超声乳化联合前房角分离术对伴有白内障的闭角型青光眼角膜内皮细胞的影响

Study on effect of phacoemulsification combined with goniosynechialysis on corneal endothelial cells for the treatment of angle closure glaucoma

目的:探讨伴有白内障的原发性闭角型青光眼(primary angle closure glaucoma,PACG)采用超声乳化白内障吸出(phacoemulsification,Phaco)人工晶状体(IOL)植入联合前房角分离术治疗后角膜内皮细胞的变化,并分析相关影响因素。方法:回顾分析接受Phaco+IOL联合前房角分离术治疗的PACG合并白内障患者95例95眼,其中女73例,男22例,年龄46~85(平均66±7)岁。记录并分析术前及术后1wk,1、2、3、6mo最佳矫正视力(BCVA)、眼内压(IOP)及角膜内皮细胞计数(endothelial cell count,ECC),同时记录术前及术后6mo前房深度(anterior chamber depth,ACD)以及前房角关闭范围。随访8mo^2a。结果:术前IOP平均为36.1±4.3(28~42)mmH g,术后6mo IOP平均为15.8±3.5(8~28)mmH g(1mmH g=0.133k Pa),术后IOP较术前显著降低,差异有统计学意义(t=17.173,P<0.01)。术后BCVA较术前显著提高,差异有统计学意义(Z=-8.351,P<0.01)。术前ACD平均为1.95±0.34mm,术后6mo ACD平均为3.11±0.33mm,术后ACD较术前显著加深,差异有统计学意义(t=11.483,P<0.01)。术前前房角关闭范围90°~180°者74眼,<90°者21眼;术后前房角关闭范围90°~180°者12眼,<90°者83眼,差异有统计学意义(Z=-9.013,P<0.01)。术前ECC平均为2 304±135个/mm2,术后1wk,1、2、3、6mo ECC平均分别为2243±152个/mm2、2135±177个/mm2、2028±172个/mm2、2017±181个/mm2、2006±143个/mm2,分别减少了2.6%、7.3%、12.0%、12.5%、13.0%。术后2mo内ECC较术前显著减少,差异有统计学意义(F=5.568,P<0.01),于2mo后趋于稳定(P3mo=0.067,P6mo=0.073)。结论:伴有白内障的PACG采用Phaco+IOL联合前房角分离术治疗可有效提高视力,使IOP恢复正常。术后ECC有所减少,但仍在正常范围内。Phaco+IOL联合前房角分离术是治疗伴有白内障的PACG一种安全有效方法。

AIM：To observe the effect of phacoemulsification and intraocular lens （ IOL ） implantation combined with goniosynechialysis on corneal endothelial cells for the treatment of primary angle closure glaucoma （ PACG ） combined cataract, and to analyze the relative factors.METHODS： Ninety-five eyes of 95 patients with PACG combined cataract were documented in this study. Twenty-two patients were male, and 73 were female. The age ranged from 46 to 85y old with a mean of（66±7） y. All patients were examined for endothelial cell count （ ECC ） , intraocular pressure （ IOP ） and best corrected visual acuity （ BCVA ） 1wk, 1, 2, 3 and 6mo after operation. Meanwhile, the range of anterior chamber closure and anterior chamber depth （ ACD ） were recorded before operation and postoperative 6mo. RESULTS： The mean IOP was 36. 1±4. 3mmHg （ 28-42mmHg） preoperatively and 15. 8±3. 5mmHg （ 8-28 mmHg）（1mmHg=0. 133kPa） 6mo after operation. There was a decreasing trend in IOP after operation（ t=17. 173, P〈0. 01）. There was an increased trend in BCVA after operation（Z=-8. 351, P〈0. 01）. The mean ACD was 1. 95±0. 34mm preoperatively and 3. 11±0. 33mm 6mo afteroperation. There was an increased trend in ACD after operation（t=11. 483, P〈0. 01）. There were 74 eyes in the range from 90o to 180o of anterior chamber and 21 eyes less than 90o before operation. There were 12 eyes in the range from 90o to 180o of anterior chamber and 83 eyes less than 90o postoperatively. The most of anterior chamber were open（Z=-9. 013, P〈0. 01）. ECC was 2304±135 cells/mm2 before operation and 2 243±152 cells/mm2 , 2 135±177 cells/mm2 , 2 028±172 cells/mm2 , 2 017±181 cells/mm2 , 2 006±143 cells/mm2 1wk, 1, 2, 3 and 6mo after operation respectively. ECC loss rates were 2. 6%, 7. 3%, 12. 0%, 12. 5% and 13. 0%. ECC had a decreased trend 2mo after operation（F=5. 568, P〈0. 01） and then kept stable（P3mo=0. 067, P6mo=0. 073）. CONCLUSION： Phacoemulsification and IOL -implantation combined with goniosynechialysis is an effective method to treat PACG combined cataract. It can increase BCVA and decrease IOP. ECC decreases after operation, but it is in the normal range. It is a safe and effective operation mode.