急性闭角型青光眼合并白内障双眼解剖参数及治疗效果的对比研究

Comparative study on binocular anatomic parameters and therapeutic effect of acute angle closure glaucoma complicated with cataract

目的:比较急性闭角型青光眼(AACG)合并白内障病人发作眼与未发作眼解剖结构的差异,探讨AACG合并白内障病人行单纯白内障摘除的时机。方法:收集30例(60眼)AACG合并白内障病人,1眼急性发作(1次或多次)(发作组),对侧眼为未发作眼(未发作组),两眼的矫正视力≤0.3。比较2组眼治疗前的眼轴、晶状体厚度和房角开放距离500(angle opening distance,AOD500)、前房深度(anteriorchamber depth,ACD),对比2组治疗前后的视力提高及并发症比例。结果:治疗前,2组眼轴、晶体厚度、晶体厚度/眼轴差异无统计学意义(P>0.05),未发作组的AOD500及ACD均明显大于发作组(P<0.01)。未发作组和发作组治疗后ACD较治疗前均加深(P<0.01和P<0.05),发作组眼压较治疗前明显降低(P<0.01),未发作组治疗前后眼压均为正常值无明显变化(P>0.05)。发作组去除未达到静息状态5例后,2组ACD差异无统计学意义(P>0.05),未发作组AOD500明显大于发作组(P<0.01)。治疗后,未发作组视力提高率93.33%(28/30)高于发作组的73.33%(23/30)(P<0.05);术后并发症方面,未发作组发生1例后发性白内障,发作组发生后发性白内障1例,残余青光眼2例,白内障加重4例,合计7例;未发作组发生率3.33%(1/30),低于发作组的23.3%(7/30)(P<0.05)。结论:AACG合并白内障病人发作眼静息状态下周边房角参数AOD500明显小于未发作组,临床前期的AACG合并明显白内障病人未发作期行白内障摘除有效减少急AACG的发作,远期视力明显提高。

Objective:To compare the difference of anatomical structure between seizer eyes and nonseizer eyes of patients with acute angle closure glaucoma(AACG)complicated with cataract,and explore the time of simple cataract extraction in AACG patients complicated with cataract.Methods:The clinical data of 30 cases(60 eyes)with AACG complicated with cataract were collected,which included one eye with acute seizer(1 or more times),contralateral eye with nonseizer,and correction vision of both eyes≤0.3.The axis,lens thickness,angle opening distance 500(AOD500)and anterior chamber depth(ACD)between two groups before treatment were compared.The visual acuity improvement and incidence rate of complications after treatment were compared between two groups.Results:Before treatment,there was no statistical significances in eye axis,crystal thickness and crystal thickness/eye axis between two groups(P>0.05),and the AOD500 and ACD in seizer group were greater than those in nonseizer group(P<0.01).After treatment,the ACD in nonseizer group and seizer group was deeper than that before treatment(P<0.01 and P<0.05),the IOP in seizer group was lower than that before treatment(P<0.01),and the IOP in nonseizer group was normal after treatment(P>0.05).After 5 patients without reaching the resting state in seizer group were removed,the difference of ACD between two groups was not statistically significant(P>0.05),and the AOD500 in nonseizer group was greater than that in seizer group(P<0.05).In terms of postoperative complications,one case with posterior cataract in nonseizer group,and 1 case with posterior cataract,2 cases with residual glaucoma and 4 cases with cataract aggravation in seizer group were found.The incidence rate of which in nonseizure group[3.33%(1/30)]was lower than that in seizer group[23.3%(7/30)](P<0.05).Conclusions:The peripheral angle parameter AOD500 of patients with AACG complicated with cataract in resting state of the seizer eye is significantly less than that in nonseizer eye.The cataract extraction in pre-clinical patients with AACG complicated with cataract during nonseizer can effectively reduce the incidence rate of AACG,and improve the long-term vision.