急性闭角型青光眼行白内障手术后视盘血流动力学研究

Optic Disc Hemodynamics Study of Acute Angle-Closure Glaucoma after Cataract Surgery

目的 利用光学相干断层扫描血流成像(OCTA),研究急性闭角型青光眼大发作的患者行白内障手术后视盘及盘周血流密度变化,并探究高眼压对视盘血流的影响。方法 以2021年2~12月本院眼科确诊的22例22只原发性闭角型青光眼急性大发作的患者作为研究对象,对患者保守治疗尽快控制眼压后,予以行白内障超声乳化吸除+人工晶体植入术+房角粘连分离术,观察术前和术后一周眼压、视力、视盘及盘周血流密度的变化。结果 本研究共纳入22只眼做OCTA视盘血流分析,术前视盘内血流平均密度41.66%,术后为44.73%,差异有统计学意义(P<0.001)。视盘周血流术前平均值为48.79%,术后为51.80%,差异有统计学意义(P<0.001)。急性闭角型青光眼患者随着眼压得到控制,眼球壁受到压力降低,眼底视盘血流密度有明显恢复。结论 原发性闭角型青光眼急性大发作的患者,行白内障手术后,患者视力得到明显改善。房水流通恢复正常,随着眼压下降,视盘及盘周血流密度明显增加。

Objective To study changes of blood flow density in optic disc and periphery of acute angle-closure glaucoma patients after cataract surgery with optical coherence tomography(OCTA),and explore effect of high intraocular pressure on optic disc blood flow.Methods The paper chose 22 patients(22 eyes)with acute major episode of primary angle closure glaucoma diagnosed by ophthalmology department of Guangzhou Medical University The Sixth Affiliated Hospital/Qingyuan City People's Hospital from February to December 2021,after conservative treatment and intraocular pressure controll as soon as possible,treated with cataract phacoemulsification,intraocular lens implantation,and separation of atrial adhesion.Changes of intraocular pressure,visual acuity,optic disc,and peripheral blood flow density were observed before and one week after surgery.Results The study collected 22 eyes for OCTA optic disc blood flow analysis,average density of blood flow in optic disc was 41.66%before surgery and 44.73%after surgery,with statistically significant difference(P<0.001).Average preoperative value of perioptic disc blood flow was 48.79%,and postoperative value was 51.80%,with statistically significant difference(P<0.001).With intraocular pressure control,pressure on ocular wall of acute angle closure glaucoma patients decreased,blood flow density of fundus and optic disc recovered significantly.Conclusion After cataract surgery,visual acuity of primary angle closure glaucoma patients was improved significantly,circulation of aqueous humor returned to normal,with decrease of intraocular pressure,blood flow density of optic disc and periphery increased significantly.