真性小眼球周边虹膜切除术后眼压不降显微联合手术疗效分析

Clinical analysis of combined microsurgery for nanophthalmic patients with uncontrolled intraocular pressure after peripheral iridectomy

目的评估限制性玻璃体切除(LPPV)加压力控制下超声乳化白内障摘除(PCP)加人工晶状体植入(IOL)加后囊膜切开术(PC)显微联合手术在周边虹膜切除术后眼压(IOP)不降的真性小眼球继发青光眼患者中的疗效和安全性。方法回顾分析2017年7月至2021年4月确诊为真性小眼球继发青光眼,施行周边虹膜切除术后IOP不降,需行LPPV加PCP加IOL加PC显微联合手术的患者24例29眼,年龄(44.6±11.0)岁。采用配对t检验比较手术前后IOP、最佳矫正视力(BCVA)、前房深度(ACD),采用Wilcoxon符号秩和检验评价所使用的降IOP药物种类的变化,P<0.05为差异有统计学意义。以IOP大于等于5 mmHg且小于等于21 mmHg、无疾病进展表现、无严重并发症为手术成功标准,分析手术成功率和观察手术相关并发症。结果显微联合手术后平均随访(11.52±12.44)个月。末次随访时,IOP从术前的(33.12±9.25) mmHg降至(14.23±3.44) mmHg,差异有统计学意义(P<0.01);ACD从术前(1.23±0.46) mm加深至(2.86±0.62) mm,用药种类3(0,3)较术前3(3,4)明显减少,差异均有统计学意义(P<0.05);手术前、后BCVA(P=0.196)和房角关闭范围(P=0.478)的改变差异无统计学意义(P>0.05)。末次随访时,手术总成功率为86.2%(25/29);2眼出现局部脉络膜脱离,用药治疗后2周内恢复。结论 LPPV加PCP加IOL加PC是治疗真性小眼球周边虹膜切除术后IOP不降的一种安全有效的新的显微联合手术方式,能显著降低患者的IOP、加深前房、减少降IOP药物的使用,保持患者的视力,可作为该类患者的首选术式。

Objective To evaluate the efficacy and safety of limited pars plana vitrectomy(LPPV),pressurecontrolled phacoemulsification(PCP),intraocular lens implantation(IOL),and posterior capsulotomy(PC)in treatment of nanophthalmic glaucoma eyes which intraocular pressure(IOP)were still out of control after peripheral iridectomy.Methods All 24 patients(29 eyes)with nanophthalmic glaucoma whose IOP failed to be reduced after peripheral iridectomy and needed LPPV plus PCP plus IOL plus PC were recruited from July 2017 to April 2021.The age of these patients was(44.6±l 1.0)years old.Preoperative and postoperative IOP,best corrected visual acuity(BCVA),anterior chamber depth(ACD)and number of glaucoma medications were recorded by chart review and compared by using paired t-test or Wilcoxon signed rank-sum test.P<0.05 was considered as statistical significant.IOP could be controlled in normal range(^5 mmHg and^21 mmHg),without both of disease progression and serious complications were regarded as the success criteria of the operation.Surgical success rate was evaluated.Surgery-associated complications were recorded.Results The average follow-up time was(l 1.52±12.44)months.After the microsurgery,IOP decreased from(33.12±9.25)mmHg to(14.23±3.44)mmHg(P<0.01);The ACD increased from(1.23±0.46)mm to(2.86±0.62)mm,and the median number of glaucoma medications dropped from 3(3,4)to 3(0,3)at final follow-up visit(P<0.05).There were no significant differences in BCVA(P=0.196)and the degrees of angle closure(AC)(P=0.478)before and after operation.The total surgical success rate was 86.2%(25/29)at the final follow-up visit.Two eyes suffered from local choroidal detachment which recovered within 2 weeks with medical treatment.Conclusion LPPV plus PCP plus IOL plus PC is a safe and effective novel surgical procedure in the treatment of nanophthalmic glaucoma patients with uncontrolled IOP after peripheral iridectomy.It could significantly decrease IOP,increase the depth of ACD,reduce the number of glaucoma medications and maintain BCVA.It can be considered as a first choice for the surgical management for patients with a such condition.