晶状体超声乳化术联合房角镜直视下房角分离术治疗晚期原发性闭角型青光眼

目的 观察晶状体超声乳化术联合房角镜直视下房角分离术治疗晚期原发性闭角型青光眼(PACG)的疗效.方法 回顾性收集2019年1月到2020年7月于本院收治的17例(25眼)晚期PACG患者.所有患者入院后均行晶状体超声乳化术+人工晶状体植入+术中房角镜直视下房角粘连分离术.术后随访6～24(15.64±4.35)个月....

Phacoemulsification combined with goniosynechialysis under gonioscopy in the treatment of advanced primary angle-closure glaucoma

Objective　To observe the effect of phacoemulsification combined with goniosynechialysis under gonioscopy in the treatment of advanced primary angle-closure glaucoma (PACG).Methods　A total of 17 patients (25 eyes) with advanced PACG admitted to our hospital from January 2019 to July 2020 and surgically treated with phacoemulsification + intraocular lens implantation + intraoperative goniosynechialysis under the direct vision of gonioscopy were retrospectively analyzed. Patients were followed up for an average of 6-24 (15.64±4.35) months. The intraoperative and postoperative complications were recorded, and the preoperative and postoperative intraocular pressure (IOP), visual vision, and medication were compared. IOP of 1 patient was uncontrolled after surgery, and the patient was re-treated with trabeculectomy. Therefore, the patient’s complications were analyzed while the remaining variables were excluded.Results　Compared with preoperative IOP with the medication, the postoperative IOP of 16 patients (24 eyes) was significantly reduced ［(15.53±5.13) mmHg (1 kPa=7.5 mmHg) vs. (24.85±10.64) mmHg］(t=4.10, P=0.000). The types of postoperative medications and drips were significantly reduced compared with those of preoperative medications (Z=-2.917, P=0.004; Z=-3.338, P=0.001). The best corrected visual acuity of 24 eyes after operation was significantly higher than that of preoperative level ［(0.05±0.00) logMAR vs. (0.28±0.41) logMAR］(t=2.985, P=0.008). Treatment failure occurred in 4 patients (4 eyes), including 1 patient had intraoperative aqueous vagus flow and the surgery was completed after puncture and drainage of the flat part of the ciliary body; 2 patients developed postoperative malignant glaucoma and were treated with YAG laser peripheral iris plus posterior capsulotomy; 1 patient was retreated with trabeculectomy due to uncontrolled IOP. logistic regression analysis was used to analyze the risk factors for complications or surgical failure in the 4 patients. It is found that the age ≤50 years, axial length <22 mm, lens thickness <4.5 mm, and mild lens opacity were risk factors for complications or surgical failure. Conclusion　Phacoemulsification + intraocular lens implantation + intraoperative goniosynechialysis under the direct vision of gonioscopy is effective for the treatment of advanced PACG. However, this procedure should be cautiously selected in young patients with short axial length, thin lens thickness and light lens opacity.