超声乳化联合IOL植入治疗闭角型青光眼后眼前节结构变化

Changes of anterior segment in patients with primary angle-closure glaucoma treated with phacoemulsification and intraocular lens implantation detected by Pentacam

目的:通过Pentacam眼前节分析系统检测急慢性原发性闭角型青光眼(primary angle-closure glaucoma,PACG)超声乳化手术前后前房结构变化,探讨影响不同类型PACG临床治疗效果的因素。方法:PACG患者163例178眼,其中急性PACG(APACG)87例92眼、慢性PACG(CPACG)76例86眼,均行超声乳化晶状体吸除人工晶状体植入,根据病情辅以房角分离。比较手术前和术后6mo视力、眼压、前房角镜检查结果以及Pentacam检测的中央前房深度(ACD,单位mm)、前房容积(ACV,单位μm3)、前房角(ACA,单位°,下同)。结果:APACG与CPACG术后眼压均显著下降(P<0.01),APACG为51.17±6.58mm Hg vs 14.32±2.66mm Hg,CPACG为33.25±5.45mm Hg vs 15.86±3.54mm Hg,且APACG降压效果优于CPACG(P<0.05)。两组患者术后视力均改善明显(P<0.01),APACG视力改善要优于CPACG(P<0.05)。术后房角镜检查,两组患者房角均显著增宽,房角粘连显著改善。Pentacam显示术后所有APACG和CPACG患者ACD、ACV和ACA均较术前明显增加(P<0.01);APACG:ACD为2.83±0.10mm vs 1.69±0.14mm,ACV为145.85±14.36μm^3 vs 68.34±14.02μm^3,ACA为30.50°±4.23°vs 18.28°±4.46°;CPACG:ACD为2.82±0.10mm vs 1.96±0.20mm,ACV为141.28±14.64μm^3 vs 88.19±15.86μm^3,ACA为31.65°±4.62°vs 22.03°±4.48°。术前APACG组患者ACD、ACV和ACA均显著低于CPACG组(P<0.01),而术后除ACV外,ACD、ACA未显示出统计学差异(P>0.05)。两组患者ACD、ACV和ACA术前术后的变化值也有显著统计学差异(P<0.01)。结论:Pentacam能有效观察PACG行超声乳化白内障吸除联合人工晶状体植入前后的眼前节结构变化,提示眼前节结构可能与PACG发病机制密切相关,其变化是超声乳化能显著改善PACG症状的重要原因。超声乳化联合人工晶状体植入治疗急慢性PACG不同的临床效果可能与其不同发病机制密切相关。

AIM：To observe the changes of anterior segment before and after phacoemulsification and intraocular lens implantation in patients with primary angle- closure glaucoma（PACG） by Pentacam system,so as to assess the efficacy and the influence factors for treating PACG.·METHODS：One hundred and sixty-three patients（178eyes） with PACG were included in the presented study,which were classified to acute PACG（APACG,87 patients with 92 yes） and chronic PACG（CPACG,76 patients with86 eyes）.Phacoemulsification and posterior-chamber IOL（PC-IOL） implantations were performed for all eyes and combined with goniosynechialysis if necessary.Visual acuity,intraocular pressure（IOP）,the central anterior chamber depth（ACD）,anterior chamber volume（ACV）and peripheral anterior chamber angle（ACA） were examined by Pentacam system pre-operatively and 1d,1wk,3 and 6mo post-operatively.·RESULTS：In both groups,the IOP was significantly decreased after operations（P 0.01）,Which in patients with APACG were 51.17 ± 6.58 mmHg and 14.32 ± 2.66 mmHg and in patients with CPACG were 33.25±5.45 mmHg and 15.86±3.54 mmHg.The IOP significantly decreased more in patients with APACG than that in patients with CPACG（P0.05）.The visual acuity was also improved after operations（P0.01） and it improved more in patients with APACG than that in patients with CPACG（P0.01）.Postoperative gonioscopy（at 3mo） results demonstrated that the angle of anterior chamber opened wider and the range of peripheral anterior synechiae（PAS） reduced after surgeries.The ACD,ACV and ACA were increased significantly after surgeries（P0.01）detected by Pentacam in all patients.In patients with APACG：ACD before and after surgeries were 1.69 ±0.14 mm vs2.83±0.10 mm respectively;ACV were 68.34±14.02μm^3 vs 145.85±14.36μm^3;ACA were 18.28°±4.46° vs30.50°±4.23°.In patients with CPACG：ACD before and after surgeries were 1.96±0.20 mm vs 2.82±0.10mm;ACV were 88.19±15.86μm^3 vs 141.28±14.64μm^3;ACA were22.03°±4.48° vs 31.65° ±4.62°.Compared to CPACG group,the ACD,ACV and ACA of patients with APACG were significantly lower before operations（P0.01） while after operations,except for ACV,no differences were found on the three indicators（P0.05）.The changes on ACD,ACV and ACA before and after operations were significant between patients with APACG and CPACG（P0.01）.·CONCLUSION：Pentacam system can directly demonstrate the changes of anterior segment before and after phacoemulsification combined with IOL for angleclosure glaucoma.It demonstrates that the anterior segments maybe closely related to the mechanisms of PACG,the changes of which contributes significantly to the clinical effects of phacoemulsification and PC-IOL implantation for both APACG and CPACG patients.The difference of clinical efficacy for APACG and CPACG is maybe correlatied to the different mechanisms.