原发性闭角型青光眼行白内障超声乳化联合人工晶状体植入术后超声生物显微镜观察

Ultrasound biomicroscope observation after phacoemulsification and intraocular lens implantation in primary angle-closure glaucoma

目的通过超声生物显微镜评估白内障超声乳化联合人工晶状体植入术对药物可以控制的原发性闭角型青光眼患者眼前节结构的影响。方法收集药物可以控制的原发性闭角型青光眼合并白内障患者30例(30眼),所有患者均自愿接受白内障超声乳化联合人工晶状体植入术。分别于术前及术后1个月、6个月行超声生物显微镜检查,通过测量前房深度、距离巩膜突500μm的房角开放距离和小梁睫状突距离来观察前房结构的变化。结果患者术前及术后1个月、6个月的前房深度分别为(1.781±0.260)mm、(3.249±0.741)mm、(3.473±0.196)mm,术后1个月和6个月患者的前房深度均较术前明显加深(均为P<0.001)。术后上方、颞侧、鼻侧和下方4个象限距离巩膜突500μm的房角开放距离较术前都有显著增加(均为P<0.001),分别平均增加0.114mm、0.147mm、0.149mm和0.110mm;4个象限的小梁睫状突距离均较术前显著增加(均为P<0.001),分别平均增加0.087mm、0.142mm、0.094mm和0.121mm。4个象限的距离巩膜突500μm的房角开放距离与小梁睫状突距离均呈显著正相关(均为P<0.05)。结论对于药物可以控制的原发性闭角型青光眼,白内障手术可使中央前房加深,前房角增宽,睫状突位置后移。

Objective To evaluate the effects of phacoemulsification and intraocular lens implantation on anterior chamber configuration in primary angle-closure glaucoma patients by ultrasound biomicroscope. Methods Thirty patients （ 30 eyes） with primary angle-closure glaucoma and cataract, which could be controlled with medicine,were enrolled in this study. All the patients accepted phacoemulsification and intraocular lens implantation. Ultrasound biomicroscopy was performed preoperatively and 1 month,6 months postoperatively. The anterior chamber depth （ACD）, angle opening distance at 500μm （AODS00） from the scleral spur, and trabecular-ciliary process distance（TCPD） were measured to detect the anterior chamber configuration changes. Results The preoperative ACD was（1. 781 ±0.260） mm,and was（3. 249 ±0. 741）mm at 1 month postoperatively, （3. 473 ± 0. 196） mm at 6 months postoperatively, there were significant differences （ all P 〈 0.001 ）. The postoperative superior, temporal, nasal and inferior AOD500 were obviously increased, there were significant differences compared with pre-operation（ all P 〈 0.001 ） ,the mean increased distance were 0.114 mm,0. 147 mm,0. 149 mm and 0.110 mm. The postoperative superior, temporal, nasal and inferior TCPD were obviously increased, there were significant differences compared with pre-operation（ all P 〈 0. 001 ）, the mean increased distance were 0.087 mm,0. 142 mm,0.094 mm and 0. 121 mm. AOD500 were positive correlated significantly with TCPD at all the four quadrants after surgery（ all P 〈 0.05）. Conclusion For medically controlled primary angle-closure glaucoma patients, cataract surgery can deepen the central ACD, widen the anterior chamber angle, and posteriorly location the ciliary process.