青光眼白内障联合手术在急性闭角型青光眼患者持续高眼压状态下的应用效果

Application effect of combined glaucoma and cataract surgery in patients with acute angle closure glaucoma under continuous high intraocular pressure

目的观察青光眼白内障联合手术在急性闭角型青光眼患者持续高眼压状态下的应用效果。方法选取2021年1月至2021年8月西安市第四医院收治的42例(42只患眼)持续高眼压状态下急性闭角型青光眼患者作为试验组,43例(43只患眼)眼压控制的急性闭角型青光眼患者作为对照组,两组患者均行青光眼白内障联合手术。随访3个月,比较两组的手术效果。结果术后1周及术后1、3个月,两组的BCVA均比术前有所改善,但组间比较,差异不显著(P>0.05)。术前,试验组的眼压高于对照组(P<0.001);术后1、3个月,两组的眼压无显著差异(P>0.05)。术前及术后1 d,试验组角膜水肿程度比对照组严重(P<0.001);术后1周,两组角膜水肿程度无显著差异(P>0.05)。术前及术后3个月,试验组角膜内皮细胞密度低于对照组(P<0.05);两组的角膜内皮细胞丢失率无显著差异(P>0.05)。术前及术后3个月,两组的前房深度无显著差异(P>0.05)。两组术后1 d的前房炎症反应发生率无显著差异(P>0.05)。试验组前房炎症持续时间长于对照组(P<0.01)。两组的晶体悬韧带异常发生率无显著差异(P>0.05)。术后两组患者均无眼内炎、角膜内皮失代偿、脉络膜上腔出血、脉络膜脱离等严重并发症。结论急性闭角型青光眼患者持续高眼压状态下行青光眼白内障联合手术安全、有效。

Objective To observe the application effect of combined glaucoma and cataract surgery in patients with acute angle closure glaucoma under continuous high intraocular pressure.Methods From January 2021 to August 2021,42 patients(42 affected eyes)with acute angle closure glaucoma under continuous high intraocular pressure were selected as experimental group,and 43 patients(43 affected eyes)with acute angle closure glaucoma under intraocular pressure control were selected as control group.Both groups underwent combined glaucoma and cataract surgery.The patients were followed up for 3 months,surgical effects of the two groups were compared.Results At 1 week and 1 and 3 months after operation,the BCVA of the two groups improved compared with that before operation,but there was no significant difference between the two groups(P>0.05).Before operation,the intraocular pressure in the experimental group was higher than that in the control group(P<0.001);at 1 and 3 months after operation,there was no significant difference in intraocular pressure between the two groups(P>0.05).Before and 1 d after operation,the degree of corneal edema in the experimental group was more serious than that in the control group(P<0.001);one week after operation,there was no significant difference in the degree of corneal edema between the two groups(P>0.05).Before and 3 months after operation,the density of corneal endothelial cells in the experimental group was lower than that in the control group(P<0.05);there was no significant difference in the loss rate of corneal endothelial cells between the two groups(P>0.05).Before and 3 months after operation,there was no significant difference in anterior chamber depth between the two groups(P>0.05).There was no significant difference in the incidence of anterior chamber inflammatory reaction between the two groups at 1 d after operation(P>0.05).The duration of anterior chamber inflammation in the experimental group was longer than that in the control group(P<0.01).There was no significant difference in the incidence of lens suspensory ligament abnormalities between the two groups(P>0.05).There were no serious complications such as endophthalmitis,corneal endothelial decompensation,suprachoroidal hemorrhage,choroidal detachment and so on.Conclusion Combined glaucoma and cataract surgery in patients with acute angle closure glaucoma under continuous high intraocular pressure is safe and effective.