原发性房角关闭疾病合并白内障术后黄斑结构变化的研究

目的：探讨原发性房角关闭疾病(PACD)合并白内障术后黄斑结构的变化。

方法：回顾性分析我院收治的PACD合并白内障患者200例的临床资料，根据手术方式分为传统小梁切除手术组(A组，60例60眼)、白内障超声乳化联合人工晶状体植入手术组(B组，72例72眼)和小梁切除手术+白内障超声乳化联合人工晶状体植入手术组(C组，68例68眼)，观察比较手术前后三组患者视力和术前及术后1wk，1、3mo眼压和黄斑厚度(中心凹区、旁中心区、中心凹周围区)的变化情况，同时比较三组患者术中及术后并发症发生情况。

结果：三组患者在术后3mo视力提高率和降低率比较，差异均有统计学意义(P<0.01)，且C组视力提高率最高，A组视力提高率最低。三组患者术后1wk，1、3mo眼压均较术前显著降低(P<0.05)，且术后1wk，1mo，B组患者眼压均显著高于A、C组(P<0.05)。三组患者手术前后中心凹区、旁中心区厚度比较，差异均有统计学意义(P<0.05)，且A组和C组术后1wk，1、3mo黄斑中心凹区、旁中心凹区厚度均较术前显著增厚(P<0.05)，B组术后1wk，1mo仅黄斑中心凹厚度较术前显著增厚(P<0.05)； A、C组患者术后1wk，1、3mo黄斑中心凹区、旁中心区厚度均较B组显著增厚(P<0.05)。三组患者术后并发症发生率比较，差异有统计学意义(P<0.01)，其中A组患者并发症发生率最高，B组最低。

结论：白内障超声乳化联合人工晶状体植入术能够解除房角关闭的瞳孔阻滞和晶状体因素，对PACD合并白内障患者术后黄斑结构影响较小，且能够改善视力，降低眼内压。

Changes of postoperative macular structure in primary angle closure disease complicated with cataract

AIM: To explore the change of postoperative macular structure in primary angle closure disease(PACD)complicated with cataract.

METHODS: The clinical data of 200 cases of PACD patients complicated with cataract treated in our hospital were analyzed retrospectively. The patients were divided into the Group A(n=60, 60 eyes, treated with trabeculectomy), the Group B(n=72, 72 eyes, given the phacoemulsification combined with intraocular lens implantation)and the Group C(n=68, 68 eyes, given the trabeculectomy and phacoemulsification combined with intraocular lens implantation). The vision changes before and after treatment and the changes of intraocular pressure and macular thickness(foveal area, near central area, foveal surrounding area)before operation and at 1wk, 1 and 3mo after operation were compared and observed, and the incidence of complications was compared between the two groups.

RESULTS: There were significant differences in the improvement rate and reduction rate of visual acuity among three groups at 3mo after operation(P<0.01), and the vision improvement rate in Group C was highest, while that in the Group A was the lowest. The intraocular pressure(IOP)of the three groups at 1wk, 1 and 3mo after operation was significantly lower than that before operation(P<0.05), and the IOP in the Group B was significant higher than that in the Group A and the Group C at 1wk, 1mo after operation(P<0.05), and there were significant differences in the thickness of foveal area and near central area among three groups before and after operation(P<0.05). And the macular thickness(foveal area, near central area, foveal surrounding area)in the Group A and C at 1wk, 1 and 3mo after operation was significantly thicker than that before operation(P<0.05), and the macular thickness of foveal area in the Group B was significantly thicker at 1wk and 1mo after operation than that before operation(P<0.05). And the comparison between groups showed that the macular thickness(foveal area, near central area)in the Group C at 1wk, 1 and 3mo after operation was significantly less compared with that in the Group A and the Group B(P<0.05). There were significant differences in the incidence rate of complications among three groups(P<0.01), and the incidence rate in the Group A was significantly higher than that in the Group B and the Group C(P<0.05).

CONCLUSION: Phacoemulsification combined with intraocular lens implantation can relieve angle closure caused by pupillary block and lens factors, and can significantly improve the vision and reduce intraocular pressure of PACD patients with cataract, and it has small effects on postoperative macular edema with few complications.