晶状体超声乳化联合房角分离术治疗小梁切除术后复发的原发性闭角型青光眼合并白内障患者的临床疗效

Clinical efficacy of phacoemulsification with goniosynechialysis for recurrent primary angle-closure glaucoma with cataract after trabeculectomy

目的评价晶状体超声乳化联合房角分离术治疗小梁切除术后复发的原发性闭角型青光眼(PACG)合并白内障患者的临床疗效。方法回顾性临床研究。选取2017年1月至2020年6月我院收治的小梁切除术后复发的PACG合并白内障患者27例(29眼),患者入院后均行晶状体超声乳化联合后房型人工晶状体植入及房角分离术。采用国际标准视力表检测患者最佳矫正视力(BCVA),用非接触眼压计测量患者眼压,超声生物显微镜测量患者中央前房深度,动态房角镜下检测房角粘连性关闭(PAS)范围;比较患者术前及术后1 d、1周、1个月、3个月、末次随访时的BCVA和眼压;比较患者术前、术后1个月、末次随访时的中央前房深度、PAS范围、角膜内皮细胞数,并记录术中并发症和后续治疗方案。结果术后1 d、1周、1个月、3个月及末次随访患者的BCVA分布等级与术前两两相比,差异均有统计学意义(均为P<0.001),术后患者BCVA均较术前提高。术后各时间点患者眼压均较术前降低,差异均有统计学意义(均为P<0.001);术后1 d患者眼压也较术后其他时间点降低,差异均有统计学意义(均为P<0.008)。术前患者眼压最高,术后1 d眼压下降最明显,之后缓慢升高。术后1个月和末次随访时患者中央前房深度较术前均明显增加(均为P<0.001)。术后1个月和末次随访时患者的PAS范围均小于术前(均为P<0.001)。术前、术后1个月和末次随访时患者的角膜内皮细胞数,差异无统计学意义(F=0.034,P=0.967)。术后4眼前房积血,给予止血、半卧位、制动等处理,3 d内积血消退。术后3眼前房渗出,给予激素滴眼液治疗后1周内渗出消退。结论晶状体超声乳化联合房角分离术治疗小梁切除术后复发的PACG合并白内障患者,可以提高患者视力,降低眼压,是安全有效的治疗方法。

Objective To evaluate the clinical efficacy of phacoemulsification with goniosynechialysis for recurrent primaryangle-closure glaucoma(PACG)with cataract after trabeculectomy.Methods Retrospective clinical study.The study recruited 27 patients(29 eyes)of recurrent PACG with cataract after trabeculectomy from January,2017 to June,2020 in our hospital.All patients accepted phacoemulsification combined with posterior chamber intraocular lens implantation and goniosynechialysis.The outcomes included the best corrected visual acuity(BCVA)by international standard visual acuity chart,intraocular pressure(IOP)by non-contact tonometer,depth of central anterior chamber by ultrasound biomicroscopy,peripheral anterior synechiae(PAS)range by dynamic gonioscopy.BCVA and IOP were compared before surgery,1 day,1 week,1 month,3 months after surgery and at the last follow-up.Central anterior chamber depth,PAS range and corneal endothelial cell count were compared before,1 month after surgery and at the last follow-up.The intraoperative complications and subsequent treatment were recorded.Results There were statistically significant differences in BCVA grade distribution between patients on day 1,1st week,3rd week and the last follow-up after surgery and those before surgery,respectively(all P<0.001),which showed BCVA improved after treatment.The IOP of patients at all time points after surgery was lower than that before surgery,and the differences were statistically significant(all P<0.001).The IOP of the patients at 1 day after surgery was also lower than that at other time points after surgery with statistical significance(all P<0.008).The IOP was highest before surgery and lowest at 1 day after operation,then increased slowly.The depth of the central anterior chamber was significantly increased at 1 month after surgery and at the last follow-up(both P<0.001).Surveys showed clear evidence of a decline in PAS range 1 month after surgery and at last follow-up time(both P<0.001).There was no significant difference in corneal endothelial cell count before surgery,1 month after surgery and at last follow-up time(F=0.034,P=0.967).Hyphema occurred in 4 eyes after surgery,which was absorbed within 3 days by hemostasis,semi-decubitus position and immobilization.Three eyes came up with exudation which subsided in 1 week after the use of hormone eye drops.Conclusion Phacoemulsification with goniosynechialysis for recurrent PACG with cataract after trabeculectomy can improve visual acuity and reduce IOP,which is proved as a safe and effective method.