青光眼小梁切除术后并发白内障的危险因素分析及防治要点

Analysis of risk factors and key points of prevention and treatment of cataract after trabeculectomy for glaucoma

目的探讨青光眼小梁切除术后并发白内障的危险因素,并分析其防治要点。方法回顾性分析2016年1月至2019年10月期间在我院接受小梁切除术治疗的30例原发性闭眼型青光眼患者(共51只患眼)的临床资料。术后随访1年,根据患者是否并发白内障分为并发组(并发白内障,5例,8眼)与未并发组(未并发白内障,25例,43眼)。对两组患者的性别、年龄、病程、术前视力、晶状体厚度、眼轴长度、前房深度、PACG类型、术前持续高眼压、术后眼压、术后浅房前、操作次数、器械消毒、糖尿病史、高血压史、葡萄膜炎史、手术损伤、抗凝药物、术后愈合情况、房角结构等资料进行单因素分析比较;再行多因素Logistic回归分析患者术后并发白内障的危险因素,并提出相关防治要点。结果并发组发生率为15.69%;未并发组发生率为84.31%;其中并发组的术前持续高眼压、术后浅房前、操作次数、房角结构与未并发组比较,差异有统计学意义(P<0.05);经多因素Logistic回归分析发现患者术前持续高眼压、术后浅房前、操作次数>2次及房角结构完全闭合是青光眼小梁切除术后并发白内障的独立危险因素,差异有统计学意义(P<0.05)。结论术前持续高眼压、术后浅房前、操作次数>2次及房角结构完全闭合是青光眼小梁切除术后并发白内障的危险因素,术前应积极对症治疗,积极实施降眼压治疗,术后密切观察,针对不同病因做出相应治疗以及时恢复前房,避免PACG患者小梁切除术后发生白内障,进一步改善患者的预后。

Objective To investigate the risk factors of cataract after trabeculectomy for glaucoma and analyze the key points of prevention and treatment.Methods The clinical data of 30 patients with primary closed-eye glaucoma(51 eyes in total)treated with trabeculectomy admitted to our hospital from January 2016 to October 2019 were analyzed retrospectively.After 1 years of follow-up,the patients were divided into the complicated group(complicated with cataract,5 cases,8 eyes)and the uncomplicated group(not complicated with cataract,25 cases,43 eyes)according to whether they were complicated with cataract.Univariate analyses performed on the data of gender,age,course of disease,preoperative visual acuity,lens thickness,axial length,anterior chamber depth,type of primary angle closure glaucoma(PACG),preoperative sustained high intraocular pressure,postoperative intraocular pressure,postoperative shallow anterior chamber,operation times,instrument disinfection,diabetes history,hypertension history,uveitis history,surgical injury,anticoagulant drugs,postoperative healing and angle structure were compared.Meanwhile,the multivariate logistic regression was used to analyze the risk factors of postoperative complicated cataract,and the related key points of prevention and treatment were put forward.Results The incidence of the complicated group was 15.69%,while that of the uncomplicated group was 84.31%.Among them,there were statistically significant differences in the preoperative sustained high intraocular pressure,postoperative shallow anterior chamber,operation times and angle structure between the complicated group and the uncomplicated group(P<0.05).Multivariate Logistic regression analysis showed that the preoperative sustained high intraocular pressure,postoperative shallow anterior chamber,operation with more than 2 times and complete closure of angle structure were independent risk factors of complicated cataract after trabeculectomy for glaucoma,with statistically significant differences(P<0.05).Conclusion Preoperative sustained high intraocular pressure,postoperative shallow anterior chamber,operation with more than 2 times and complete closure of angle structure are the risk factors of complicated cataract after trabeculectomy for glaucoma.Preoperative symptomatic treatment should be actively carried out,intraocular pressure reduction should be actively implemented,postoperative close observation should be made,and corresponding treatment should be given according to different causes to restore anterior chamber in time,so as to avoid postoperative cataract after trabeculectomy in PACG patients and further improve the prognosis of patients.