超声乳化联合房角分离治疗房角广泛粘连的AACG合并白内障

Efficacy of phacoemulsification with goniosynechialysis on acute angle-closure glaucoma and cataract complicated with extensive synechial angle closure

目的:评估广泛房角粘连的急性闭角型青光眼(AACG)合并白内障患者行超声乳化白内障摘除、人工晶状体植入联合房角分离术(PEI+GSL)的临床疗效。方法:采用回顾性研究,选取我院2018-01/2019-06收治的AACG合并白内障患者32例35眼,房角粘连关闭的范围均≥180°,所有患者均行PEI+GSL,观察术后1d,1wk,1、3mo最佳矫正视力(BCVA)、眼压、中央前房深度(ACD)、房角开放距离(AOD500)、小梁虹膜面积(TISA500),术后1、3mo的房角关闭范围、盘周视网膜神经纤维厚度(RNFL)及并发症情况。结果:术后3mo,BCVA(0.334±0.154),眼压(14.63±3.59mmHg)较术前(0.914±0.290,42.54±8.06mmHg)改善(P<0.05);ACD(3.203±0.214mm)及鼻侧、颞侧OCT房角参数AOD500、TISA500(0.308±0.014、0.315±0.015mm、0.134±0.013、0.139±0.018mm2)较术前均明显增加,房角镜下房角关闭范围(72.32°±28.33°)较术前(215.29°±30.66°)减少,盘周RNFL较术前变薄(P<0.001)。术后3mo鼻侧、颞侧AOD500、TISA500变化量与眼压存在负相关性,但与ACD变化量无相关性,术后3mo无明显并发症发生。结论:应用PEI+GSL治疗广泛房角粘连的AACG合并白内障患者可以改善视力,早期加深前房,有效促进房角开放,从而降低眼压。

AIM:To assess the clinical efficacy of phacoemulsification,intraocular lens implantation with goniosynechialysis(PEI+GSL)for acute angle closure glaucoma(AACG)and cataract with extensive angle closure synechiae.METHODS:A retrospective study,we studied 35 eyes of 32 patients with AACG and cataract in our hospital.The extent of anterior chamber angle-closure synechiae was defined as an eye with>180°.All patients underwent PEI+GSL and completed an ophthalmologic examination including vision,intraocular pressure(IOP),anterior chamber depth(ACD),angle-opening distance(AOD500),trabecular-iris space area(TISA500)were observed at 1d,1wk,1mo and 3mo after cataract surgery.The angle closure range and retinal nerve fiber layer(RNFL)thickness changes at postoperative 1mo and 3mo were observed,and recorded complications.RESULTS:Postoperative 3mo BCVA(0.334±0.154)and IOP(14.63±3.59mmHg)were improved compared with preoperative(0.914±0.290,42.54±8.06mmHg)(P<0.05).ACD(3.203±0.214mm),OCT angle parameters AOD500 and TISA500(0.308±0.014,0.315±0.015mm,0.134±0.013,0.139±0.018mm2)were significantly increased compared with preoperation.The extent of angle closure with gonioscopy(72.32±28.33°)decreased compared preoperation(215.29°±30.66°),and RNFL thickness thinner than preoperation(P<0.001).Changes in AOD500 and TISA500 for both nasal and temporal were negatively correlated with IOP,but not with changes in ACD,and no significant complications occurred in the 3mo after surgery.CONCLUSION:The treatment of PEI+GSL can improve vision,deeper ACD and effectively open ACA in the early stage,thus controlling IOP.