超声乳化联合小瞳下房角分离术治疗APACG合并年龄相关性白内障患者的效果及其对角膜内皮细胞丢失情况的影响

Effect of phacoemulsification combined with lower pupil angle separation in the treatment of APACG patients with age-related cataracts and its influence on the loss of corneal endothelial cells

目的:探究超声乳化(Phacoemulsification,PE)联合小瞳下房角分离术(Goniosynechialysis,GSL)对急性闭角型青光眼(Acute primary angle closure glaucoma,APACG)合并年龄相关性白内障患者的效果。方法:选取我科2021年8月至2023年6月期间115例APACG合并年龄相关性白内障患者,根据抽签法分为两组。对照组57例给予PE合并小梁切除术(Trabeculectomy,TE)治疗,观察组58例给予PE合并GSL治疗,分别于术前、术后1 w、术后4 w、术后12 w采用非接触式眼压计测量术眼眼压(Intraocular pressure,IOP),用TX-20型眼压计测量患者术眼最佳矫正视力(Best corrected visual acuity,BCVA);在术前和术后12 w用超声生物显微镜测量前房角度,用角膜内皮细胞密度仪器检测角膜内皮细胞丢失率(Endothelium corneal loss,ECL)并记录患者手术并发症情况。结果:观察组术后1 w、术后4 w时刻IOP水平高于对照组,术后12 w观察组前房角度较对照组高,并发症发生率、ECL较对照组低,差异有统计学意义(P<0.05)。结论:PE合并GSL术可有效改善APACG合并白内障患者最佳矫正视力、眼压、前房角度以及ECL,且安全性高。

Objective:To explore the effects of phacoemulsification(PE)combined with goniosynechialysis(GSL)on patients with acute primary angle closure glaucoma(APACG)and age-related cataracts.Methods:A total of 115 patients with APACG combined with age-related cataracts were selected from our department from August 2021 to June 2023 and divided into two groups according to the lottery method.Fifty-seven cases in the control group were treated with PE combined with trabeculectomy(TE),while fifty-eight cases in the observation group were treated with PE combined with GSL.Intraocular pressure(IOP)was measured using a non-contact tonometer before surgery,1 week after surgery,4 weeks after surgery,and 12 weeks after surgery.The patient's best corrected visual acuity(BCVA)was measured using a TX-20 tonometer;the anterior chamber angle was measured using ultrasound biomicroscopy before and 12 weeks after surgery,the corneal endothelial cell loss(ECL)was measured using a corneal endothelial cell density instrument,and the patient's surgical complications were recorded.Results:The IOP level in the observation group was higher than that in the control group at 1 week and 4 weeks after surgery,the anterior chamber angle in the observation group was higher than that in the control group at 12 weeks after surgery,and complication rate and ECL were lower than that in the control group,the difference was statistically significant(P<0.05).Conclusion:PE combined with GSL can effectively improve the best corrected visual acuity,IOP,anterior chamber Angle,and ECL in APACG patients with cataracts,and it is safe.