白内障摘出联合小梁切除术对急性闭角型青光眼黄斑区视网膜的影响

Effect of cataract extraction combined with trabeculectomy on macular retina of acute angle-closure glaucoma

目的定量分析白内障摘出联合小梁切除术对急性闭角型青光眼(AACG)黄斑区视网膜微循环状态和组织结构的影响。方法前瞻性队列研究。纳入郑州大学第一附属医院2021年10月至2022年7月行白内障摘出联合小梁切除术的AACG患者30例(30只眼)。随访1个月,以光学相干断层扫描血管成像(OCTA)分析黄斑区视网膜血管密度、黄斑中心区厚度、黄斑区节细胞层复合体平均厚度、黄斑区节细胞层复合体最小厚度及黄斑体积的变化。结果术前和术后1 d,1周及1个月:黄斑区上方视网膜血管密度依次为(64.08±6.27)%、(52.81±7.02)%、(58.09±6.64)%及(63.93±5.73)%,各时间点比较差异有统计学意义(F=106.77,P<0.001)。黄斑区下方、鼻侧及颞侧视网膜血管密度术前与术后差异均有统计学意义(均P<0.05)。黄斑中心区厚度依次为(246.68±19.32)μm、(205.42±7.80)μm、(219.08±19.72)μm及(244.14±19.31)μm,差异有统计学意义(F=17.41,P<0.001)。黄斑区节细胞层复合体平均厚度依次为(67.21±13.55)μm、(65.20±12.96)μm、(66.77±13.49)μm及(70.04±12.44)μm,差异无统计学意义(F=2.72,P>0.05)。黄斑区节细胞层复合体最小厚度及黄斑体积术前与术后差异均无统计学意义(均P>0.05)。结论白内障摘出联合小梁切除术治疗AACG患者术后1个月眼底黄斑区视网膜血管密度和黄斑中心区厚度先下降后恢复至术前水平,其余结构参数无显著变化。

Objective To quantitatively analyze the effect of cataract extraction combined with trabeculectomy on the microvascular perfusion and structure in macular retina of acute angle-closure glaucoma(AACG).Methods This was a prospective cohort study.A total of 30 patients with AACG who underwent cataract extraction combined with trabeculectomy in the First Affiliated Hospital of Zhengzhou University from Oct.2021 to Jul.2022 were included.The follow-up time was 1 month after surgery.The changes of vessel density of macular retina,macular central thickness,the average and the minimum thickness of macular ganglion cell layer complex and macular volume were analyzed with optical coherence tomography angiography(OCTA).Results Before surgery,1 day after surgery,1 week after surgery and 1 month after surgery,the vessel density of superior quadrant in macular retina were(64.08±6.27)%,(52.81±7.02)%,(58.09±6.64)%and(63.93±5.73)%in order,the difference was statistically significant compared with those at different time points(F=106.77,P<0.001).There were statistically significant differences in the vessel density of inferior,nasal and temporal quadrant of macular retina preoperatively and postoperatively(all P<0.05).The macular central thicknees were(246.68±19.32)μm,(205.42±7.80)μm,(219.08±19.72)μm and(244.14±19.31)μm in order,the differences were statistically significant(F=17.41,P<0.001).The average thickness of macular ganglion cell layer complex were(67.21±13.55)μm,(65.20±12.96)μm,(66.77±13.49)μm and(70.04±12.44)μm in order,and there was no statistically significant difference(F=2.72,P>0.05).There was no statistically significant difference in the minimum thickness of macular ganglion cell layer complex and macular volume preoperatively and postoperatively(all P>0.05).Conclusion At 1 month after cataract extraction combined with trabeculectomy,the vessel density and macular central thickness of macular retina in AACG patients first decrease and then return to the preoperative level,while other structural parameters do not change significantly.