巩膜瓣下应用黏弹剂对青光眼白内障联合术后前房的影响

目的：研究闭角型青光眼急性发作的白内障患者行青光眼白内障联合术中巩膜瓣下应用黏弹剂对术后前房的影响。

方法：前瞻性研究。选取我院2016-08/2018-08采用青光眼白内障联合术治疗青光眼急性发作的白内障患者，随机分为应用黏弹剂组和常规手术组，分别于术后1、3、7d应用眼前节OCT测量前房深度(ACD)、巩膜突前500μm房角开放距离(AOD₅₀₀)、虹膜小梁网夹角(TIA)和眼压。

结果：术后1、3、7d，前房结构参数应用黏弹剂组为：ACD：3.82±0.51，3.71±0.63，3.78±0.33mm； AOD_500：0.25±0.04，0.24±0.04，0.25±0.05mm； TIA：32.01°±7.71°，31.36°±5.61°，31.82°±7.53°； 常规手术组为：ACD：2.71±0.29，3.21±0.43，3.60±0.57mm； AOD_500：0.20±0.08，0.21±0.05，0.24±0.07； TIA：25.13°±8.06°，26.18°±8.06°，29.25°±6.22°。其中术后1、3d ACD、AOD_500、TIA，两组患者有差异(P<0.05)； 而术后7d无差异(P>0.05)。两组患者术后眼压均显著降低至20mmHg以下，术后1d应用黏弹剂组眼压高于常规手术组(P<0.05)； 术后7d两组患者眼压无差异(P>0.05)。

结论：青光眼白内障联合手术中巩膜瓣下应用黏弹剂，能有效加深术后早期前房，术后眼压稳定，具有避免术后早期浅前房发生，维持房角开放的作用。

Changes of anterior chamber structure in patients after combined surgery of glaucoma and cataract with viscoelastics injection under the sclera valve

AIM: To evaluate the changes of anterior chamber structure in patients after combined surgery of glaucoma and cataract with viscoelastics injection under the sclera valve by OCT.

METHODS: The cataract with acute glaucoma patients who underwent combined surgery of glaucoma and cataract from 2016 to 2018 were enrolled. The patients were divided into the viscoelastics group and the control group. The anterior chamber depth(ACD), the angle opening distance(AOD₅₀₀)and the trabecular iris angle(TIA)were examined to compare the changes of the anterior chamber structure between the two groups.

RESULTS: At 1 and 3d after surgery, the ACD(3.82±0.51,3.71±0.63, 3.78±0.33mm), the angle opening distance(AOD₅₀₀: 0.25±0.04, 0.24±0.04, 0.25±0.05mm)and the TIA(25.13°±8.06°, 26.18°±8.06°, 29.25°±6.22°)were statistically different between two groups. There was no significant difference on the ACD, the AOD₅₀₀ and the TIA of the two groups 7d after surgery(P<0.05).

CONCLUSION: Viscoelastics injection under the sclera valve can deepen the anterior chamber effectively after combined surgery of glaucoma and cataract. It avoids the occurrence of shallow anterior chamber in the early postoperation and maintains the opening of anterior chamber.