晶体相关手术在原发性急性闭角型青光眼合并白内障中的疗效分析

Analysis of the Curative Effect of Lens Related Surgery in Acute Primary Angle Closure Glaucoma with Cataract

目的:研究超声乳化白内障摘除+人工晶体植入联合房角分离术在治疗原发性急性闭角型青光眼(APACG)合并白内障患者中的效果及安全性。方法:以本院2018年12月-2020年9月住院治疗的APACG合并白内障患者45例(46眼)作为研究对象,然后随机分为研究组(房角分离术联合超声乳化白内障吸除+人工晶体植入术组)和对照组(超声乳化白内障吸除+人工晶体植术组),剔除随访资料不完整者及1例双眼患者仅以第1眼纳入研究,最终纳入研究的患者每组20例(20眼)。比较两组术后的眼压、中央前房深度、最佳矫正视力、前房角开放程度及并发症情况等。结果:(1)术前,两组眼压比较,差异无统计学意义(P>0.05);术后1 d、1、4、12、24周两组眼压均较术前显著降低(P<0.01);术后1 d、1周眼压降低程度两组比较,差异无统计学意义(P>0.05),术后4、12、24周时研究组眼压较对照组低(P<0.05)。(2)术前两组中央前房深度比较,差异无统计学意义(P>0.05);术后12周时两组中央前房深度均较术前显著加深(P<0.001),且研究组比对照组加深更多(P<0.05)。(3)术前两组BCVA比较,差异无统计学意义(P>0.05),术后两组BCVA均较术前显著提升(P<0.05),但术后两组BCVA比较,差异无统计学意义(P>0.05)。(4)术前两组前房角开放程度比较,差异无统计学意义(P>0.05),术后24周时两组前房角均较术前显著开放(P<0.05),且研究组比对照组开放更多(P<0.05)。(5)研究组并发症发生率为25.0%,对照组为20.0%,两组比较差异无统计学意义(P>0.05)。结论:超声乳化白内障吸除+人工晶状体植入联合房角分离术是治疗APACG合并白内障安全有效的方法,不仅可以改善患者视力,且长期控制眼压效果更好,并且不增加并发症的发生。

Objective:To investigate the clinical curative efficacy and safety of phacoemulsification and intraocular lens implantation combined with goniosynechialysis in the treatment of acute primary angle closure glaucoma(APACG)with cataract.Method:A total of 45 patients(46 eyes)with APACG and cataract who were hospitalized in our hospital from December 2018 to September 2020 were selected and divided into the research group(angle separation combined with phacoemulsification+intraocular lens implantation)and the control group(phacoemulsification+intraocular lens implantation),excluding those with incomplete follow-up data and one patient with both eyes,only the first eye was included in the study,and finally 20 patients(20 eyes)were included in each group.The intraocular pressure,central anterior chamber depth,best corrected visual acuity,anterior chamber angle opening and complications were compared between the two groups.Result:(1)There was no significant difference in intraocular pressure between the two groups before operation(P>0.05);the IOP of the two groups at 1 day,1 week,4 weeks,12 weeks and 24 weeks after operation were significantly lower than before operation(P<0.01);there were no significant differences between the two groups at 1 day and 1 week after operation(P>0.05),and the IOP of the study group at 4 weeks,12 weeks and 24 weeks after operation were lower than those of the control group(P<0.05).(2)There was no significant difference in central anterior chamber depth between the two groups before operation(P>0.05);at 12 weeks after operation,the central anterior chamber depth of the two groups was significantly deeper than that before operation(P<0.001),and the study group was deeper than that of the control group(P<0.05).(3)There was no significant difference in BCVA between the two groups before operation(P>0.05),and the BCVA of the two groups after operation was significantly higher than that before operation(P<0.05),but there was no significant difference in BCVA between the two groups after operation(P>0.05).(4)There was no significant difference in the opening degree of anterior chamber angle between the two groups before operation(P>0.05).At 24 weeks after operation,the anterior chamber angle of the two groups was significantly opened compared with that before operation(P<0.05),and the study group was more deepened than the control group(P<0.05).(5)The incidence of complications in the study group was 25.0%and that in the control group was 20.0%.There was no significant difference between the two groups(P>0.05).Conclusion:Phacoemulsification and intraocular lens implantation combined with goniosynechialysis is an effective and safe surgery for the treatment of APACG complicated with cataract,which can not only improve the best corrected visual acuity(BCVA)of patients,but also reduce the intraocular pressure for a long time,without increasing the occurrence of complications.