玻璃体切除术治疗睫状环阻塞性青光眼的效果观察

Obervation on the efficacy of vitrectomy in the treatment of ciliary block glaucoma

目的观察玻璃体切除术治疗睫状环阻塞性青光眼的效果。方法回顾性病例系列研究。收集郴州市第一人民医院眼科2014年1月至2023年5月收治的32例(32眼)睫状环阻塞性青光眼作为研究对象。所有患者术中均采用经睫状体平坦部入路23 G微创玻璃体切除术联合晶状体后囊切开术,术后随访1个月,观察患眼最佳矫正视力(BCVA,logMAR)、前房深度、眼压及角膜内皮细胞密度等情况,采用单因素方差分析评估玻璃体切除术治疗睫状环阻塞性青光眼的效果。结果术后患者均获得不同程度视功能恢复,术后1周、1个月BCVA分别为0.50±0.34、0.40±0.31,与术前(1.21±0.06)相比差异具有统计学意义(F=48.58,P<0.001),术后1周和1个月眼压分别(13.77±1.32)mmHg(1 mmHg=0.133 kPa)及(13.42±1.12)mmHg,均与术前眼压(33.23±10.06)mmHg相比差异具有统计学意义(F=117.49,P<0.001)。术后1周、1个月前房深度分别为(3.32±0.15)、(3.32±0.14)mm,均与术前前房深度(1.45±0.94)mm相比差异具有统计学意义(F=120.87,P<0.001)。术后1周、1个月角膜内皮细胞密度分别为(2380.94±217.00)、(2374.41±215.22)个/mm^(2),均与术前角膜内皮细胞密度(2420.31±202.35)个/mm^(2)相比差异无统计学意义(F=0.44,P>0.05)。结论玻璃体切除术治疗睫状环阻塞性青光眼可以加深前房深度,解除房水流出阻力,降低眼压,从而提高视力,取得较好的疗效。

Objective To observe the efficacy of vitrectomy in the treatment of ciliary block glaucoma.Methods This was a retrospective case series study.A total of 32 eyes of 32 patients with ciliary block glaucoma in total were collected as the study subjects in Chenzhou First People′s Hospital from Jan.2014 to May 2023.All cases received 23 G pars plana minimally invasive vitrectomy combined with posterior capsulotomy.Best corrected visual acuity(BCVA,logMAR),depth of anterior chamber,intraocular pressure and corneal endothelial cells density before operation,at 1 week and 1 month after operation were in the midst of observation.One-way ANOVA was used to evaluate the effect of vitrectomy in the treatment of ciliary block glaucoma.Results Visual function of all eyes recovered in varying degrees after operation.BCVA at 1 week and the first month after operation was(0.50±0.34)and(0.40±0.31),which were significantly different from those before operation(1.21±0.06)(F=48.58,P<0.001).IOP at 1 week and 1 month after operation were(13.77±1.32)mmHg(1 mmHg=0.133 kPa)and(13.42±1.12)mmHg,which were significantly different from those before operation(33.23±10.06)mmHg(F=117.49,P<0.05).The anterior chamber depth at one week and one month after operation was(3.32±0.15)mm and(3.32±0.14)mm,respectively,which were significantly different from those before operation(1.45±0.94)mm(F=120.87,P<0.05).The corneal endothelial cell density was(2380.94±217.00)cells/mm^(2) at 1 week after operation,(2374.41±215.22)cells/mm^(2) at 1 month after operation and(2420.31±202.35)cells/mm^(2) before operation,respectively.There was no significant difference at different time points before and after surgery.Conclusion Vitrectomy in the treatment of ciliary block glaucoma can deepen the depth of anterior chamber,relieve the resistance of aqueous humor outflow,reduce intraocular pressure,improve visual acuity and thus obtain better efficacy.