白內障超聲乳化人工晶體植入聯合房角分離術治療慢性閉角型青光眼合并白內障的遠期療效分析

李文濤　陳彥霓　高穩生　周靈

【摘要】 目的：研究白內障超聲乳化人工晶體植入聯合房角分離術治療慢性閉角型青光眼合并白內障患者的遠期療效。方法：將77例（77眼）診斷為慢性閉角型青光眼合并白內障且房角粘連≤1/2的患者根據治療方式分為單純白內障超聲乳化人工晶體植入術37例37眼（超乳組）與白內障超聲乳化人工晶狀體植入聯合房角分離術40例40眼（聯合手術組）。所有患者均于術前1 d、術后1個月、術后半年、術后1年行最佳矯正視力、非接觸式眼壓、前房深度、Goldmann前房角鏡檢查。且于術后1周、術后1個月、術后半年、術后1年行光學相干斷層掃描（OCT）視盤周邊神經纖維層厚度（RNFL）檢查。結果：術后1年隨訪結束時，兩組術后最佳矯正視力均較術前提高，但兩組視力、RNFL變化比較，差異均無統計學意義（P>0.05）。術后1年，兩組眼壓變化情況比較，差異無統計學意義（P>0.05）。但與超乳組相比，聯合手術組術后中央前房深度更深[（1.98±0.64）mm vs （2.31±0.43）mm，P<0.05]，房角開放象限更寬。術中及術后無嚴重并發癥發生。結論：對于慢性閉角型青光眼而言，聯合房角分離術即便在加深前房、開放房角方面比單純白內障超聲乳化人工晶體植入術表現出更多優勢，但卻并未在眼壓控制方面表現出更好的療效。

【關鍵詞】 慢性閉角型青光眼 超聲乳化 房角分離 前房深度 眼壓

Clinical Study on the Long-term Effect of Phacoemulsification Combined with Goniosynechialysis in the Treatment of Chronic Angle-closure Glaucoma with Cataract/LI Wentao， CHEN Yanni， GAO Wensheng， ZHOU Ling. //Medical Innovation of China， 2020， 17（10）： 0-035

[Abstract] Objective： To investigate the long-term effects of phacoemulsification combined with goniosynechialysis in the treatment of chronic angle-closed glaucoma with cataract. Method： A total of 77 chronic angle-closure glaucoma with cataract patients with anterior chamber angle closed over 1/2 were divided into phacoemulsification 37 cases 37 eyes （phacoemulsification alone group） and phacoemulsification combined with goniosynechialysis 40 cases 40 eyes （combined operation group） according to the treatment methods. The best corrected visual acuity （BCVA）， non-contact tonometer （NCT）， anterior chamber depth （ACD）， Goldmann gonioscopy were examined at 1 d pre-operation， 1 week post-operation， 6 months post-operation and 1 year post-operation. RNFL were examined by Optical Coherence tomography （OCT） at 1 d post-operation， 1 week post-operation， 6 months post-operation and 1 year post-operation. Result： One year after operation， the BCVA was improved for most cases （90.9%）， and there were no significant differences in BCVA and RNFL between two groups （P>0.05）. There was no significant difference between two groups in IOP at the end of the follow-up time （P>0.05）. However， compared to phacoemulsification alone group， combined operation group had deeper ACD [（1.98±0.64） mm vs （2.31±0.43） mm， P<0.05] and wider anterior angle. No sever complications occurred during and after surgery. Conclusion： Compared with phacoemulsification， phacoemulsification combined with goniosynechialysis in the treatment of chronic angle-closure glaucoma has more advantages in deeper ACD and opening angle， but it has not shown better effect in IOP control.

[Key words] Chronic angle-closure glaucoma Phacoemulsification Goniosynechialysis Anterior chamber depth IOP

First-authors address： Huizhou Third Peoples Hospital， Huizhou Hospital Affiliated to Guangzhou Medical University， Huizhou 516002， China

doi：10.3969/j.issn.1674-4985.2020.10.008

原發性閉角型青光眼（primary angel-closure glaucoma，PACG）是我國主要的致盲性眼病之一[1-2]，其中慢性閉角型青光眼占PACG總數的50%以上[3-4]，該病多發生于年長者[1]，且常同時合并白內障。鑒于慢性閉角型青光眼患者房角存在不同程度的房角粘連關閉，因此在臨床工作中，對于房角粘連≤1/2的慢性閉角型青光眼合并白內障患者的手術治療，常選擇白內障超聲乳化人工晶體植入聯合粘彈劑鈍性房角分離。研究表明，白內障超聲乳化能有效加深前房、降低眼壓[5-6]。但聯合粘……