP（33．0±5．3）mmHgvs（40．1±3．6）mmHg，P〈0．01、抗青光眼药物数量（2．9±0．9vs4．1±0．4，P〈0．01）、房角粘连范围（2．9±0．5）钟点VS（4．2±0．8）钟点，P〈0．01）之间的差异具有统计学意义，而POAG组成功与失败病例在术前IOP（25．3±3．4）mmHgvs（35．4±3．6）mmHg，P〈0．01、抗青光眼药物数量（1．2±0．4vs2．8±0．9，P〈0．01）之间的差异具有统计学意义。Cox逐步回归分析发现，在PACG组中术前IOP（P〈0．05，RR=I．17）、PAS（P〈0．01，RR=3．971），在POAG组中术前IOP（P〈0．01，RR=1．284），与相应两组术后生存时间具有相关性。结论在术前PACG患者考虑到IOP和房角粘连范围、POAG患者考虑到IOP的条件下，超声乳化联合人工晶状体植入术对于伴有白内障的早期原发性青光眼，是一种可供选择的有效的控制眼内压的治疗方法。

Objective To assess and find associated factors for favorable postoperative intraocular pressure （lOP） after cataract phacoemulsification with intraocular lens implantation in patients with primary glaucoma on early stage. Methods Forty-five patients （43 eyes） with primary angle closure glaucoma （PACG） and 32 patients with primary open angle glaucoma （POAG） were retrospectively selected. All patients had undergone standard 3.2ram limbal incision phacoemulsification, and 2 years of routine follow-up after cataract surgery. Success was defined as an IOP between 6-21mmHg, with fewer antiglaucoma medications needed than those during pre-operation, no obvious progressions of glaucomatous neuropathy and its coincident visual field loss, and no need of additional＇ glaucoma surgery. Results After phacoemulsification with intraocular lens implantation, there Were 28 cases （65.1%） in PACG group and 12 cases ＇（37.5%） in POAG group with well controlled postoperative IOP, and the different of 2-year survival rate was statistically significant （P 〈0.05）. There were significant different in the pre-IOP （33.0± 5.3mmHg vs 40.1 ± 3.6mmHg, P 〈0.01）, the number of antiglaucoma medications （2.9± 0.9 vs 4.1 ± 0.4, P 〈0.01） and the extent of peripheral anterior synechiae （PAS） （2.9± 0.5 clock hours vs 4.2± 0.8 clock hours, P 〈0.01） between success and failure cases in PACG group. The pre-IOP （25.3± 3.4 mmHg vs 35.4± 3.6 mmHg, P 〈0.01）, the number of antiglaucoma medications （1.2± 0.4 vs 2.8± 0.9, P 〈0.01） were significant different between the success and failure cases in POAG group. Cox stepwise regression analysis found that pre-IOP （P 〈0.05, RR=I.17） and the extent of PAS （P 〈0.01, RR=3.971） in PACG group and the pre-IOP （P 〈0.01, RR=1.284） in the POAG group was significant associated with the corresponding survival time after cataract surgery. Conclusions Phacoemulsification with intraocular lens implantation may be an alternative procedure for effective IOP control of the patients with primary glaucoma on early stage coexisting with cataract on considering pre-IOP and the extent of PAS in PACG and pre-IOP in POAG.