内窥镜下睫状体光凝术治疗短眼轴闭角型青光眼的疗效及安全性

Efficacy and safety of endoscopic cyclophotocoagulation in the treatment of short-axis angle-closure glaucoma

目的 探讨内窥镜下睫状体光凝术(ECP)治疗短眼轴闭角型青光眼的疗效及安全性。方法 收集2020年1月至10月在西安市第四医院就诊的短眼轴闭角型青光眼患者40例(40眼)临床资料。将符合纳入标准的患者分为ECP组(患者行ECP联合超声乳化白内障吸除+人工晶状体植入术)20例20眼和对照组(患者行房角分离联合超声乳化白内障吸除+人工晶状体植入术)20例20眼。术前及术后6个月检测两组患者视力、眼压、前房深度、睫状突厚度(CPT)、睫状突宽度(CPW)、睫状突面积(CPA)、虹膜睫状突接触长度(ICPCL)等指标,记录术后并发症发生情况并进行比较。结果 术后6个月ECP组、对照组患者最佳矫正视力均优于术前,差异均有统计学意义(均为P<0.05)。术后6个月ECP组患者眼压低于对照组,差异有统计学意义(P<0.05);与术前相比,术后6个月两组患者眼压均降低,差异均有统计学意义(均为P<0.05)。两组患者术前前房深度比较,差异无统计学意义(P>0.05)。术后6个月ECP组患者前房深度大于对照组,差异有统计学意义(P<0.05);与术前相比,术后6个月两组患者前房深度均增加,差异均有统计学意义(均为P<0.05)。术后6个月,ECP组患者CPT、CPW、CPA、ICPCL均低于对照组,差异均有统计学意义(均为P<0.05);ECP组患者CPT、CPW、CPA、ICPCL均明显低于其术前,差异均有统计学意义(均为P<0.05);对照组患者各指标与其术前相比,差异均无统计学意义(均为P>0.05)。术后6个月时,对照组6眼出现前房变浅、眼压再次升高,其中2眼发生了睫状环阻滞性青光眼,而ECP组中无此类并发症发生。结论 ECP可显著降低短眼轴闭角型青光眼患者术后浅前房、高眼压甚至睫状环阻滞性青光眼的发生,并发症少,安全性高。

Objective To observe the efficacy and safety of endoscopic cyclophotocoagulation(ECP) on short-axis angle-closure glaucoma. Methods Clinical data of 40 eyes of 40 patients with short-axis angle-closure glaucoma who visited the Xi’an Fourth Hospital from January to October 2020 were collected. The patients enrolled were divided into the ECP group(20 eyes) and the control group(20 eyes). Patients in the ECP group were treated with ECP combined with phacoemulsification+intraocular lens implantation, while patients in the control group were treated with atrial angle separation combined with phacoemulsification + intraocular lens implantation. Their visual acuity, intraocular pressure, anterior chamber depth, ciliary process thickness(CPT), ciliary process width(CPW), ciliary process area(CPA), iris ciliary process contact length(ICPCL) before and 6 months after the treatment, as well as postoperative complications were recorded and compared. Results The best corrected visual acuity of patients in the ECP group and control group 6 months after the surgery improved compared with that before the surgery, and the differences were statistically significant(both P<0.05). At 6 months after the surgery, the intraocular pressure of patients in the ECP group was significantly lower than that in the control group(P<0.05). Compared with preoperative values, the intraocular pressure 6 months after the surgery in both groups significantly decreased(both P<0.05). There was no significant difference in preoperative anterior chamber depth between the two groups(P>0.05). The anterior chamber depth in the ECP group was significantly higher than that in the control group 6 months after the surgery(P<0.05). Compared with preoperative values, the anterior chamber depth in both groups significantly increased 6 months after surgery(both P<0.05). At 6 months after surgery, CPT, CPW, CPA and ICPCL in the ECP group were significantly lower than those in the control group(all P<0.05), and significantly lower than those before surgery(all P<0.05). There was no statistical significance in those indexes of the control group before and 6 months after the surgery(all P>0.05). In the control group, 6 eyes showed shallow anterior chamber and high intraocular pressure 6 months after the surgery, among which 2 eyes showed ciliary block glaucoma. There were no such complications in the ECP group. Conclusion ECP can significantly reduce the incidence of the shallow anterior chamber, high intraocular pressure and even ciliary block glaucoma in patients with short-axis angle-closure glaucoma, with fewer complications and high safety.