超声乳化联合房角分离治疗房角广泛粘连的AACG合并白内障

目的：评估广泛房角粘连的急性闭角型青光眼(AACG)合并白内障患者行超声乳化白内障摘除、人工晶状体植入联合房角分离术(PEI+GSL)的临床疗效。

方法：采用回顾性研究，选取我院2018-01/2019-06收治的AACG合并白内障患者32例35眼，房角粘连关闭的范围均≥180°，所有患者均行PEI+GSL，观察术后1d，1wk，1、3mo最佳矫正视力(BCVA)、眼压、中央前房深度(ACD)、房角开放距离(AOD₅₀₀)、小梁虹膜面积(TISA₅₀₀)，术后1、3mo的房角关闭范围、盘周视网膜神经纤维厚度(RNFL)及并发症情况。

结果：术后3mo， BCVA(0.334±0.154)，眼压(14.63±3.59mmHg)较术前(0.914±0.290，42.54±8.06mmHg)改善(P<0.05)； ACD(3.203±0.214mm)及鼻侧、颞侧OCT房角参数AOD_500、TISA₅₀₀(0.308±0.014、0.315±0.015mm、0.134±0.013、0.139±0.018mm²)较术前均明显增加，房角镜下房角关闭范围(72.32°±28.33°)较术前(215.29°±30.66°)减少，盘周RNFL较术前变薄(P<0.001)。术后3mo鼻侧、颞侧AOD₅₀₀、TISA₅₀₀变化量与眼压存在负相关性，但与ACD变化量无相关性，术后3mo无明显并发症发生。

结论：应用PEI+GSL治疗广泛房角粘连的AACG合并白内障患者可以改善视力，早期加深前房，有效促进房角开放，从而降低眼压。

Efficacy of phacoemulsification with goniosynechialysis on acute angle-closure glaucoma and cataract complicated with extensive synechial angle closure

AIM: To assess the clinical efficacy of phacoemulsification, intraocular lens implantation with goniosynechialysis(PEI+GSL)for acute angle closure glaucoma(AACG)and cataract with extensive angle closure synechiae.

METHODS: A retrospective study, we studied 35 eyes of 32 patients with AACG and cataract in our hospital. The extent of anterior chamber angle-closure synechiae was defined as an eye with >180°. All patients underwent PEI+GSL and completed an ophthalmologic examination including vision, intraocular pressure(IOP), anterior chamber depth(ACD), angle-opening distance(AOD₅₀₀), trabecular-iris space area(TISA₅₀₀)were observed at 1d, 1wk, 1mo and 3mo after cataract surgery. The angle closure range and retinal nerve fiber layer(RNFL)thickness changes at postoperative 1mo and 3mo were observed, and recorded complications.

RESULTS: Postoperative 3mo BCVA(0.334±0.154)and IOP(14.63±3.59mmHg)were improved compared with preoperative(0.914±0.290, 42.54±8.06mmHg)(P<0.05). ACD(3.203±0.214mm), OCT angle parameters AOD₅₀₀ and TISA₅₀₀(0.308±0.014, 0.315±0.015mm, 0.134±0.013, 0.139±0.018mm²)were significantly increased compared with preoperation. The extent of angle closure with gonioscopy(72.32±28.33°)decreased compared preoperation(215.29°±30.66°), and RNFL thickness thinner than preoperation(P<0.001). Changes in AOD₅₀₀ and TISA₅₀₀ for both nasal and temporal were negatively correlated with IOP, but not with changes in ACD, and no significant complications occurred in the 3mo after surgery.

CONCLUSION: The treatment of PEI+GSL can improve vision, deeper ACD and effectively open ACA in the early stage, thus controlling IOP.