高眼压状态下急性闭角型青光眼术后前部巩膜厚度的研究

目的：：通过超声生物显微镜评估白内障超声乳化吸除联合人工晶状体植入术治疗高眼压状态下急性闭角型青光眼患者术后前部巩膜厚度的改变。方法：采用前瞻性临床研究,收治65例72眼急性闭角型青光眼合并白内障患者,入院时眼压均在50 mmHg以上,经过三种以上降眼压药物治疗眼压仍高于45 mmHg且前房较浅,所有患者行玻璃体腔放液降眼压后再行白内障超声乳化吸出联合人工晶状体植入并房角分离术。对术前及术后1、6 mo的检查结果进行比较分析,通过超声生物显微镜检查前房深度( anterior chamber depth, ACD ),上方、颞侧、鼻侧和下方4个象限前部巩膜厚度( anterior scleral thickness,AST)及距离巩膜突500μm的房角开放距离( angle opening distance at 500μm from the scleral spur, AOD500)观察眼前节结构的变化。结果：患者术前及术后1、6 mo的前房深度分别为1.532±0.316、3.337±0.652、3.458±0.482mm,术后1、6mo患者的前房深度均较术前明显加深(P<0.01),上方、颞侧、鼻侧和下方4个象限前部巩膜厚度较术前均增加,下方及鼻侧巩膜厚度变化有统计学差异(P<0.05),上方及颞侧巩膜厚度变化无统计学差异(P>0.05)。随访期末,上方、颞侧、鼻侧和下方4个象限的AOD500分别较术前平均增加0.007、0.006、0.014和0.019mm,较术前有显著统计学意义(均P<0.01)。结论：对于药物控制不佳的浅前房急性闭角型青光眼患者,白内障手术可以使中央前房加深,前房角增宽,前部巩膜变厚,但是巩膜厚度的改变尚需要更大样本的研究。

Changes of anterior scleral thickness after surgery in acute angle-closure glaucoma patients with high intraocular pressure

AlM: To evaluate the changes of anterior scleral thickness in acute angle-closure glaucoma patients with high intraocular pressure ( lOP) after phacoemulsification and intraocular lens implantation with ultrasound biomicroscope.METHODS: The prospective clinical study enrolled 65 cases ( 72 eyes ) with primary acute angle - closure glaucoma and cataract of whom lOP were all over 50mmHg. lOP of all patients were still over 45mmHg with shallow anterior chamber after general and topical medical management. Phacoemulsification and intraocular lens implantation combined with goniosynechialysis were performed after vitreous aspiration in all patients. Ultrasound biomicroscope was performed preoperatively and at 1, 6mo postoperatively. The anterior chamber depth ( ACD ) , anterior scleral thickness ( AST ) and angle opening distance at 500μm from the scleral spur ( AOD500 ) were measured at superior, temporal, nasal and inferior to detect the changes of anterior segment parameters.RESULTS:The ACD were 1. 532±0. 316, 3. 337±0. 652 and 3. 458 ± 0. 482mm preoperatively and at 1 and 6mo postoperatively, and there were significant differences between before and postoperatively ( P < 0. 01 ). The postoperative nasal and inferior AST obviously increased (P<0. 05), but the postoperative superior and temporal AST increased a little ( P > 0. 05 ). Compared with preoperative, the mean AOD500 increased by 0. 007, 0. 006, 0. 014 and 0. 019mm at superior, temporal, nasal and inferior, and the differences were significant compared to those before surgeries(all P<0. 01). CONCLUSlON: For acute angle - closure glaucoma patients with shallow anterior chamber and sustained high lOP and can′t be managed with drugs, cataract surgery can deepen the central ACD, increase the anterior scleral thickness, and widen the anterior chamber angle. But the change of scleral thickness needs larger sample study.