微创玻璃体切除联合超声乳化白内障吸除术治疗睫状环阻塞性青光眼的效果观察

Observation on the efficacy of minimally invasive vitrectomy combined with phacoemulsification in the treatment of ciliary block glaucoma

目的观察微创玻璃体切除联合超声乳化白内障吸除术治疗睫状环阻塞性青光眼的效果。方法回顾性病例对照研究。选取成都普瑞眼科医院和新疆四七四医院眼科2021年5月至2022年8月睫状环阻塞性青光眼者65例(65眼)。所有患者均为原发性慢性闭角型青光眼抗青光眼术后者。患者按不同手术方法分成两组,治疗组33例(33眼),对照组32例(32眼)。治疗组采用微创玻璃体切除联合超声乳化白内障吸除术,对照组采用超声乳化术治疗。随访3个月,观察两组治疗后视力、眼压、前房深度及并发症情况。结果术后治疗组视力改善情况优于对照组(Z=-3.55,P<0.001),随访3个月治疗组眼压控制优于对照组(F_(组别)=80.57,P<0.001;F_(交互)=15.34,P<0.001;F_(时间)=47.53,P<0.001),治疗组前房深度较对照组更深(F_(组别)=193.23,P<0.001;F_(交互)=89.78,P<0.001;F时间=57.58,P<0.001),治疗组术后前房积血、脉络膜脱离等并发症高于对照组(χ^(2)=10.11,P=0.001;χ^(2)=10.94,P=0.001;χ^(2)=4.99,P=0.026)。结论微创玻璃体切除联合超声乳化白内障吸除术治疗睫状环阻塞性青光眼术后视力更好且眼压控制更佳,前房维持更为稳定。

Objective To observe the efficacy of minimally invasive vitrectomy combined with phacoemulsification in the treatment of ciliary block glaucoma.Methods This was a retrospective case control study.Total of 65 eyes with 65 cases of ciliary block obstruction glaucoma secondary to surgeries of primary chronic angle closure glaucoma were selected from Chengdu Purui Ophthalmology Hospital and Xinjiang 474 Hospital from May 2021 to Aug.2022.These patients were divided into two groups based on the surgical methods:the treatment group consisting of 33 eyes of 33 cases and the control group consisting of 32 eyes of 32 cases.The treatment group received minimally invasive vitrectomy combined with phacoemulsification,while the control group received phacoemulsification.The postoperative vision,intraocular pressure,anterior chamber depth,and complications in both groups were observed.Results The postoperative visual acuity improvement in the treatment group was better than that in the control group(Z=-3.55,P<0.001),and the intraocular pressure control in the treatment group was better than that in the control group(F_(group)=80.57,P<0.001;F_(interaction)=15.34,P<0.001;F_(time)=47.53,P<0.001)after 3 months follow-up.The depth of the anterior chamber in the treatment group was more deeper than that in the control group(F_(group)=193.23,P<0.001;F_(interaction)=89.78,P<0.001;F_(time)=57.58,P<0.001).Comparison of postoperative complications such as hyphema and choroidal detachment between the two groups:the treatment group was superior to the control group(χ^(2)=10.11,P=0.001;χ^(2)=10.94,P=0.001;χ^(2)=4.99,P=0.026).Conclusion Minimally invasive vitrectomy combined with phacoemulsification for the treatment of ciliary block glaucoma has better visual acuity,better intraocular pressure control,more stable anterior chamber.