超声乳化白内障吸除联合房角分离术治疗原发性闭角型青光眼后的再手术情况分析

Clinical analysis of reoperation after phacoemulsification combined with goniosynechialysis for primary angle-closure glaucoma

目的探讨原发性闭角型青光眼(PACG)行超声乳化白内障吸除联合IOL植入联合房角分离(PEI-GSL)术后再次手术的原因及临床特征。设计回顾性病例系列。研究对象2018年1月1日至2021年12月31日在温州医科大学附属眼视光医院接受PEI-GSL的PACG患者1241例(1461眼)。方法回顾患者的病历资料,总结其临床特征、再手术方式及再手术原因等。主要指标PACG患者PEI-GSL术后再手术原因及其临床特征。结果1241例(1461眼)中再次行手术治疗的患者有17例(19眼,1.3%)。再手术原因主要为眼压失控(73.7%),其次为晶状体皮质残留(5.3%)、虹膜嵌顿于角膜切口(5.3%)、囊袋皱缩(5.3%)、IOL偏位(5.3%)、瞳孔散大(5.3%)。眼压失控的原因包括术后早期房角粘连关闭(9眼,64.2%)、术后远期房角粘连关闭(3眼,21.4%)和小梁网功能不良(2眼,14.3%)。早期出现房角粘连关闭的患者均为女性,其中6眼为原发性慢性闭角型青光眼(CACG)(66.7%),PEI-GSL术后中位眼压失控时间为16(1,46.5)天(范围1~60天),再手术前平均房角粘连关闭范围为(308.3±34.0)°(范围:240°~360°),平均中央前房深度为(2.4±0.4)mm(范围1.7~3.1mm),71.4%的患者存在近视漂移。结论PEI-GSL治疗PACG后再手术的主要原因是眼压失控。若PEI-GSL术后早期出现房角粘连关闭,可能与IOL位置前移相关。

Objective To investigate the causes and clinical characteristics of reoperation after phacoemulsification combined with intraocular lens implantation plus goniosynechialysis(PEI-GSL)for primary angle-closure glaucoma(PACG).Design Retrospective case series.Participants 1241 patients(1461 eyes)with PACG who underwent PEI-GSL in the Eye Hospital of Wenzhou from January 1,2018 to December 31,2021.Methods The patients'medical records were reviewed to analyze their clinical characteristics,type of reoperation,and reasons for reoperation.Main Outcome Measures Causes and clinical features of reoperation after PEI-GSL in patients with PACG.Results A total of 1241 PACG patients(1461 eyes)received PEI-GSL during the study period,including 17 patients(19 eyes)who received unplanned reoperation,with an incidence of 1.3%.Uncontrolled intraocular pressure was the main reason for reoperation,accounting for 73.7%.The complications such as residual lens cortex(5.3%),iris incarceration in corneal incision(5.3%),bag collapse(5.3%),deviation of intraocular lens(5.3%)and dilated pupil(5.3%)were the other reasons.The reason for uncontrolled intraocular pressure after PEI-GSL include early angle closure(9 eyes,64.2%),late angle closure(3 eyes,21.4%)and trabecular meshwork dysfunction(2 eyes,14.3%).All patients with early angle closure were women.Among them,6 eyes were CACG(66.7%),the median outset of uncontrolled intraocular pressure after PEI-GSL was 16(1,46.5)days(range:1~60 days),the average range of anterior chamber angle synechiae before reoperation was(308.3±34.0)°(range:240°~360°),the average central anterior chamber depth was(2.4±0.4)mm(range:1.7~3.1 mm),and 71.4%of patients had myopia drift.Conclusion The main reason for reoperation after PEI-GSL was uncontrolled intraocular pressure.Patients with early angle closure after PEI-GSL surgery may have anterior displacement of intraocular lens.