晶状体摘出联合直视下房角分离术治疗晶状体不全脱位继发闭角型青光眼

Efficacy of lens extraction combined with goniosynechialysis in treatment of angle closure glaucoma secondary to lens subluxation

目的探讨晶状体摘出联合术中房角镜辅助直视下机械性房角分离术治疗晶状体不全脱位继发闭角型青光眼的疗效。方法回顾性分析2018年1月至2020年1月在我院眼科中心接受治疗的晶状体不全脱位继发闭角型青光眼患者21例21眼的临床资料,手术摘出脱位的晶状体后在术中房角镜辅助下行房角分离术。其中晶状体脱离范围小于180°的12眼行囊袋张力环植入+人工晶状体植入+直视下房角分离术;脱离范围大于180°的9眼行25 G闭合式玻璃体切割术切除残留囊膜及皮质,其中1眼术前视力无光感未植入人工晶状体,直接行房角分离术,8眼行人工晶状体巩膜层间无缝线固定术后再行房角分离术。术后随访6个月,记录术前、术后的最佳矫正视力、眼压、前房深度、房角粘连关闭范围及并发症情况。结果术后6个月20眼(95.2%)最佳矫正视力提高。术前11眼房角粘连关闭>180°~270°,10眼房角粘连关闭>270°;术后6个月10眼房角完全开放,6眼房角粘连关闭≤90°,3眼房角粘连关闭>90°~180°,1眼房角粘连关闭>180°~270°,1眼房角粘连关闭>270°,与术前比较差异具有统计学意义(P<0.05)。术前眼压(38.6±7.4)mmHg(1 kPa=7.5 mmHg),术后6个月降至(17.2±4.0)mmHg,与术前比较差异具有统计学意义(P<0.05)。术前前房深度(1.79±0.15)mm,术后6个月增加至(4.06±0.36)mm,与术前比较差异具有统计学意义(P<0.05)。术中及术后均无严重并发症发生。结论在虹膜拉钩、囊袋张力环及微创玻璃体切割系统的应用下,晶状体摘出联合房角镜辅助直视下机械性房角分离术治疗晶状体不全脱位继发闭角型青光眼安全有效。

Objective To investigate the efficacy of lens extraction combined with mechanically goniosynechialysis assisted by gonioscope in treatment of angle closure glaucoma secondary to subluxation of lens.Methods Twenty-one patients(21 eyes)diagnosed as secondary angle closure glaucoma caused by subluxation of lens and undergone lens extraction combined with mechanically goniosynechialysis assisted by gonioscope in Leshan Ophthalmic Center from January 2018 to January 2020 were retrospectively analyzed.Among them,12 eyes with the lens detachment range less than 180°underwent capsular bag tension ring implantation+intraocular lens implantation+direct viewing angle separation.Nine eyes with a detachment range greater than 180°underwent 25G closed vitrectomy to remove the residual capsule and cortex,of which one eye had preoperative vision without light perception and no intraocular lens implantation,and directly underwent angulation surgery,and 8 eyes underwent intraocular lens and scleral sutureless fixation and then underwent angulation surgery.Follow-up was 6 months.The best corrected visual acuity(BCVA),intraocular pressure(IOP),central anterior chamber depth(CACD),range of goniosynechia and complications were closely observed before and after surgery.Results BCVA improved in 20 eyes(95.2%)at 6 months postoperatively(P<0.05).At preoperative examination,goniosynechia ranged from 180°to 270°were observed in 11 eyes and above 270°in 10 eyes.At 6 months postoperatively,goniosynechia improved significantly with completely open angles in 10 eyes,goniosynechia≤90°in 6 eyes,goniosynechia ranged from 90°to 180°in 3 eyes,from 180°to 270°in 1 eye,and there was significant difference(P<0.05).Postoperative IOP(17.2±4.0)mmHg(1 kPa=7.5 mmHg)significantly declined compared with the preoperative measurements(38.6±7.4)mmHg(P<0.05),and postoperative CACD(4.06±0.36)mm significantly deepened compared with preoperative values(1.79±0.15)mm(P<0.05).There were no serious complications intra-operation and postoperation.Conclusion Lens extraction combined with mechanical goniosynechialysis with gonioscope is safe and effective in treatment of angle closure glaucoma secondary to subluxation of lens under the use of iris retractor,capsular tension ring and minimally invasive vitrectomy.