伴有浅前房的白内障行微切口超声乳化吸除联合IOL植入术的疗效

Clinical efficacy of micro incision phacoemulsification and intraocular lens implantation in patients with shallow anterior chamber and cataract

目的:探讨浅前房伴白内障患者行超声乳化吸除联合人工晶状体植入术的疗效及安全性。方法:回顾性病例对照研究。收集2014-02/2015-07在我院行微切口超声乳化白内障吸除术的浅前房伴白内障患者65例65眼,分为轻度浅前房组及高危浅前房组,观察手术前后各组患者最佳矫正视力、眼压、中央前房深度(central anterior chamber depth,CACD)、房角开放程度及术后并发症,并进行分析。结果:轻度浅前房组34眼中,术后29眼视力提高,4眼视力稳定;1眼视力下降。高危浅前房组31眼中,术后16眼视力较前提高,10眼视力稳定,5眼视力下降,轻度浅前房组患眼视力预后好于高危浅前房组,差异有统计学意义(t=-2.956,P<0.05)。轻度浅前房与高危浅前房组术后平均眼压均呈降低趋势,前者平均眼压降低5.71±2.07mmH g,后者则减少9.77±4.04mmH g,两组间增加幅度差异有明显统计学意义(t=-5.02,P=0.000)。轻度浅前房与高危浅前房组术后CACD均呈明显增加,前者CACD平均增加1.37±0.38mm,后者则增加1.67±0.43 mm,两组间增加幅度差异亦有明显统计学意义(t=-3.04,P=0.003)。术前患眼nAOD500平均值为200.57±33.74μm;术后1d,1、3mo时nAOD500依次为346.62±101.37、410.75±137.48、398.69±122.28μm,均较术前nAOD500明显增加,差异有显著统计学意义(F=203.75,P<0.01),而颞侧、上方、下方的AOD500均呈现类似的趋势。65眼中,并发症依次为角膜水肿5眼、一过性眼压升高2眼、后囊膜混浊4眼,后囊膜破裂1眼。结论:微切口白内障手术适用于轻度及高危浅前房伴白内障患者,是一种安全有效的治疗方式,可以有效改善视力预后,降低眼压,加深中央前房深度,并开放房角。

AIM ： To investigate the efficacy and safety of phacoemulsification combined with intraocular lens implantation in the treatment of shallowanterior chamber with cataract. METHODS： Retrospective case series. FromFebruary2014 to July 2015 in our hospital,65 eyes in 65 patients with cataract were enrolled and divided into mild and high risk of shallowanterior chamber group. Best-corrected visual acuity（ BCVA）, intraocular pressure（ IOP）, central anterior chamber dept（ CACD）,angle opening distance（ AOD）,complications pre-and post treatment,were observed and analyzed as outcome measures. RESULTS： In this study, the mild shallowanterior chamber group included 34 eyes; postoperative BCVA were improved in 29 eyes,with 4 eyes remaining stable and decreased in 1 eye; BCVA was improved in 16 eyes,with 10 eyes remaining stable and decreased in 5 eyes in high risk of shallowanterior chamber group postoperatively. BCVA had a better prognosis in the mild shallowanterior chamber group than another group（ t=-2. 956,P0. 05）. M eanwhile,IOP decreased by 5. 71 ±2. 07 mmHg and CACD increased by 1. 37 ± 0. 38 mmin the mild shallowanterior chamber group,by 9. 77±4. 04 mmHgand 1. 67±0. 43 mmrespectively in high risk group,and the difference has statistical significance（ t =-5. 02,-3. 04; P0. 05）. The mean preoperative nasal AOD500 was 200. 57±33. 74μ m,and they were 346. 62 ± 101. 37μ mand 410. 75 ±137. 48μ mand 398. 69 ± 122. 28μ mrespectively at postoperative 1d,1 and 3mo,and all n AOD500 comparing with preoperative were increased obviously, and the difference has statistical significance（ F= 203. 75,P0. 01）.And AOD500 at temporal,superior and inferior presented similar trends. Complications were corneal edema（ 5eyes）, transient intraocular hypertension（ 2 eyes）,posterior capsular opacification（ 4 eyes）,and posterior capsular rupture（ 1 eye）.CONCLUSION： Micro incision cataract surgery is useful,effective and safe in patients with cataract and shallowanterior chamber which can stabilize or improve BCVA,reduce IOP,deepen CACD and open the anterior chamber angle.