摘要
目的:探讨自制眼内前房角镜－分离器行前房角分离(GSL)联合超声乳化白内障吸除及后房型人工晶状体植入术治疗原发性闭角型青光眼(PACG)的临床疗效。方法:选择2021年10月至2022年9月于潍坊眼科医院青光眼科诊断为PACG合并白内障患者45例(60只眼)。其中，男性23例(28只眼)，女性22例(32只眼)；年龄53~81岁，平均年龄(67.5±14.7)岁。使用随机数字表法将患者分为25例(30只眼)实验组和20例(30只眼)对照组。两组患者均先行超声乳化白内障吸除及后房型人工晶状体植入术，实验组再行自制眼内前房角镜－分离器分离前房角，对照组采用传统恢复器分离。记录两组患者的眼压、房水闪辉计数、最佳矫正视力、中央前房深度、前房角粘连范围(PAS)、角膜内皮细胞密度、青光眼用药数量及并发症的发生情况。PAS范围以眼数和百分比表示，组间比较采用秩和检验。黏弹剂使用剂量、GSL时间、中央前房深度、眼压、最佳矫正视力、房水闪辉计数及角膜内皮细胞密度等符合正态分布，以±s表示，两组组间比较采用独立样本t检验，多个时间点比较采用重复测量方差分析；术后用药数量不符合正态分布，以M(Q1，Q3)表示，组间比较采用Mann－Whitney U检验。结果:实验组患者的GSL手术时间和黏弹剂使用量分别为(1.07±0.77)min和(48.86±11.44)μL；对照组分别为(1.07±0.77)min和(119.07±14.08)μL，比较的差异均有统计学意义(t＝－10.00，－21.20；P<0.05)。实验组患者术前、术后1周、1个月、3个月及6个月，眼压分别为(25.30±10.63)mmHg(1 mmHg＝0.133 kPa)、(17.23±3.20)mmHg、(16.80±2.38)mmHg、(16.97±1.87)mmHg及(17.83±2.56)mmHg；中央前房深度分别为(2.31±0.25)mm、(4.38±0.17)mm、(4.36±0.15)mm、(4.33±0.12)mm及(4.26±0.12)mm；房水闪辉计数分别为(13.67±7.26)pc/ms、(28.01±15.72)pc/ms、(15.81±8.30)pc/ms、(12.12±5.32)pc/ms及(10.63±4.47)pc/ms；视力分别为(0.37±0.43)、(0.15±0.27)、(0.14±0.32)、(0.16±0.33)及(0.15±0.28)；角膜内皮细胞计数分别为(2624.07±277.29)mm2、(2375.70±321.45)mm2、(2310.13±277.00)mm2、(2311.80±243.03)mm2及(2311.10±333.54)mm2。两组患者中央前房深度、眼压、视力、房水闪辉计数及角膜内皮细胞计数各时间点交互作用的差异均无统计学意义(F＝1.62，1.53，1.41，0.80，0.25；P>0.05)。两组PACG患者术前、术中PAS范围比较的差异均有统计学意义(Z＝－0.30，－0.28；P>0.05)。实验组术后1个月PAS范围0°、0°~90°及≥90°分别为16例(18只眼)、5例(8只眼)及4例(4只眼)，分别占60.0%、26.7%及13.3%；术后6个月PAS范围0°、0°~90°及≥90°分别为11例(13只眼)、8例(11只眼)及6例(6只眼)，分别占43.3%、43.3%及20.0%。两组患者术后PAS范围2个时间点比较的差异均无统计学意义(Z＝－1.65，－0.90；P>0.05)。两组患者术后1个月、3个月及6个月青光眼用药数量比较的差异均无统计学意义(Z＝－1.04，－1.25，－0.95；P>0.05)；术中并发症发生率比较的差异无统计学意义(χ2＝2.04，P>0.05)。结论:自制眼内前房角镜－分离器GSL与传统前房角镜下GSL治疗PACG合并白内障患者的疗效相当，且眼内前房角镜－分离器GSL术更方便快捷效率高，值得临床推广。
Abstract
Objective:The aim of this study is to investigate the clinical efficacy of a novel goniosynechialysis (GSL) with cataract phacoemulsification for primary angle-closure glaucoma (PACG).Methods:Forty-five patients (60 eyes) diagnosed as PACG complicated with cataract in Department of Glaucomatology of Weifang Eye Hospital from October 2021 to September 2022 were selected. Among them, there were 23 cases (28 eyes) male and 22 cases (32 eyes) female with the mean age of (67.5±14.7) years (ranged from 53 to 81 years). They were divided into experimental group 25 cases (30 eyes) and control group 20 cases (30 eyes) according to the random number table method. They all underwent cataract phacoemulsification, then a novel GSL and a conventional method was used for patients of experimental group and control group, respectively. The range of peripheral anterior synechia (PAS) were recorded before, during and postoperation. The volume of viscoelastic used, GSL time and complications were recorded during operation in the two groups. The number of antiglaucoma medications were recorded, intraocular pressure, the count of aqueous flare, best corrected visual acuity, anterior chamber depth and corneal endothelial cell density were measured before operation and after operation for 1 week, 1 month, 3 months, 6 months.The PAS was counted as the number and percentage of eyes, and used to compare by the rank sum test. The volume of viscoelastic used, GSL time, anterior chamber depth, intraocular pressure, best corrected visual acuity, the count of aqueous flare, corneal endothelial cell density were in accordance with normal distribution, and expressed as ±s, and used to compare by the independent samples t test between groups, and used to compare by repeated measures variance analysis at multiple time points. The number of postoperative medications was expressed as M (Q1, Q3), and used to compare by the Mann-Whitney U test between groups.Results:The GSL time and the volume of viscoelastic used in the experimental group were (1.07±0.77) min and (48.86±11.44) μL, respectively, while those in the control group were (1.07±0.77) min and (119.07±14.08) μL, respectively with the significant difference (t=-10.00, -21.20; P<0.05). The intraocular pressure of the experimental group were (25.30±10.63)mmHg (1 mmHg=0.133 kPa), (17.23±3.20)mmHg, (16.80±2.38)mmHg, (16.97±1.87)mmHg, (17.83±2.56)mmHg after operation for 1 week, 1 month, 3 months, 6 months, respectively; anterior chamber depth were (2.31±0.25)mm, (4.38±0.17)mm, (4.36±0.15)mm, (4.33±0.12)mm and (4.26±0.12)mm, respectively; the count of aqueous flare were (13.67±7.26)pc/ms, (28.01±15.72)pc/ms, (15.81±8.30)pc/ms, (12.12±5.32)pc/ms, (10.63±4.47)pc/ms, respectively; the best corrected visual acuity were (0.37±0.43), (0.15±0.27), (0.14±0.32), (0.16±0.33) and (0.15±0.28), respectively; the corneal endothelial cell density were (2624.07±277.29)mm2, (2375.70±321.45) mm2, (2310.13±277.00)mm2, (2311.80±243.03)mm2, (2311.10±333.54)mm2, respectively. There was significant difference in anterior chamber depth, intraocular pressure, the best corrected visual acuity, the count of aqueous flare, and the corneal endothelial cell density at each time point after surgery (F=1.62, 1.53, 1.41, 0.80, 0.25; P>0.05). In the experimental group, there were 16 cases (18 eyes), 5 (8 eyes), 4 cases (4 eyes) in the range of PAS with 0°, 0°to 90°, ≥90° after operation for 1 month, accounting for 60.0%, 26.7%, 13.3%, respectively; were 11 cases (13 eyes), 8 cases (11 eyes), 6 cases (6 eyes) after operation for 6 months, accounting for 43.3%, 43.3%, 20.0%, respectively. There was no statistical difference in the PAS between two groups (Z= -1.65, -0.90; P>0.05). There was no statistical difference in the number of antiglaucoma medications of patients with experimental group and control group after operation for 1 month, 3 months, 6 months (Z=-1.04, -1.25, -0.95; P>0.05); there was no statistical difference in the complication rate between them (χ2=2.04, P>0.05).Conclusions:A novel GSL is equal to trational method in the clinical efficacy. The novel GSL has the advantages of time saving, less consumables, easy performing and more efficient, which deserve to be widely applied.
基金项目
山东省医药卫生科技发展计划项目(202207020297)
万方数据