高眼压持续状态下经巩膜二极管激光睫状体光凝术后青光眼白内障联合手术的远期效果

Long-term effect of combined operation for glaucoma and cataract after scleral diode laser ciliary photocoagulation in the treatment of glaucoma with persistent intraocular hypertension

目的评估原发性急性闭角型青光眼高眼压持续状态患者采用经巩膜二极管激光睫状体光凝术后再行青光眼白内障联合手术治疗的远期效果。方法回顾性病例系列研究。纳入郑州大学附属郑州中心医院2017年1月至2019年1月采用经巩膜二极管激光睫状体光凝术后3~5 d再行白内障超声乳化人工晶状体植入联合小梁切除术(联合术)治疗的原发性闭角型青光眼高眼压持续状态患者37例(39眼)。所有患者观察术后5年最佳矫正视力、眼压、前房深度及并发症发生的情况。结果术后眼压得到有效控制,经巩膜二极管激光睫状体光凝术后及联合术后各时间点眼压分别为术后1周(15.6±6.3)mmHg(1 mmHg=0.133 kPa)、1个月(15.4±6.2)mmHg、3个月(15.5±5.7)mmHg、6个月(14.9±6.1)mmHg、1年(14.7±6.0)mmHg、3年(14.8±5.9)mmHg、5年(14.7±5.9)mmHg。各时间点眼压较术前降低,差异有统计学意义(F=266.02,P=0.013)。经巩膜二极管睫状体光凝术后及联合术后各时间点BCVA分布比例,差异有统计学意义(χ^(2)=267.00,P=0.019)。术后随访并发症包括经巩膜二极管激光睫状体光凝术后3例眼痛、1例前房积血、3例睫状体脱离治疗后均恢复正常。结论经巩膜睫状体光凝术后行白内障超声乳化人工晶状体植入联合小梁切除术治疗原发性急性闭角型青光眼高眼压持续状态远期效果较好,并发症少。

Objective To evaluate the long-term effects of combined surgery for glaucoma and cataract after transscleral diode laser ciliary cyclophotocoagulation surgery for the treatment of persistent high intraocular pressure in primary acute angle-closure glaucoma.Methods This was a retrospective case series study.Total of 39 eyes of 37 patients with persistent high intraocular pressure in primary angle-closure glaucoma in Zhengzhou Central Hospital affiliated to Zhengzhou University from Jan.2017 to Jan.2019 were collected.All cases underwent phacoemulsification,intraocular lens implantation,trabeculectomy,and iridectomy after scleral ciliary body photocoagulation.The best corrected visual acuity,intraocular pressure,anterior chamber depth and complications within 5 years were observed.Results Postoperative intraocular pressure was(15.6±6.3)mmHg at 1 week(1 mmHg=0.133 kPa),(15.4±6.2)mmHg at 1 month,(15.5±5.7)mmHg at 3 months,(14.9±6.1)mmHg at 6 months,(14.7±6.0)mmHg at 1 year,(14.8±5.9)mmHg at 3 years,(14.7±5.9)mmHg at 5 years after sclera diode laser ciliary body photocoagulation and combined surgery,respectively.The difference was statistically significant in the intraocular pressure at each time point before and after operation(F=266.02,P=0.013).There was significant difference in BCVA distribution ratio at each time point between ciliary body photocoagulation and combined surgery(χ^(2)=267.00,P=0.019).During the follow-up,the complications included 3 cases of ophthalmic pain,1 case of anterior chamber hematosis and 3 cases of ciliary detachment after scleral diode laser photocoagulation.Conclusion Phacoemulsification and intraocular lens implantation combined with trabeculectomy after scleral cyclophotocoagulation is safe and effective in the treatment of primary acute angle-closure glaucoma with persistent ocular hypertension,with less complication.