超声乳化白内障吸除术联合前房角分离术治疗闭角型青光眼伴发白内障的效果及其影响因素分析

The influencing factors and efficacy of phacoemulsification combined with goniosynechialysis in the treatment of angle-closure glaucoma with cataract

目的分析超声乳化白内障吸除术联合前房角分离术治疗闭角型青光眼伴发白内障的效果及其影响因素。方法回顾性病例系列研究。纳入焦作市人民医院2019年1月至2022年8月闭角型青光眼伴发白内障82例(82只眼),所有患者均接受超声乳化白内障吸除术联合前房角分离术。观察术前,术后1个月、3个月的眼压、视力情况,比较术前、术后3个月的眼前节参数(前房深度、前房角开放距离及前房角隐窝面积)。并采用多因素logistic回归分析患者超声乳化白内障吸除术联合前房角分离术疗效的影响因素。结果术后3个月,手术成功42例,条件成功25例,失败15例;术后1个月、3个月的视力(logMAR)分别为0.42±0.06、0.36±0.05,较术前0.54±0.09提高,术后1个月、3个月眼压[(15.28±2.45)mmHg、(14.86±2.26)mmHg]较术前[(20.99±3.35)mmHg]降低(均P<0.05);术后3个月前房深度[(3.35±0.46)mm]、前房角开放距离[(0.47±0.18)mm]及前房角隐窝面积[(0.22±0.15)mm^(2)]分别较术前[(1.74±0.29)mm、(0.16±0.12)mm、(0.06±0.04)mm^(2)]增加(均P<0.05);经多因素logistic回归分析结果显示,术前眼轴长度、术前眼压、术前前房深度及术前前房角粘连均是疗效的影响因素(OR=2.65、2.08、0.01、14.37,95%CI=1.323~5.289、1.125~3.840、0.003~0.484、1.084~20.431,P=0.006、0.019、0.021、0.043)。结论超声乳化白内障吸除术联合前房角分离术治疗闭角型青光眼伴发白内障效果良好。术前眼轴长度、术前眼压、术前前房深度及术前前房角粘连均是手术效果的影响因素。

Objective To analyse the influencing factors and efficacy of phacoemulsification combined with goniosynechialysis in the treatment of angle-closure glaucoma with cataract.Methods This was a retrospective case series study.The clinical data of 82 eyes of 82 patients with angle-closure glaucoma with cataract in Jiaozuo People’s Hospital from Jan.2019 to Aug.2022 were collected.All patients underwent phacoemulsification combined with goniosynechialysis surgery.The intraocular pressure and visual acuity were observed before operation,1 month and 3 months after operation,and the parameters of anterior segment parameters such as anterior chamber depth,anterior chamber angle opening distance and anterior chamber angle recess area were compared before operation and 3 months after operation.Multivariate logistic regression was used to analyze the influencing factors of phacoemulsification combined with goniosynechialysis in patients with angle-closure glaucoma with cataract.Results At 3 months after operation,42 cases were successful,25 cases were conditional successful,and 15 cases were unsuccessful.Visual acuity(logMAR)at 1 and 3 months after operation(0.42±0.06,0.36±0.05)were improved than the 0.54±0.09 before operation,and intraocular pressure at 1 month and 3 months after operation[(15.28±2.45)mmHg,(14.86±2.26)mmHg]were lower than that before operation[(20.99±3.35)mmHg](all P<0.05).The anterior chamber depth[(3.35±0.46)mm],anterior chamber corner[(0.47±0.18)mm]and anterior chamber angle recess area[(0.22±0.15)mm^(2)]at 3 months after operation increased than those before surgery[(1.74±0.29)mm,(0.16±0.12)mm,(0.06±0.04)mm^(2)](all P<0.05).The results of multivariate logistic regression analysis showed that preoperative axial length,preoperative intraocular pressure,preoperative anterior chamber depth,and preoperative anterior chamber angle adhesion were factors that affect the therapeutic effect(OR=2.65,2.08,0.01,14.37;95%CI=1.323~5.289,1.125~3.840,0.003~0.484,1.084~20.431;P=0.006,0.019,0.021,0.043).Conclusion The combination of phacoemulsification combined with goniosynechialysis in the treatment of angle-closure glaucoma patients with cataract is effective.In addition,preoperative axial length,preoperative intraocular pressure,preoperative anterior chamber depth,and preoperative anterior chamber angle adhesion are all factors that affect the therapeutic efficacy.