PACG患者青白联合手术后的屈光状态及影响因素

Analysis of Refractive Outcome and Related Factors in PACG Patients after Phacotrabeculectomy

目的:探讨原发性闭角型青光眼(PACG)患者行青光眼白内障联合手术后3个月的屈光状态以及相关影响因素。方法:前瞻性临床研究。选择2018年12月至2019年9月于吉林大学第二医院眼科中心行小梁切除联合白内障超声乳化摘除及人工晶状体植入术(简称青白联合术)的PACG合并白内障患者51例(51眼)。术前用药后眼压≤21 mmHg(1 mmHg=0.133 kPa)患者作为正常眼压组(24例),>21 mmHg作为高眼压组(27例)。所有患者术前使用AL-scan测量前房深度(ACD)、眼轴长度(AL)、角膜曲率,并通过该仪器内置的SRK-T公式预测术后屈光度。随访至术后3个月行综合验光。根据术后屈光误差(RE)将患者分为近视误差组(RE<-0.5 D)、远视误差组(RE>0.5 D)、无屈光误差组(-0.5 D≤RE≤0.5 D)。正常眼压组与高眼压组患者术后屈光误差分布比较采用卡方检验,近视误差组与远视误差组患者术前生物参数比较采用独立样本t检验,手术前后生物参数比较采用配对样本t检验。结果:正常眼压组患者术后近视误差4例(17%),远视误差3例(12%),无屈光误差17例(71%);高眼压组患者近视误差7例(26%),远视误差16例(59%),无屈光误差4例(15%)。高眼压组患者术后AL缩短程度大于正常眼压组患者,组间差异有统计学意义(t=-4.308,P<0.001)。远视误差组患者术前ACD浅于近视误差组患者,术前AL短于近视误差组患者,组间差异比较均有统计学意义(t=3.226,P=0.03;t=4.993,P<0.001);近视误差组与远视误差组间的角膜曲率差异无统计学意义(t=-1.143,P=0.263)。术后RE与术前ACD、AL均呈负相关(r=-0.32,P=0.023;r=-0.52,P<0.001),与术前角膜曲率无相关性(r=0.15,P=0.101)。结论:相对于术前眼压正常的PACG患者,术前高眼压患者青白联合术后屈光误差发生的比例更高,且大多是远视屈光误差。另外,PACG患者青白联合术后总体上存在术前ACD越浅,AL越短,术后屈光状态越倾向于远视的趋势。

Objective:To study the refractive outcome and related factors in primary angle closure glaucoma(PACG)patients 3 months after phacotrabeculectomy.Methods:This was a prospective clinical study.Fifty-one eyes of 51 patients with PACG and co-existing cataract who underwent phacotrabeculectomy at the Eye Center of the Second Hospital of Jilin University from December 2018 to September 2019 were enrolled.Patients with intraocular pressure(IOP)≤21 mmHg(1 mmHg=0.133 kPa)were classified as the normal IOP group and patients with IOP>21 mmHg were classified as the high IOP group.Anterior chamber depth(ACD),axial length(AL)and keratometry were measured by AL-scan,and the SRK-T formula of AL-scan software was used to calculate the intraocular lense power and predict the refractive outcome.Subjective refraction was performed at 3 months.According to postoperative refractive error(RE),the patients were divided into a myopia group(RE<-0.5 D),hyperopia group(RE>0.5 D)and no refractive error group(-0.5 D≤RE≤0.5 D).A Chi-square test was used to compare the distribution of refractive errors between the normal and high IOP groups.The preoperative biological parameters of the myopia group and hyperopia group were compared by an independent t-test,and a paired sample t-test was used to compare the biological parameters before and after surgery.Results:In the normal IOP group,there were 4 patients with myopia(17%),3 patients with hyperopia(12%),and 17 patients without refractive error(71%);in the high IOP group,there were 7 patients with myopia(26%),16 patients with hyperopia(59%),and 4 patients without refractive error(15%).The reduction of AL in patients with high IOP was greater than that in patients with normal IOP,and the difference was statistically significant(t=-4.308,P<0.001).The preoperative ACD of the hyperopia group was shallower than that of the myopia group,and the preoperative AL was shorter than that of myopia group.The difference was statistically significant(t=3.226,P=0.03;t=4.993,P<0.001).With keratometry,there was no significant difference between the two groups(t=-1.143,P=0.263).There was a negative correlation between postoperative RE and preoperative ACD and AL(r=-0.32,P=0.023;r=-0.52,P<0.001);there was no significant correlation between postoperative RE and keratometry(r=0.15,P=0.101).Conclusions:Compared with normal IOP,PACG patients with high IOP have more RE,and most of them are hyperopic RE.In addition,the shallower the ACD and the shorter the AL were,the refractive outcome of PACG patients after phacotrabeculectomy more likely tends to be hyperopia.