A Meta-Analysis: Safety and Efficacy of Phacoemulsification with Goniosynechialysis versus Trabeculectomy for Acute Angle Closure Glaucoma in China

Aim: The aim is to evaluate the safety and efficacy of phacoemulsification with goniosynechialysis versus trabeculectomy in the treatment of acute angle closure glaucoma (AACG) systematically. Methods: From January 1, 2000 to August 31, 2022, we searched PubMed, Science Citation Index Database, China National Knowledge Infrastructure, and Wanfang Database for pertinent material about the treatment of AACG with various operations. The imported literature was carefully vetted using the inclusion and exclusion criteria, assessed for quality, and the raw data were retrieved and integrated into EndNoteX9. For the meta-analysis, STATA 16.0 and RevMan 5.3 were used as the tools. Results: The meta-analysis includes 20 clinical investigations in all, involving 1463 eyes. The quality of the literature was rated as excellent and the data homogeneity among the studies was excellent based on the various study types that were included in the literature. According to a meta-analysis, phacoemulsification with goniosynechialysis is superior to trabeculectomy for treating acute angle-closure glaucoma because it results in improved postoperative visual acuity, lower intraocular pressure, a broader anterior chamber depth, and fewer complications. Conclusion: If conditions allow, phacoemulsification in conjunction with goniosynechialysis performs better than trabeculectomy in terms of visual acuity, intraocular pressure, anterior chamber depth, and comorbidities.

A Meta-Analysis: Safety and Efficacy of Phacoemulsification with Goniosynechialysis versus Trabeculectomy for Acute Angle Closure Glaucoma in China

Aim: The aim is to evaluate the safety and efficacy of phacoemulsification with goniosynechialysis versus trabeculectomy in the treatment of acute angle closure glaucoma (AACG) systematically. Methods: From January 1, 2000 to August 31, 2022, we searched PubMed, Science Citation Index Database, China National Knowledge Infrastructure, and Wanfang Database for pertinent material about the treatment of AACG with various operations. The imported literature was carefully vetted using the inclusion and exclusion criteria, assessed for quality, and the raw data were retrieved and integrated into EndNoteX9. For the meta-analysis, STATA 16.0 and RevMan 5.3 were used as the tools. Results: The meta-analysis includes 20 clinical investigations in all, involving 1463 eyes. The quality of the literature was rated as excellent and the data homogeneity among the studies was excellent based on the various study types that were included in the literature. According to a meta-analysis, phacoemulsification with goniosynechialysis is superior to trabeculectomy for treating acute angle-closure glaucoma because it results in improved postoperative visual acuity, lower intraocular pressure, a broader anterior chamber depth, and fewer complications. Conclusion: If conditions allow, phacoemulsification in conjunction with goniosynechialysis performs better than trabeculectomy in terms of visual acuity, intraocular pressure, anterior chamber depth, and comorbidities.

Bilateral acute angle closure glaucoma precipitated by over the counter oral decongestant

Dear Sir,We hereby report a case of bilateral acute angle closure glaucoma secondary to a systemic decongestant containing pseudoephedrine freely available over the counter.Acute angle closure glaucoma is an ocular emergency.Delayed recognition and treatment inevitably leads to permanent visual impairment.Acute angle closure occurs as a result of obstruction to aqueous drainage by blockage of the trabecular meshwork by the iris.Typical presenting symptoms include acute onset of ocular pain,headache and blurred vision.On clinical examination,it is characterized by a markedly raised IOP of above 21 mm Hg together with

Combined treatment of phacoemulsification and single-port limited pars plana vitrectomy in acute angle-closure glaucoma

AIM: To evaluate the efficacy of combined treatment of phacoemulsification(PE) and micro-incisional single-port transconjunctival limited pars plana vitrectomy(PPV) in acute angle-closure glaucoma(AACG).METHODS: A retrospective study included 26 patients who underwent PE diagnosed with AACG. Among them, 16 patients(16 eyes) underwent PE alone, 10 patients(10 eyes) underwent combined limited vitrectomy and PE. Then we compared intraocular pressure(IOP), anterior chamber angle, anterior chamber depth, central corneal thickness and corneal endothelial cell count before and after surgery, and effective PE time during cataract surgery.RESULTS: Effective PE time was shorter in the combined surgery group than in the single surgery group(P=0.040). There was no statistically significant difference in IOP and best-corrected visual acuity between the two groups postoperatively. At 6 mo postoperatively, there was no difference in the anterior chamber angle, anterior chamber depth, and central corneal thickness between two groups, but corneal endothelial cell count was higher in the combined surgery group than in the single surgery group(P=0.046). No complication such as vitreoretinal disease, endophthalmitis, bullous keratopathy was noted.CONCLUSION: Combined micro-incisional single-port transconjunctival limited PPV and PE are more effective and safer than PE alone because of less operation time and fewer complications for management of AACG.

Phacoemulsification versus combined phacotrabeculectomy in the treatment of primary angle-closure glaucoma with cataract: a Meta-analysis

AIM： To compare the efficacy and safety of phacoemulsification（Phaco） against combined phacotrabeculectomy（Phacotrabe） in primary angle-closure glaucoma（PACG） with coexisting cataract.·METHODS： By searching electronically the Pub Med,EMBASE, Scientific Citation Index and Cochrane Library published up from inception to January 2014, all randomized controlled trials that matched the predefined criteria were included. The quality of included trials was evaluated according to the guidelines developed by the cochrane collaboration. And the outcomes estimating efficacy and safety of two different surgical treatments were measured and synthesised by Rev Man 5.0.· RESULTS： Five randomized controlled trials were selected and included in Meta-analysis with a total of468 patients（468 eyes） with both PACG and cataract. We found that Phacotrabe had a greater intraocular pressure（IOP） lowing effect [preoperative IOP： weighted mean difference（WMD）=0.58, 95% confidence intervals（95% CI,-0.53 to 1.69）, P =0.31; postoperative IOP： WMD =1.37,95% CI（0.45 to 2.28）, P =0.003], a lower number of antiglaucoma medications [risk ratio（RR）=0.05, 95% CI（0.02 to 0.18）, P 〈0.00001] needed postoperatively and less serious damage of optic nerve [RR =0.48, 95% CI（0.21 to 1.07）, P =0.07], but a higher risk of complications[odds ratio（OR）=0.04, 95% CI（0.01 to 0.16）, P 〈0.00001]compared with Phaco. The rest studies indicated that there had no significantly difference between the two surgical methods for postoperative best-corrected visual acuity（BCVA） [WMD =-0.05, 95% CI（-0.14 to 0.05）, P =0.32] and loss of visual field [RR=1.06, 95% CI（0.61 to1.83）, P =0.83].·CONCLUSION： Phaco alone compared with Phacotrabe had a better effect in IOP reduction, whereas the securitydecline. Considering the number of sample size, our results remains to be further studied.

Angle parameter changes of phacoemulsification and combined phacotrabeculectomy for acute primary angle closure

·AIM: To evaluate the difference in angle parameters and clinical outcome following phacoemulsification and combined phacotrabeculectomy in patients with acute primary angle closure(APAC) using ultrasound biomicroscopy(UBM).·METHODS: Patients(n =23, 31 eyes) were randomized to receive phacoemulsification or combined phacotrabeculectomy(n =24, 31 eyes). Best-corrected visual acuity(BCVA), intraocular pressure(IOP), the main complications following surgery, and indentation gonioscopy and angle parameters measured using UBM were documented preoperatively and postoperatively.· RESULTS: The improvement in BCVA in the phacoemulsification group was significantly greater than in the combined group(P 【0.05). IOP in the phacoemulsification group was slightly higher than in the combined group following 1wk of follow-up(P 【0.05),whereas there was no significant difference between the two groups at the latter follow-up(P 】0.05).Phacoemulsification alone resulted in a slight increase in the trabecular ciliary processes distance compared with the combined surgery(P 【0.05), whereas the other angle parameters showed no significant difference between the groups. Complications in combined group were greater than phacoemulsification only group.·CONCLUSION: Both surgeries effectively opened the drainage angle and deepened the anterior chamber, and IOP was well controlled postoperatively. However,phacoemulsification showed better efficacy in improving visual function and showed reduced complications following surgery.

Role of Phacoemulsification in Angle Closure Glaucoma

Cataract or clear lens extraction has been suggested as a treatment option for different spectrums of primary angle closure diseases.It might reduce the risk of progression of angle closure and/or glaucoma by helping to open the angle and control the intraocular pressure (IOP).Conventionally,medically uncontrolled primary angle closure glaucoma was treated with trabeculectomy or phacotrabeculectomy and acute primary angle closure was treated with laser peripheral iridotomy. However,recent randomized controlled trials have demonstrated greater promise of phacoemulsification cataract surgery alone for control of the IOP. In this report we review the current literature to evaluate the impact of cataract surgery upon preventing and controlling primary angle closure diseases.

Safety and Efficacy of Combined Trabeculectomy for Primary Angle Closure Glaucoma with Persistent Ocular Hypertension

Purpose:To investigate the safety and efficacy of combined trabeculectomy for primary acute angle closure glaucoma with persistent ocular hypertension.Methods:A total of 36 patients.(40 eyes).with primary acute angle closure glaucoma,who were treated with combined trabeculectomy in the Ophthalmology Unit of our hospital,were selected.Before the procedure,patients were assigned to ocular hypertension group(≥ 40 mm Hg) or control group(< 40 mm Hg) based on intraocular pressure.These two groups were followed up for one year,and compared for post-operative visual acuity,intraocular pressure,filtering bleb,anterior chamber depth,and the occurrence of complications.Results:At 1 week,6 months,and 12 months after the procedure,intraocular pressure was controlled in both the ocular hypertension group and the control group,without significant differences between the two groups(P>0.05).At 1 week,6 months,and 12 months after the procedure,all of the patients,in both groups,had improved in terms of visual acuity,with a significant difference before and after the procedure for the ocular hypertension group(P<0.05).After follow-up at 12 months,the two groups presented no statistically significant differences in anterior chamber depth,filtering bleb survival,or the incidence of post-operative complications(P>0.05 for all).Conclusion:It is feasible,safe,and effective to perform combined trabeculectomy on patients with primary acute angle closure glaucoma complicated by persistent ocular hypertension.

Anterior Segment Parameters Associated to Acute Glaucoma with Slit Lamp Optical Coherence Tomography

Purpose: To identify the anterior segment parameters associated to acute primary angle closure. Patients and Methods: Case-control study in 58 primary angle closure suspect eyes (PACS, control group) and in 19 acute primary angle closure fellow eyes, case group. All subjects underwent SL OCT imaging in a dark room. Results: The SS, ACD and ACV measures were significantly smaller in case group than in control group (p = 0.011;p < 0.001;p = 0.007 respectively);while the IT was significantly greater (at 500 and 750 μm) (p = 0.038 and p = 0.050). The difference between quadrants were statistically significant only for control group (p = 0.001;p = 0.003;p = 0.009;p = 0.018;p = 0.002 and p 500, AOD500, AOD750, TISA500, and TISA750 respectively. Conclusion: Acute primary angle closure is associated to the smaller anterior segment dimensions and the thicker iris compared to PACS.

Clear lens extraction in angle-closure glaucoma patients

AIM: To describe the results of 5 consecutive cases of clear lens extraction in angle closure patients for the treatment of elevated intraocular pressure (IOP). ·METHODS: Retrospective observational case series. All angle closure patients were on two or more topical glaucoma medications and had prior laser iridotomy. Eyes underwent clear lens extraction by phacoemu - lsification with intraocular lens implantation. ·RESULTS: All five patients in this case series carried the diagnosis of angle -closure glaucoma and had uncontrolled IOP prior to surgery despite topical medications. After clear lens extraction three of the cases had good IOP control (IOP 【22mmHg) without the need for topical medications. In one case the IOP was better controlled after surgery, however, topical medications were required. The desired IOP was not met in one case despite restarting maximum topical therapy. ·CONCLUSION: This case series suggests that there may be a role for therapeutic clear lens extraction in select cases of angle-closure glaucoma.

Phacoemulsification with or without goniosynechialysis for angle-closure glaucoma: a global Meta-analysis based on randomized controlled trials

AIM: To compare the benefits and potential harms of routine phacoemulsification(phaco) alone and combined surgery with goniosynechialysis(GSL) for angle-closure glaucoma(ACG) and coexisting lens opacity, as shown in different randomized controlled trials(RCTs).METHODS: A systematic review was conducted searching several databases including PubMed, Cochrane Library, EMBASE, ClinicalTrials.gov from the inception to September 2018 for RCTs with data published on the effects and safety of phaco and intraocular lens implantation combined with GSL or routine cataract surgery alone. Several studies were recruited which reported data at baselines and postoperative follow-up, including the mean values of postoperative intraocular pressure(IOP) and mean numbers of antiglaucoma medications using postoperatively. The numbers of complications happening were also included. Fixedeffect and random-effect models were applied, and the quality of evidence was evaluated.RESULTS: Analysis of the seven included RCTs, with a total number of 321 participants(358 eyes) diagnosed with ACG and cataract, received a solo procedure(phaco group) or a combined surgery(phaco-GSL group) randomly, and follow-up periods ranging from 2 to 12 mo postoperatively. The involved studies showed that the mean value of IOP between the two groups at 3(four studies, one study follow-up at 2 mo postoperative was included), 6, 12 mo postoperative were not significantly different. Only two studies reported the change in IOP value at 12 mo compared with baseline but showed nosignificant differences between the two interventions. Although three studies did not have the significant difference in the number of medications using to reduce IOP at 3 mo postoperatively, two studies reported that the participants using fewer anti-glaucoma medications at 12 mo postoperative in the phaco group than in the phacoGSL surgery group.CONCLUSION: The analysis provides a low to moderatequality evidence that phaco-GSL surgery lead to an equivalent IOP-lowering effect. The phaco-GSL surgery may not help patients to reduce the consumption of antiglaucoma eyedrops in the long period. The results of this analysis suggested that additional GSL may not be necessary for primary angle closure glaucoma(PACG) patients. Further studies, especially RCTs with more participants and longer follow-up time were needed to provide more sufficient data.

Bilateral simultaneous primary acute angle-closure glaucoma

Dear Editor,Acute primary angle-closure glaucoma(PACG)is an important cause of blindness in East Asia.1 It is estimated that the overall prevalence of PACG will increase from 1.44%to 2.01%from 2020 to 2050.2 Acute PACG is typically related to increased high intraocular pressure(IOP),with symptoms including red eye,blurred vision,nausea,vomiting,and headache.Delay in timely IOPlowering treatment can result in permanent optic nerve damage and vision loss.

Efficacy of laser peripheral iridoplasty and iridotomy on medically refractory patients with acute primary angle closure： a three year outcome

Background Argon laser peripheral iridoplasty （ALPI） is proved to be effective in lowering intraocular pressure （lOP） of patients with mild acute primary angle closure （APAC）. It is unclear whether this laser treatment is equally efficient in managing patients with severe APAC. This study aimed peripheral iridotomy （LPI） on patients with refractory APAC, therapy. to evaluate the IOP-lowering efficacy of ALPI and laser who have previously responded poorly to intensive medical Methods Thirty-six patients （8 men and 28 women） were identified as medically refractory APAC, who still had ocular pain, red eye, hazy cornea, closed anterior chamber （AC） angle, and lOP of not less than 21 mmHg after two days or more of anti-glaucoma medication. All enrolled patients underwent ophthalmologic examinations including measurement of visual acuity （VA）, best corrected VA （BCVA）, lOP, biomicroscopy, and gonioscopy followed by ALPI immediately in the APAC eye and LPI in both eyes. Results All patients were affected unilaterally, with average age of （54.6±11.7） （range, 37.0-75.0） years old. The mean lOP value of the affected eyes dropped from （31.6±7.7） （range, 21.0-39.0） mmHg at enrollment to （18.4±8.7） （range, 10.0-27.0） mmHg 2 hours after ALPI. At follow-up day 7, the mean lOP value maintained at （14.8±4.2） （range, 9.0-21.0） mmHg, which was significantly different （P=0.000） compared with baseline. The average decrease of lOP in the APAC eyes was （16.8±7.4） （range, 12.0-21.0） mmHg. At follow-up three years later, the mean lOP of the APAC eyes stabilized at （16.3±3.2） （range, 9.0-20.0） mmHg with at least 180° of AC angle opened. Conclusion ALPI and LPI lower the lOP of medically refractory cases of APAC though they have responded poorly to anti-glaucoma medication.

Comparison of combined phacotrabeculectomy with trabeculectomy only in the treatment of primary angle-closure glaucoma

Background Trabeculectomy has become a mainstream treatment in intraocular pressure （lOP） reduction for primary angle-closure glaucoma （PACG）; combined trabeculectomy and cataract surgery was reported to reduce lOP and simultaneously improve vision for patients with PACG and coexisting cataract. This study was specialized to compare the efficacy and safety of combined phacotrabeculectomy with that of trabeculectomy only in the treatment of PACG with coexisting cataract. Methods This is a comparative case series study. Thirty-one patients （31 eyes） with PACG and coexisting cataract were enrolled. Of these, 17 underwent phacotrabeculectomy and 14 underwent trabeculectomy alone, lOP, filtering blebs, and complications were compared at the final follow-up. Complete success was defined as a final lOP less than 21 mmHg without lOP-lowering medication. Results After 10 months of postoperative follow-up, the phacotrabeculectomy and trabeculectomy groups showed no significant differences regarding lOP reduction （（20.59±7.94） vs. （24.85±14.39） mmHg, P=0.614）, complete success rate （88% vs. 71%, P=0.370）, formation rate of functioning blebs （65% （11/17） vs. 93% （13/14）, P=0.094）, and complications （41% （7/17） vs. 57% （8/14）, P=0.380）. lOP-lowering medication was not required for most of the patients in both groups. Additional surgery interventions, including anterior chamber reformation and phacoemulsification, were needed in the trabeculectomy group, whereas no surgery was needed postoperatively in the phacotrabeculectomy group. Conclusion Phacotrabeculectomy and trabeculectomy treatments exhibit similar lOP reduction, successful rates, and complications when it comes to treating PACG patients with coexisting cataract, although additional surgery intervention may be needed for a few cases with cataract and complications after trabeculectomy.

Phaco联合房角分离术治疗急性闭角型青光眼合并白内障患者的疗效及对视盘血流密度的影响

目的:探讨白内障超声乳化吸出(Phaco)联合房角分离术治疗急性闭角型青光眼(APACG)合并白内障患者的疗效及对视盘血流密度的影响。方法:选取100例APACG合并白内障患者为研究对象,依据手术方式不同分为对照组和观察组,每组各50例。对照组患者实施Phaco+小梁切除术治疗;观察组患者实施Phaco+房角分离术治疗,随访2个月。比较两组患者术后2个月临床疗效;术前、术后7 d、术后1及2个月最佳矫正视力(BCVA);术前及术后2个月眼压、散光度、前房深度及前房角度;术前、术后1 d、术后7 d、1个月及2个月视盘及盘周血流密度;治疗及随访期间并发症发生情况。结果:观察组术后2个月临床总有效率高于对照组(96.00%vs.84.00%,P<0.05)。术后随时间推移,两组患者BCVA均上升(P<0.05),且观察组各时间点均高于对照组(P<0.05)。术后2个月,两组患者眼压均下降(P<0.05),但组间差异无统计学意义(P>0.05);散光度均上升(P<0.05),但观察组低于对照组(P<0.05);前房深度均上升,但组间差异无统计学意义(P>0.05);前房角度均上升(P<0.05),且观察组高于对照组(P<0.05)。术后1 d,两组患者视盘整体血流密度均下降(P<0.05),术后7 d开始上升(P<0.05),术后1个月与术前无统计学差异(P>0.05),术后2个月较术前升高(P<0.05),且术后各时间点观察组均高于对照组(P<0.05)。术前及术后各时间点两组盘周血流密度差异无统计学意义(P>0.05)。观察组总并发症发生率低于对照组(8.00%vs.24.00%,P<0.05)。结论:相较于Phaco+小梁切除术,Phaco联合房角分离术能进一步提升APACG合并白内障患者临床疗效,能更好改善患者术眼散光度及前房角度,提升患者视盘血流密度,且并发症较少。

噻吗洛尔滴眼液在急性房角关闭危象序贯治疗中的疗效

目的观察噻吗洛尔滴眼液在急性房角关闭危象序贯治疗中的疗效。方法前瞻性随机双盲病例对照研究。连续纳入2021年4月至2023年10月河北大学附属医院诊断为急性房角关闭危象(acute angle-closure crisis,AACC)的患者,收集其病例资料并以随机数字表法分为应用噻吗洛尔组(A组)与安慰剂组(B组)。所有患者序贯应用药物治疗、前房穿刺、激光周边虹膜成形术,以治疗后2 h、4 h、6 h为治疗节点,记录并统计在各个节点2组患者的眼压下降值、AACC得到控制的眼数及所需时间。结果在序贯治疗后2 h、4 h、6 h的3个节点,A组的眼压下降值分别为(13.87±13.85)mmHg(1 mmHg=0.133 kPa)、(28.42±12.87)mmHg、(35.69±8.51)mmHg,AACC得到控制的眼数分别为23眼(29.87%)、51眼(66.23%)、71眼(92.20%);B组的眼压下降值分别为(15.88±14.95)mmHg、(28.17±13.63)mmHg、(33.90±13.59)mmHg,AACC得到控制的眼数分别为30眼(36.59%)、58眼(70.73%)、75眼(91.46%);治疗有效的患者中,AACC控制的时间A组为(3.29±1.31)h,B组为(3.38±1.34)h。2组患者在序贯治疗各个节点的眼压下降值、AACC缓解的眼数及病情缓解所需时间差异均无统计学意义(P>0.05)。结论在AACC的序贯治疗过程中,噻吗洛尔滴眼液对于提高治疗成功率无明显帮助。

激光周边虹膜切除术在原发性急性闭角型青光眼患者中的应用效果及对眼压和视力的影响

目的探讨激光周边虹膜切除术在原发性急性闭角型青光眼患者中的应用效果及对眼压和视力的影响。方法以随机法选取2020年10月至2022年10月的80例(86眼)原发性急性闭角型青光眼患者作为研究对象,所有患者给予激光周边虹膜切除术治疗。观察患者术前、术后的眼压、视力水平、房角关闭情况及角膜内皮细胞指标。结果术后,患者的眼压低于术前,视力水平高于术前(P<0.05)。术后,患者的前房角角度(ACA)、前房容积(ACV)和周边前房深度(PACD)均显著大于术前(P<0.05);术后,患者的中央前房深度(CACD)与术前比较,差异无统计学意义(P>0.05)。术后,患者的平均内皮细胞面积(AVE)、最大细胞面积(MAX)、最小细胞面积(MIN)、细胞密度(CD)、变异系数(CV)及细胞面积标准差(SD)与术前比较,差异无统计学意义(P>0.05)。结论原发性急性闭角型青光眼患者早期给予激光周边虹膜切除术治疗对降低眼压有明显效果,且还能提升视力水平,改善房角关闭情况,对患者角膜内皮细胞的损伤较小,安全性较高。

激光辅助巩膜切除及白内障摘除联合房角分离治疗闭角型青光眼

目的探究激光辅助巩膜切除及白内障摘除联合房角分离治疗闭角型青光眼的临床疗效。方法选择闭角型青光眼患者162例为研究对象,分为观察组81例行激光辅助巩膜切除及白内障摘除联合房角分离术,对照组81例行白内障摘除联合房角分离术,观察两组患者治疗效果。结果观察组患者术后视力、BCVA、房角宽度、角膜内皮细胞计数高于对照组,眼压、中央前房深度、角膜厚度均低于对照组,观察组不良反应发生率(6.2%)低于对照组(13.6%)。术后随访,两组眼压均无再升高,对照组滤过泡高度降低无观察组明显;术后1个月观察组BCVA、角膜内皮细胞计数高于对照组(P<0.05),角膜厚度低于对照组(P<0.05),术后3个月、6个月差异均无统计学意义;散光情况术后3个月观察组优于对照组,术后1个月、6个月差异无统计学意义(P>0.05)。结论激光辅助巩膜切除及白内障摘除联合房角分离术治疗闭角型青光眼临床效果好,安全性高。

PEI联合术中房角镜下房角分离及房角切开术治疗中晚期PACG合并白内障

目的:评价超声乳化白内障吸除人工晶状体植入术(PEI)联合术中房角镜直视下房角分离术(GSL)及房角切开术(GT)治疗中晚期原发性闭角型青光眼(PACG)合并白内障的效果。方法:回顾性病例系列研究方法。收集2021-12-01/2023-03-31在安徽医科大学第二附属医院手术的中晚期PACG合并白内障患者62例65眼,根据手术方式不同分为两组:观察组30例32眼行PEI+GSL+GT,对照组32例33眼行PEI+GSL。评估两组患者术前,术后1 d, 1 wk, 1、3、6 mo眼压、最佳矫正视力(BCVA)和抗青光眼药物使用数量。术前和术后6 mo时分别评估视野、杯盘比、前房角开放范围、前房深度、RNFL平均厚度。结果:PEI+GSL+GT组术后6 mo眼压和平均眼压降幅(16.68±2.65、11.12±8.53 mmHg)与PEI+GSL组(18.71±2.51、8.32±4.17 mmHg)有显著差异(P<0.05),眼压降幅率无差异(44.57%±21.79%和35.20%±17.94%,P>0.05)。术后6 mo两组抗青光眼药物使用数量、BCVA、前房深度、房角关闭范围均较术前改善(均P<0.01),PEI+GSL+GT组术后6 mo的药物减少数量和房角开放范围均大于PEI+GSL组(P<0.05),其余指标两组间比较均无差异(均P>0.05)。两组术后6 mo的视野平均偏差、杯盘比及RNFL平均厚度较术前均无差异(均P>0.05)。PEI+GSL+GT组手术完全成功率为81%(26/32),手术条件成功率为94%(30/32);PEI+GSL组手术完全成功率为58%(19/33),手术条件成功率为76%(25/33)。两组间手术成功率均有差异(完全成功率χ^(2)=4.275,P=0.039;条件成功率χ^(2)=4.040,P=0.044)。两组患者均未见危及视力的并发症及再次手术。结论:对于中晚期原发性闭角型青光眼合并白内障患者,采用PEI+GSL+GT治疗比PEI+GSL治疗更有效。

原发性闭角型青光眼合并白内障术后视觉质量变化及影响因素

近年来,白内障超声乳化吸除加人工晶状体植入联合房角分离手术逐渐成为治疗原发性闭角型青光眼合并白内障的主要有效手段,然而随着医疗技术不断进步,术后眼压的控制不再是唯一的追求,患者对术后的视觉质量期望越来越高。为了使患者术后拥有更好的屈光状态和更高的视觉质量,需减少因原发性闭角型青光眼所带来的负面影响,个性化选择不同人工晶状体或计算公式等。视觉质量评价指标包括视力、对比敏感度、高阶像差、主观感受等。因此,本文就原发性闭角型青光眼合并白内障患者行白内障超声乳化吸除加人工晶状体植入联合房角分离手术术后屈光漂移、高阶像差、对比敏感度变化及其影响因素以及人工晶状体的选择做出综述。