护理学  >> Vol. 8 No. 6 (December 2019)

超声乳化白内障吸除联合房角分离术治疗闭角型青光眼合并白内障疗效及对房角宽度的影响
Efficacy of Phacoemulsification Combined with Goniosynechialysis on Angle-Closure Glaucoma with Cataract and Its Effects on the Angle of Anterior Chamber

DOI: 10.12677/NS.2019.86073, PDF, HTML, XML, 下载: 362  浏览: 508 

作者: 李 珂:濮阳市安阳地区医院,河南 濮阳

关键词: 超声乳化白内障吸除术房角分离术闭角型青光眼白内障Phacoemulsification Goniosynechialysis Angle-Closure Glaucoma Cataract

摘要: 目的:探讨超声乳化白内障吸除联合房角分离术(Phaco-GSL)治疗闭角型青光眼(ACG)合并白内障疗效及对房角宽度的影响。方法:将我院眼科收治的90例ACG合并白内障患者随机分为Phaco-GSL组和Phaco组,各45例,Phaco组接受Phaco + 人工晶状体植入(IOL)术,Phaco-GSL组接受Phaco + IOL + GSL,比较两组手术前后眼压、降眼压药种类、房角宽度、最佳矫正视力及并发症。结果:两组术后1 d和术后1、3个月眼压均低于术前(P < 0.05),术后1个月眼压低于术后1 d (P < 0.05);Phaco-GSL组术后1 d眼压低于Phaco组(P < 0.05),两组术前及术后1、3个月眼压比较,无显著差异(P > 0.05);两组术前、术后降眼压药种类无显著差异(P > 0.05);Phaco-GSL组手术前后眼压差值及降眼压药种类差值均高于Phaco组(P < 0.05);两组术后1个月房角均较术前明显增宽(P < 0.05),Phaco-GSL组房角开放情况优于Phaco组(P < 0.05);两组术后3个月最佳矫正视力均明显提高(P < 0.05),两组术前、术后3个月最佳矫正视力比较,无显著差异(P > 0.05);Phaco-GSL组术后出现角膜水肿11例(24.44%),前房微出血2例(4.44%);Phaco组术后出现角膜水肿10例(22.22%);两组均未出现视网膜脱落、后囊破裂等并发症。结论:Phaco-GSL治疗ACG合并白内障疗效确切,能有效降低眼压、开放房角,并改善患者是功能。
Abstract: Objective: To explore the efficacy of phacoemulsification combined with goniosynechialysis (Pha-co-GSL) on angle-closure glaucoma (ACG) with cataract and its effects on angle of anterior chamber. Methods: 90 patients with ACG and cataract admitted to ophthalmology department of our hospital were randomly divided into Phaco-GSL group and Phaco group, with 45 cases in each group. Phaco group was given Phaco + intraocular lens implantation (IOL), and Phaco-GSL group was given Phaco + IOL + GSL. The intraocular pressure, types of ocular hypotensive agents, angle of anterior chamber, best corrected visual acuity and complications were compared between the two groups before and after surgery. Results: The intraocular pressure in the two groups at 1 d, a month and 3 months after surgery was lower than that before surgery (P < 0.05), and the intraocular pressure at 1 month after surgery was lower than that at 1 d after surgery (P < 0.05). The intraocular pressure in Phaco-GSL group at 1 d after surgery was lower than that in Phaco group (P < 0.05), and there was no significant difference in intraocular pressure between the two groups before surgery and at 1 month and 3 months after surgery (P > 0.05). There were no significant differences in the types of ocular hypotensive agents before and after surgery (P > 0.05). The intraocular pressure difference and difference of types of ocular hypotensive agents before and after surgery in Phaco-GSL group were higher than those in Phaco group (P < 0.05). The angle of anterior chamber in the two groups was significantly wider than that before surgery (P < 0.05), and the angle opening in Phaco-GSL group was better than that in Phaco group (P < 0.05). The visual acuity in the two groups was significantly improved at 3 months after surgery (P < 0.05), and there was no significant difference in the best corrected visual acuity between the two groups before surgery and at 3 months after surgery (P > 0.05). There were 11 cases (24.44%) of corneal edema and 2 cases (4.44%) of anterior chamber microbleeds in Phaco-GSL group. There were 10 cases (22.22%) of corneal edema after surgery in Phaco group. There were no complications such as retinal detachment and posterior capsule rupture in the two groups. Conclusions: Phaco-GSL has exact efficacy in the treatment of ACG with cataract, and it can effectively reduce intraocular pressure, open angle, and improve the function of patients. 

文章引用: 李珂. 超声乳化白内障吸除联合房角分离术治疗闭角型青光眼合并白内障疗效及对房角宽度的影响[J]. 护理学, 2019, 8(6): 397-403. https://doi.org/10.12677/NS.2019.86073

1. 引言

青光眼、白内障是目前全球范围内排名最前的两种致盲性眼病,西方国家的青光眼患者以开角型青光眼为主,我国90%的原发性青光眼患者为闭角型青光眼(angle-closure glaucoma, ACG),且好发于中老年人 [1]。白内障与ACG一样,好发于中老年人,两种眼病相互影响,导致患者眼压升高,房角狭窄甚至关闭,视力严重受影响 [2]。近年来,关于ACG合并白内障的手术方法争议较大,有的学者认为单纯行超声乳化白内障吸除术(phacoemulsification, Phaco)即可,有的学者认为应选择Phaco联合人工晶状体植入术(intraocular lens, IOL) [3]。研究显示,Phaco联合IOL和房角分离术(goniosynechialysis, GSL)能同时解决白内障、青光眼,成功降低患者眼压,该手术方案也逐渐被重视 [4]。本研究对我院眼科收治的ACG合并白内障行Phaco + IOL + GSL,旨在探讨其手术疗效及对房角宽度的影响。

2. 资料与方法

2.1. 一般资料

选取2016年5月~2018年5月我院眼科收治的90例ACG合并白内障患者为研究对象,纳入标准:① 符合ACG、白内障的诊断标准 [5] [6];② ACG病史不超过2年;③ 单眼发病;④ 前房角镜检查提示房角粘连、闭合;⑤ 用降眼压药可将眼压控制在25 mmHg及以下(1 mmHg = 0.133 kPa);⑥ 自诉患眼白内障已明显影响视力(≤0.4);⑦ 患者自愿同意接受手术治疗。排除标准:① 虹膜角膜内皮综合征;② 新生血管性青光眼;③ 眼外伤或葡萄膜炎继发性青光眼;④ 既往有眼科手术史;⑤ 合并严重脏器疾病;⑥ 合并严重基础疾病,无法耐受手术者。采用随机数字表法,将90例ACG合并白内障患者随机分为Phaco-GSL组和Phaco组,各45例。Phaco-GSL组男29例,女16例;年龄57~84岁,平均(69.11 ± 7.48)岁;急性ACG 31例,慢性ACG 14例;房角关闭<180˚6例,≥180˚39例;晶状体核硬度分级:I级27例,II级10例,III级8例。Phaco组男27例,女18例;年龄56~85岁,平均(68.53 ± 7.35)岁;急性ACG 32例,慢性ACG 13例;房角关闭<180˚10例,≥180˚35例;晶状体核硬度分级:I级28例,II级11例,III级6例。两组患者性别、年龄、急/慢性ACG、房角关闭度数、晶状体核硬度分级比较,差异无统计学意义(P > 0.05)。本研究经我院医学伦理委员会批准,所有患者均签署知情同意书。

2.2. 方法

Phaco组接受Phaco+人工晶状体植入(IOL)术,Phaco-GSL组接受Phaco + IOL + GSL,具体如下:

两组患者术前均完善相关检查,给予降眼压药控制眼压(控制在21 mmHg以下),盐酸左洋佛沙星滴眼液滴眼,术前1 d停止使用缩瞳剂,术前半小时用美多丽散瞳。用0.4%奥布卡因行表面麻醉,于11点位角膜缘内透明角膜处作3.2 mm宽角膜隧道切口,2点钟角膜缘作1 mm透明角膜侧切口,前房内注入粘弹剂,用撕囊镊进行连续环形撕囊,直径5~5.5 mm,然后水分离将囊、皮质粘连完全分层,超声乳化吸出,清除皮质,行抛光,然后再次注入粘弹剂,囊袋内植入IOL。Phaco组植入IOL后彻底抽吸前房、IOL后面及囊袋内的粘弹剂,机化膜及色素等残留物质,检查切口闭合情况良好后结束手术。Phaco-GSL组则接着进行GSL,在12点位房角粘连处注入透明质酸钠,进行钝性分离,用人工晶状体定位钩后压虹膜根部,彻底抽吸出前房好囊袋内的透明质酸钠、积血块、机化膜、色素等残留物质,然后对透明角膜切口进行水化处理,检查切口闭合无漏水,结束手术。

2.3. 观察指标

分别于术前、术后1d和术后1、3个月用眼压计测量两组患者患眼眼压,并记录手术前后所用降眼压药种类,计算手术前后眼压差值及降眼压药种类差值;术前和术后1个月行前房角镜检查测量房角宽度,测量术前和术后3个月的最佳矫正视力,并观察术后并发症情况。

2.4. 统计学分析

所有采用SPSS19.0软件进行统计学分析,计量数据以均数±标准差( x ¯ ± s )表示,组间比较采用成组t检验,多时间点比较采用重复测量方差分析,若有差异,采用LSD-t检验进行组内两两比较;计数数据以[n(%)]表示,组间比较行χ2检验,等级资料采用秩和检验,P < 0.05表示差异有统计学意义。

3. 结果

3.1. 两组不同时间眼压比较

两组术后1 d和术后1、3个月眼压均低于术前(P < 0.05),术后1个月眼压低于术后1 d (P < 0.05);Phaco-GSL组术后1 d眼压低于Phaco组(P < 0.05),两组术前及术后1、3个月眼压比较,