超声乳化吸除术联合房角分离术治疗PACG滤过术后眼压失控的临床疗效观察

Clinical efficacy of Phaco+IOL implantation combined with angle separation in the treatment of uncon⁃trolled intraocular pressure after PACG filtration

目的探讨超声乳化吸除术(Phaco)+人工晶状体(IOL)植入联合房角分离术治疗原发性闭角型青光眼(PACG)滤过术后眼压失控的临床疗效。方法回顾性病例研究。对2020年8月至2022年5月收治的24例(25只眼)PACG滤过术后眼压失控患者,采用Phaco+IOL植入联合房角分离术治疗,比较术前、术后1 d、1周、1个月、3个月、6个月的眼压情况,术前及6个月最佳矫正视力(BCVA)、房角粘连性关闭(PAS)范围变化情况。记录术中、术后并发症情况。结果术后1 d、1周、1个月、3个月、6个月眼压、PAS范围均显著低于术前,差异具有统计学意义(均P<0.05);术后6个月视力较术前21例(22只眼)BCVA提高,3例(3只眼)BCVA无变化;术中10只眼发生前房出血,术后6只眼发生短暂性前房出血,15只眼发生前房渗出,8只眼发生角膜水肿。结论Phaco+IOL植入联合房角分离术治疗PACG滤过术后眼压失控能够有效降低眼压,提高患者视力,是安全有效的治疗方法。

Objective To investigate the clinical effect of phacoemulsification(Phaco)+intraocular lens(IOL)implantation combined with angle separation in the treatment of uncontrolled intraocular pressure after primary angle clo⁃sure glaucoma(PACG)filtration.Methods A retrospective case series study.Twenty-four patients(25 eyes)with uncon⁃trolled intraocular pressure after PACG filtering from August 2020 to May 2022 were selected as the study subjects.The Phaco+IOL implantation combined with angle separation were used to treat.Compared the intraocular pressure before the operation,at 1 day,1 week,1 month,3 months and 6 months after the operation,and the changes of best corrected visual acuity(BCVA)and peripheral anterior synechiae(PAS)before and at 6 months after the operation were observed.The intra⁃operative and postoperative complications were recorded.Results The intraocular pressure and range of PAS at 1 day,1 week,1 month,3 months and 6 months after the operation were significantly lower than those before the operation(P<0.05).The BCVA of 21 cases(22 eyes)was improved at 6 months after the operation,while the BCVA of 3 cases(3 eyes)re⁃mained unchanged.Anterior chamber hemorrhage occurred in 10 eyes,transient anterior chamber hemorrhage occurred in 6 eyes,anterior chamber exudation occurred in 15 eyes,and corneal edema occurred in 8 eyes.Conclusions Phaco+IO⁃Limplantation combined with angle separation is a safe and effective treatment for uncontrolled intraocular pressure after PACG filtration,which can effectively reduce intraocular pressure and improve patients'vision.