四种手术方式治疗急性闭角型青光眼急性发作期的临床观察

Clinical observation of four surgical methods for primary acute angle-closure glaucoma

目的参照眼球解剖参数,观察4种术式治疗APACG急性发作后的临床效果,研究其手术方式的选择,减少并发症的发生。方法回顾性病例研究。选择2011年5月至2015年5月在我科治疗的APACG急性发作期的患者,48例53眼。根据我国原发性青光眼诊断和治疗专家共识和眼球参数(晶状体厚度、眼轴长度、前房深度等)作为手术方式的选择条件分别作复合式小梁切除术、青白联合手术、单纯白内障手术、激光虹膜周切术,观察术后眼压(非接触性)、BCVA、房角改变、前房深度、滤过泡形态、并发症等。结果术后眼压较术前均明显下降,青白联合手术后眼压水平低于其他术式。视力较术前均有提高,单纯白内障手术提高最明显。前房深度较术前均有不同程度的加深,青白联合手术和单纯白内障手术加深显著。术后并发症无明显差异。复合式小梁切除术和青白联合手术术后滤过泡差异无统计学意义。结论对于具有短眼轴、晶状体相对比较厚的APACG患者,白内障手术指针可适当扩大,倡议行复合式小梁切除术时联合行晶状体摘除术,术后眼压控制更好,同时提高视力,短期内避免二次手术。

Objetive To observe the clinical results from four surgical methods treating primary acute angle-closure glaucoma. Methods This was a retrospective case series study. 53 eyes of 48 patients, who were diagnosed with primary acute angleclosure glaucoma between May, 2011 and May, 2015 were recruited. Based on expert consensus and differences in eyeball′s anatomical parameters（lens thickness, axial length, anterior chambers depth）, the patients were treated by compound trabeculectomy、phacotrabeculectomy、phocoemulsification and laser peripheral iridotomy, Intraocular pressure、BCVA、bleb morphology shape、anatomical parameters and complications after surgery were observed. Results Postoperative intraocular pressure decreased significantly with the four surgeries. Postoperative IOP with phacotrabeculectomy was lower than those with other three surgeries. Postoperative BCVA increased with different degrees. Postoperative BCVA with phocoemulsification was better than others. Postoperative anterior chambers depth was deepened with different degrees. Postoperative anterior chambers depth with phacotrabeculectomy and phocoemulsification was larger significantly than others. Complications were not significantly different among the four operations. Bleb morphology was not significantly different within trabeculectomy and phacotrabeculectomy. Conclusion In primary acute angle-closure glaucoma with a shorter axial length and thicker lens, phocoemulsification, could remove the lens. When combined with trabeculectomy., IOP control is better in and it can increase visual acuity and avoid second surgery.