慢性闭角型青光眼小梁切除术后早期眼前节及屈光变化的临床研究

Clinical study of early anterior segment and refractive changes after trabeculectomy on chronic angle-closure glaucoma

目的:观察并分析慢性闭角型青光眼患者小梁切除术后早期眼前节及屈光状态变化。方法:采用前瞻性研究方法,收集青光眼小梁切除手术病例20例20只眼,分别测定术前、术后1周、1个月及3个月的球面镜度数、角膜曲率、眼轴长度、前房深度,并进行统计学分析。结果:小梁切除术后1周球面镜度数较手术前差异均具有统计学意义(P<0.05),差值为(−1.20±0.55)D;术后1个月、3个月球面镜度数较手术前差异无统计学意义(P>0.05)。术前、术后1周、1个月垂直方向角膜曲率分别为(44.89±1.20)D、(45.72±1.54)D、(45.65±1.35)D,术后1周、1个月垂直方向角膜曲率较手术前显著性增加,差异具有统计学意义(P<0.05);术后3个月垂直方向角膜曲率较术后1个月差异无统计学意义(P>0.05)。术前眼轴长度(22.49±0.43)mm和前房深度(2.75±0.45)mm与术后1周眼轴长度(21.60±0.59)mm和前房深度(2.25±0.34)mm比较差异具有统计学意义(P<0.01);术后1个月和3个月前房深度、眼轴长度较手术前差异无统计学意义(P>0.05)。结论:小梁切除术后早期(术后1个月)可发生球面镜度数增加,前房变浅、眼轴变短、垂直方向曲率增加的眼前节和屈光改变。从而发生近视飘移、而影响术后视力。随时间推移(术后3个月),前房加深、眼轴长度逐渐增加、垂直散光和近视飘移度数逐渐减少,眼前节和屈光变化逐渐趋于稳定,术后视力逐渐恢复。

Objective:To observe and analyze the changes of anterior segment and refractive state in patients with chronic angle closure glaucoma after trabeculectomy. Methods: It was a prospective study. A total of 20 cases with 20 eyes that have met the inclusion criteria undergoing trabeculectomy were collected. The diopter of spherical power, corneal curvature, axial length (AL) and anterior chamber depth (ACD) were measured before the surgery and 1 week, 1 month, and 3 months after the surgery respectively. Results: There was significant difference (P<0.05) for the diopter of spherical power before and 1 week after the trabeculectomy, the difference was (−1.20±0.55) D. After 1 month and 3 months, the diopter of spherical power was not statistically significant (P>0.05). The corneal curvature in the vertical direction was (44.89±1.20) D, (45.72±1.54) D, (45.65±1.35) before, 1 week and 1 month after operation. The corneal curvature in the vertical direction increased significantly at 1 week and 1 month after operation (P<0.05), and there was no significant difference (P>0.05) after 3 months. The preoperative mean ocular axis length (22.49±0.43 mm) and mean anterior chamber depth (2.75±0.45 mm) compared with postoperative mean ocular axis length (21.60±0.59 mm) and mean anterior chamber depth (2.25±0.34 mm) were statistically significant (P<0.01). Comparing 1 month and 3 months after operation, there was no significant difference in the depth of the anterior chamber and the length of the eye axis (P>0.05). Conclusion: In the early stage after trabeculectomy (1 month after operation), the diopter of spherical power can be increased. The ACD became shallower, the eye axis became shorter, and the curvature of vertical direction increased resulting in myopic drift, which affected postoperative visual acuity. Over time (3 months after operation), the anterior chamber deepened, the axial length gradually increased, the vertical astigmatism and myopia drift degree gradually decreased, the anterior segment and refractive changes gradually stabilized, and the postoperative visual acuity gradually recovered.