超声乳化白内障吸除联合后房型人工晶状体植入及前房角镜下前房角分离术治疗急性闭角型青光眼合并白内障的临床研究

Therapeutic effects of goniosynechialysis under the gonioscope and phacoemulsification cataract extraction combined with posterior chamber intraocular lens implantation on acute angle closure glaucoma complicated with cataract

目的观察超声乳化白内障吸除联合后房型人工晶状体植入及前房角镜下前房角分离术治疗急性闭角型青光眼(AACG)合并白内障的效果,并分析患者术后屈光误差的影响因素。方法选取2020年4月至2022年6月于邯郸市眼科医院就诊AACG合并白内障患者148例(148只眼)的临床资料。其中,男性40例(40只眼),女性108例(108只眼);年龄45~76岁,平均年龄(58.8±9.9)岁。所有患者均接受超声乳化白内障吸除联合后房型人工晶状体植入及前房角镜下前房角分离术治疗。检查并记录所有患者术前和术后3个月最佳矫正视力(BCVA)、眼压、降眼压药物使用种类、前房角开放距离(AOD)500、角膜曲率、眼轴长度、中央前房深度(ACD)及并发症的情况。BCVA、眼压、AOD500、角膜曲率、眼轴长度及ACD符合正态分布,采用x^(-)±s表示,术前术后的比较采用配对样本t检验;降眼压药物使用种类和并发症情况不符合正态分布,采用中位数和四分位数表示,术前术后的比较采用Wilcoxon符号秩和检验。术后屈光误差与BCVA变化量、眼压变化量、AOD500、眼轴长度缩短量及ACD加深量的相关性采用Pearson相关分析。结果术前所有患者平均最小分辨率角的对数(logMAR)BCVA、眼压、降眼压药物使用种类、AOD500、角膜曲率、眼轴长度及ACD分别为(0.32±0.07)、(25.17±4.08)mmHg(1 mmHg=0.133 kPa)、3(3,4)种、(0.15±0.03)mm、(44.72±0.83)D、(21.69±0.55)mm及(1.91±0.43)mm;术后3个月分别为(0.06±0.02)、(16.34±3.19)mmHg、0(0,0)种、(0.57±0.12)mm、(44.69±0.85)D、(21.57±0.59)mm及(3.65±0.40)mm。术前与术后3个月患者BCVA、眼压、AOD500、眼轴长度及ACD的差异均有统计学意义(t=70.290,29.552,-68.127,2.561,-51.007;P<0.05);降眼压药物使用种类的差异有统计学意义(Z=-15.777,P<0.05)。术后发生一级前房出血者9例(9只眼),前房渗出者6例(6只眼),高眼压者9例(9只眼),均经药物控制治疗后恢复。术后屈光误差与术后眼轴长度缩短量及ACD加深量呈正相关,且有统计学意义(r=0.392,0.423;P<0.05)。结论超声乳化白内障吸除术联合后房型人工晶状体植入及前房角镜下前房角分离术,可有效地开放前房角,加深前房,降低眼压,提高BCVA,并且术后并发症轻微;术后眼轴长度缩短量和ACD加深量是术后屈光误差的影响因素。

Objective The aim of this study is to observe the therapeutic effects of goniosynechialysis under gonioscope and phacoemulsification cataract extraction combined with posterior chamber intraocular lens implantation on acute angle-closure glaucoma(AACG)complicated with cataract,and analyze the influencing factors of postoperative refractive errors.Methods The clinical data of 148 patients(148 eyes)with AACG complicated with cataract treated in Handan Eye Hospital from April 2020 to June 2022 were selected.Among them,there were 40 males(40 eyes)and 108 females(108 eyes)ranged from 45 to 76 years with an average age of(58.8±9.9)years.All patients underwent phacoemulsification cataract extraction combined with posterior chamber intraocular lens implantation and goniosynechialysis under gonioscope.The best corrected visual acuity(BCVA),intraocular pressure,types of intraocular pressure-lowering drugs,angle opening distance(AOD)500,corneal curvature,axial length,central anterior chamber depth(ACD)and complications were recorded before and after surgery for 3 months.The BCVA,intraocular pressure,AOD500,corneal curvature,axial length and ACD followed a normal distribution and were expressed asx^(-)±s.Paired sample t test was used to compare the preoperative and postoperative data.The types of intraocular pressure-lowering drugs and complications did not meet the normal distribution and were expressed as median and interquartile range,compared by the Wilcoxon signed rank test before and after surgery.Pearson correlation analysis was used to analyze the correlation between postoperative refractive error and changes in BCVA,intraocular pressure,AOD500,shortening of axial length,and deepening of ACD.Results The preoperative logarithm of the mean minimum resolution angle(logMAR)BCVA,intraocular pressure,types of intraocular pressure-lowering drugs,AOD500,corneal curvature,axial length,and ACD of all patients were(0.32±0.07),(25.17±4.08)mmHg(1 mmHg=0.133 kPa),and 3(3,4)types,(0.15±0.03)mm,(44.72±0.83)mm,(21.69±0.55)mm and(1.91±0.43)mm.After operation for 3 months,they were(0.06±0.02),(16.34±3.19)mmHg,0(0,0)type,(0.57±0.12)mm,(44.69±0.85)D,(21.57±0.59)mm and(3.65±0.40)mm,respectively.There were significant differences in BCVA,intraocular pressure,AOD500,axial length and ACD before and after surgery(t=70.290,29.552,-68.127,2.561,-51.007;P<0.05);the types of intraocular pressure-lowering drugs(Z=-15.777,P<0.05).There were 9 cases(9 eyes)of primary anterior chamber hemorrhage,6 cases(6 eyes)of anterior chamber exudation,9 cases(9 eyes)of high intraocular pressure,which were controlled by drug.The postoperative refractive error was positively correlated with the shortening of axial length and the deepening of ACD(r=0.392,0.423;P<0.05).Conclusions Goniosynechialysis under the gonioscope and phacoemulsification cataract extraction combined with posterior chamber intraocular lens implantation can effectively open the chamber angle,deepen the anterior chamber,reduce the intraocular pressure level,improve BCVA,and the milder postoperative complications.The shortening of axial length and the deepening of ACD are the influencing factors of postoperative refractive error.