白内障手术对滤过术后的原发性闭角型青光眼前房深度和晶状体位置的影响

目的比较滤过术后晶状体混浊的原发性闭角型青光眼(PACG)与单纯老年性白内障患者超声乳化白内障吸出联合人工晶状体(IOL)植入术手术前后前房深度和晶状体位置的改变。设计比较性病例系列。研究对象小梁切除术后具有功能性滤过泡且未用药下眼压≤21 mm Hg的PACG患者16例(16眼)及年龄、性别匹配的单纯老年性白内障患者17例(17眼)。方法在超声乳化白内障吸出联合IOL植入术前及术后1周行眼前段相干光断层扫描(AS-OCT),比较PACG组和对照组手术前后的前房深度和晶状体位置参数。主要指标中央前房深度(ACD)、前房宽度(ACW)、晶状体厚度(LT)和晶状体矢高(CLR)。结果术前PACG组的ACD(1.74±0.33)mm较正常对照组(2.67±0.21)mm浅(t=-5.961,P=0.00),LT(5.38±0.44)mm和CLR(0.98±0.46)mm较正常对照组(分别为4.72±0.25 mm和0.51±0.17 mm)大(t=-3.707、3.028,P=0.00和0.04),两组间ACW比较无统计学差异(t=1.608,P=0.09);术后两组间的ACD(3.32±0.20 mm vs.3.65±0.40 mm)、ACW(11.12±0.42 mm vs.11.30±0.25 mm)和CLR(-0.60±0.14 mmvs.-0.56±0.29 mm)比较均无统计学差异(P均>0.05);手术后两组间ACD的平均增加值(1.58 mm vs.0.98 mm),CLR的平均减少值(1.58 mm vs.1.06 mm)有统计学差异(t=0.771、0.236,P=0.04、0.00)。结论滤过术后的PACG患者前房深度仍比正常人浅,晶状体较厚且位置靠前;行超声乳化吸出联合IOL植入术后可明显加深前房深度、改善前房拥挤的现象。

The changes of anterior chamber depth and lens position after cataract surgery in the eyes with filtered primary angle closured glaucoma

Objective To observe the changes of central anterior chamber depth（ACD） and lens＇ position after phacoemulsification and intraocular lens（IOL） implantation in the eyes with filtered primary angle closure glaucoma（PACG） in comparison with cataract cases.Design Comparative case series.Participants PACG group included sixteen eyes（16 patients） with successful filtration surgery（IOP≤21 mm Hg） that required cataract surgery.The age-and gender-matched control group included 17 eyes（17 patients） with simple senile cataract.Method Anterior segment optical coherence tomography（AS-OCT） was used to measure the anterior segment parameters pre-and 1 week post-phacoemulsification combined with IOL implantation in both groups.Then the AS-OCT parameters were compared between the PACG group and normal control group.Main Outcome Measures Anterior chamber depth（ACD）,anterior chamber width（ACW）,lens thickness（LT） and crystalline lens rise（CLR）.Result Compared with the control group,ACD（P0.01） was significantly shallower,LT（P0.01） was significantly thicker and CLR（P=0.04） was larger in the PACG group before cataract surgery.There were no significant differences between groups in ACD,ACW and CLR（P all0.05） after cataract surgery.After cataract extraction,ACD increased（1.58 mm vs.0.98 mm）,while CLR decreased（1.58 mm vs.1.06 mm） significantly in the PACG group than that of control group（P0.01）.Conclusion Filtered PACG still has shallow ACD because of lens thickened and forwards.Phacoemulsification and IOL implantation can deepen ACD and improve the lens position in filtered PACG.