青光眼激光和手术治疗对角膜生物力学参数的影响

Effect of Laser and Surgical Treatment of Glaucoma on Corneal Biomechanical Parameters

目的探析青光眼治疗中激光和手术治疗的有效性,以及对患者角膜生物力学参数的影响。方法回顾性分析2018年10月至2020年8月,急性闭角型青光眼患者104例130只眼的临床资料,按照治疗方法不同分为两组,激光组患者52例66只眼,采用激光虹膜周边切除术治疗,治疗能量4~6 mJ,光斑直径3 mm;手术组52例64只眼,采用超声乳化吸出联合人工晶状体植入+房角分离术治疗。比较两组患者治疗前和治疗后6个月眼压、视力、角膜内皮细胞面积、中央角膜内皮细胞密度、角膜生物力学参数包括角膜滞后量(corneal hysteresis,CH)和角膜阻力因子(corneal resistance factor,CRF)变化情况。记录治疗后6个月前房积血、眼压升高、虹膜炎等并发症发生情况。结果两组患者治疗前视力、眼压比较,差异无统计学意义(P>0.05)。治疗后6个月,两组眼压均低于治疗前,视力均高于治疗前;手术组眼压和视力优于激光组(P<0.05)。治疗前两组角膜内皮细胞面积及角膜内皮细胞密度趋于一致(P>0.05),治疗后两组角膜内皮细胞面积均较治疗前上升,角膜内皮细胞密度均较治疗前下降,但两组间比较差异具有统计学意义(P<0.05)。治疗前两组角膜生物力学参数的CH、CRF基本一致(P>0.05),治疗后CH、CRF均有显著下降,但组间比较差异无统计学意义(P>0.05)。治疗后6个月,手术组并发症发生率与激光组基本一致(P>0.05)。结论青光眼治疗中激光治疗及手术治疗均可恢复患者视力、降低眼压,但均会导致患者术后角膜生物力学参数中的角CH下降和CRF上升。手术治疗具有眼压、视力改善效果更明显的优势,激光治疗具有角膜内皮细胞的损伤更小的优势。

Objective To explore the effectiveness of laser and surgery in the treatment of glaucoma and their effect on corneal biomechanical parameters.Methods The clinical data of 104 patients(130 eyes)with acute angle closure glaucoma treated during the period from Oct.2018 to Aug.2020 were retrospectively analyzed.They were divided into two groups by treating methods:the laser group(52 cases,66 eyes),in which the patients were treated with laser peripheral iridectomy(laser energy:4~6 mJ;spot diameter:3 mm),and the operation group(52 cases,64 eyes),in which the patients were treated jointly with phacoemulsification,intraocular lens implantation and chamber angle implantation.The intraocular pressure,visual acuity,corneal endothelial cell area,central corneal endothelial cell density,corneal biomechanical parameters including corneal hysteresis(CH)and corneal resistance factor(CRF)were compared between the two groups before and 6 months after the treatment respectively.The complications such as hyphema,elevated intraocular pressure and iritis were recorded 6 months after the treatment.Results There was no significant difference in the visual acuity or intraocular pressure between the two groups before the treatment(P>0.05).Six months after the treatment,the intraocular pressure of both groups decreased and the visual acuity increased.The intraocular pressure and visual acuity of the operation group were better than those of the laser group(P<0.05).Before the treatment,the corneal endothelial cell area and corneal endothelial cell density of the two groups were similar(P>0.05).After the treatment,despite of the improvement observed in both groups,the results were much better in the laser group(P<0.05).The CH and CRF as two corneal biomechanical parameters were basically identical in the two groups before the treatment and dropped remarkably after the treatment in both groups,but the difference between the two groups were not statistically significant(P>0.05).The incidence of complications in the operation group was basically similar to that in the laser group(P<0.05).Conclusions While treating glaucoma,both laser therapy and surgery will restore the visual acuity and reduce the intraocular pressure,but will also lead to the decrease of CH and increase of CRF as corneal biomechanical parameters.Surgery has more obvious advantages in improving the intraocular pressure and visual acuity,but laser therapy has less damage to corneal endothelial cells.