单纯超声乳化白内障吸除联合后房型人工晶状体植入术治疗原发性闭角型青光眼疗效的临床观察

目的观察单纯超声乳化白内障吸除联合后房型人工晶状体植入术治疗原发性闭角型青光眼的疗效。 方法收集2013年8月至2015年1月武警总医院眼科收治的原发性闭角型青光眼合并白内障患者48例(60只眼)进行研究。其中，男性20例(28只眼)，女性28例(32只眼)。年龄在57~82岁，平均年龄为(69.20±7.32)岁。按照起病缓急，将急性闭角型青光眼者32例(34只眼)分为A₁组；将慢性闭角型青光眼者16例(26只眼)分为A₂组。按照前房角粘连范围，将<180°者22例(28只眼)分为B₁组；将≥180°者26例(32只眼)分为B₂组。按照两种局部降压药物是否能控制眼压在正常范围，将控制良好者18例(21只眼)分为C₁组；将控制不佳者30例(39只眼)分为C₂组。所有患者均行单纯超声乳化白内障吸除联合后房型人工晶状体植入术。术后3个月对受试者进行随访，记录眼压、最佳矫正视力、中央前房深度、前房角开放距离、前房角开放度数、前房角粘连范围、术中术后并发症及药物使用情况。对所得数据采用独立样本t检验进行组间比较。 结果A₁组和A₂组术前眼压分别为(30.52±8.29)mmHg(1 mmHg＝0.133 kPa)和(23.91±8.12)mmHg，术后3个月眼压分别为(12.3±4.21)mmHg和(17.7±4.13)mmHg，经独立样本t检验，其差异具有统计学意义(t＝3.09，4.96；P<0.05)；B₁组和B₂组术前眼压分别为(20.8±4.45)mmHg和(32.59±8.16)mmHg，术后3个月眼压分别为(14.04±3.19)mmHg和(16.38±4.80)mmHg，经独立样本t检验，其差异具有统计学意义(t＝-6.81，2.19；P<0.05)；C₁组和C₂组术前眼压分别为(19.8±1.05)mmHg和(34.59±7.26)mmHg，术后3个月眼压分别为(12.04±2.19)mmHg和(18.98±2.65)mmHg，经独立样本t检验，其差异具有统计学意义(t＝9.25，-10.25；P<0.05)；所有受试者，术前中央前房深度、前房角开放距离、前房角开放度数分别为(2.01±0.31)mm、(0.14±0.05)mm及(15.6±5.36)mm；术后3个月中央前房深度、前房角开放距离、前房角开放度数分别(3.60±0.15)mm、(0.34±0.04)mm及(34.3±3.42)mm。术后3个月与术前相比，中央前房加深，前房角开放距离增大、开放度数增加，差异有统计学意义(t＝-35.76，-24.19，-22.78；P<0.05)。术后3个月与术前相比，前房角粘连范围差异有统计学意义(χ²＝33.39，P<0.05)。术后3个月与术前相比，最佳矫正视力差异有统计学意义(χ²＝16.88；P<0.05)。术后随访3个月，A₁、A₂、B₁、B₂、C₁及C₂组患者的眼压控制率分别为97%、88%、96%、91%、100%及91%。此外，术前眼压小于30 mmHg的原发性闭角型青光眼患者，术后眼压下降程度与术前眼压以及晶体拱高之间存在着一定的相关性，相应的函数关系为Y＝-0.854+0.813X₁-1.648X₂ (X₁为术前眼压，X₂为晶体拱高)。 结论单纯超声乳化白内障吸除联合后房型人工晶状体植入术能有效降低术前应用两种或两种以内降眼压药物能有效控制眼压或前房角粘连范围<180°的原发性闭角型青光眼患者的眼压。对于术前眼压小于30 mmHg的原发性闭角型青光眼患者，术后眼压下降程度与术前眼压以及晶状体拱高密切相关。单纯超声乳化白内障吸除联合后房型人工晶状体植入术可使原发性闭角型青光眼患者前房加深、前房角开放、最佳矫正视力提高。

Clinical observation the curative effect of phacoemulsification combined with posterior chamber intraocular lens implantation for primary angle-closure glaucoma

ObjectiveThe aim of this study was to observe the clinical effect of phacoemulsification combined with posterior chamberintraocularlens implantation in primary angle closure glaucoma. MethodsA total of 48 cases (60 eyes) with primary angle closure glaucoma and cataract admitted to the ophthalmology department of the General Hospital of Armed Police from August 2013 to January 2015 were studied. Among them, there were 20 males (28 eyes) and 28 females (32 eyes). The age ranged from 57 to 82 years, with an average age of (69.20±7.32) years. Patients with acute angle-closure glaucoma (34 eyes) were divided into A₁ group and chronic angle-closure glaucoma (26 eyes) into A₂ group according to the onset time. According to the range of angle adhesion, 28 eyes were divided into B₁ group and 32 eyes were divided into B₂ group. According to whether two local antihypertensive drugs can control (intraocular pressure, IOP) in normal range, 21 eyes with good control were divided into C₁ group and 39 eyes with poor control were divided into C₂ group. All patients underwent phacoemulsification combined with posterior chamber intraocular lens implantation. Three months after operation, the subjects were followed up to record intraocular pressure, best corrected visual acuity, central anterior chamber depth, angle opening distance, angle opening degree, angle adhesion range, intraoperative and postoperative complications and drug use. The data were compared by independent sample t test. ResultsThe intraocular pressure of group A₁ and group A₂ were (30.52±8.29) mmHg (1 mmHg=0.133 kPa) and (23.91±8.12) mmHg respectively before operation, and (12.3±4.21) mmHg and (17.7±4.13) mmHg 3 months after operation. After independent sample t test, the difference was statistically significant (t=3.09, 4.96; P<0.05); preoperative intraocular pressure of group B₁ and group B₂ were (20.8±4.45) mmHg and (32.59±8.16) mmHg, respectively, and intraocular pressure of group B₁ and group B₂ were (14.04±3.19) mmHg and (16.38±4.80) mmHg three months after operation. After independent sample t test, the difference was statistically significant (t=-6.81, 2.19; P<0.05); preoperative intraocular pressure in C₁ group and C₂ group were (19.8±1.05) mmHg and (34.59±7.26) mmHg respectively, and intraocular pressure in 3 months after operation were (12.04±2.19) mmHg and (18.98±2.65) mmHg respectively. The difference was statistically significant (t=9.25, - 10.25; P<0.05) by independent sample t test. The preoperative central anterior chamber depth, angle opening distance and angle opening degree were (2.01±0.31) mm, (0.14±0.05) mm and (15.6±5.36) mm for all subjects, respectively. The central anterior chamber depth, angle opening distance and angle opening degree were (3.60±0.15) mm, (0.34±0.04) mm and (34.3±3.42) mm, respectively three months after operation. Three months after operation, the central anterior chamber deepened, the angle opened distance increased and the degree of opening increased. The difference was statistically significant (t=-35.76, -24.19, -22.78; P<0.05). There was a significant difference in the angle adhesion range between the three months after operation and before operation (χ² =33.39, P<0.05). There was significant difference in the best corrected visual acuity (χ² =16.88; P<0.05) between 3 months after operation and before operation. After 3 months follow-up, the IOP control rates of A₁, A₂, B₁, B₂, C₁ and C₂ groups were 97%, 88%, 96%, 91%, 100% and 91%, respectively. In addition, in patients with primary angle closure glaucoma whose intraocular pressure was less than 30 mmHg before surgery, there is a certain correlation between the degree of intraocular pressure decline after surgery and preoperative intraocular pressure and lens arch height. The corresponding functional relationship is Y=-0.854+ 0.813X₁-1.648X₂ (X₁ is preoperative intraocular pressure, X₂ is lens arch height). ConclusionsPhacoemulsification and intraocular lens implantation could reduce the IOP of primary angle-closure glaucoma(PACG) patients with goniosynechia <180° and with whose two kinds of drugscould get IOP well controlled.Preoperative IOP and lens vault are significant correlated with the degree of IOP decline, for PACG patients with preoperative IOP of less than 30 mmHg. What's more, phacoemulsification and intraocular lens implantation can improve the anterior chamber, angle and visual acuity of PACG.