青白联合手术对原发性闭角型青光眼患者眼部生物学参数的影响

The Influence of Phacotrabeculectomy on Ocular Biological Parameters in Patients with Primary Angle-Closure Glaucoma

摘要: 目的：探讨青白联合手术前后眼部生物学参数变化，分析青白联合术对原发性闭角型青光眼合并白内障患者眼部形态学影响。方法：回顾性分析于我院行青白联合手术的原发性闭角型青光眼(primary angle-closure glaucoma, PACG)合并白内障患者20例25眼，其中急性闭角型青光眼患者11例14眼，慢性闭角型青光眼患者9例11眼。应用UBM采用Pavlin法测量手术前后房角参数及相关结构变化，包括中央前房深度(anterior chamber depth, ACD)、小梁虹膜角(TIA)、房角开放距离AOD500 (AOD500)、小梁睫状体距离(TCPD)及虹膜厚度(IT)；使用IOL-Master500测量手术前后眼轴长度(AL)和角膜曲率(K)。比较手术前后眼压、最佳远矫正视力(BCVA)、ACD、各方向房角参数、AL、K值的变化。结果：青白联合术后BCVA由术前0.34 ± 0.34 (logMAR)变化至术后0.04 ± 0.14 (logMAR)，眼压由术前23.28 ± 10.29 mmHg降低至术后14.56 ± 2.73 mmHg，ACD由术前1.74 ± 0.41 mm加深至3.85 ± 0.47 mm，AL由术前22.60 ± 1.27 mm减少至术后22.39 ± 1.23 mm，差异均具有显著统计学意义(P < 0. 01)；术后各方向房角参数AOD500增宽，差异均具有显著统计学意义(P < 0.01)；术后各方向房角参数TCPD增大，差异均具有显著统计学意义(P < 0.05)；术后各方向房角参数TIA增大，差异均具有显著统计学意义(P < 0.01)；术后各方向房角参数IT未见明显变化(P = 0.37; P = 0.47; P = 0.51; P = 0.77)。结论：青白联合术可有效地解除闭角型青光眼瞳孔阻滞，加深前房的深度，增宽房角，在一定程度上改善房水循环，降低眼压并提高视力；另外，青白联合术后AL变短，为青白联合手术术前人工晶体度数的选择提供一定的临床指导意义。

Abstract: Purpose: To investigate the changes of ocular biological parameters before and after phacotra-beculectomy, and to analyze the influence of phacotrabeculectomy on ocular morphology in patients with primary angle-closure glaucoma. Methods: A retrospective analysis was made of 20 patients (25 eyes) with primary angle-closure glaucoma (PACG) and cataract who underwent pha-cotrabeculectomy in our hospital. Among them, 11 patients (14 eyes) had acute angle-closure glaucoma and 9 patients (11 eyes) had chronic PACG. Ultrasound biomicroscopy (UBM) was used to observe the patency of filtering passage and the filtering passage were unobstructed in all patients. Pavlin method was used to measure anterior chamber depth (ACD), trabecular iris angle (TIA), angle open distance at 500 μm (AOD500), trabecular-ciliary process distance (TCPD) and peripheral iris thickness (IT) before and after surgery. IOL-Master 500 was used to measure axial length (AL) and keratometry (K). The changes of intraocular pressure, best corrected visual acuity (BCVA), ACD, anterior chamber angle parameters, AL and K values before and after surgery were compared. Results: BCVA significantly changed from 0.34 ± 0.34 (logMAR) to 0.04 ± 0.14 (logMAR); Intraocular pressure significantly decreased from 23.28 ± 10.29 mmHg to 14.56 ± 2.73 mmHg; ACD deepened from 1.74 ± 0.41 mm to 3.85 ± 0.47 mm; AL significantly decreased from 22.60 ± 1.27 mm to 22.39 ± 1.23 mm (P < 0.01). AOD500 significantly increased in all directions (P < 0.01). TCPD significantly increased in all directions (P < 0.05). TIA significantly increased in all directions (P < 0.01). There was no significant change in IT before and after surgery in all directions (P = 0.37; P = 0.47; P = 0.51; P = 0.77). Conclusion: Phacotrabeculectomy can effectively relieve pupil block, deepen anterior chamber depth, widen chamber angle, improve aqueous circulation to a certain extent, reduce intraocular pressure and improve visual acuity. In addition, Axial length (AL) becomes shorter after phacotrabeculectomy, which provides certain clinical guidance for the selection of intraocular lens power before surgery in patients with primary angle-closure glaucoma.