持续高眼压对急性大发作期原发性闭角型青光眼行白内障手术的影响

The effect of persistent high intraocular pressure on cataract surgery in eyes with acute primary closed angle glaucoma

摘要:

目的：研究持续高眼压对原发性闭角型青光眼急性大发作期行白内障手术的影响与其相关因素分析，并探讨持续高眼压状态下的治疗方案。

方法：选取武汉同济医院眼科收治的284例293眼接受白内障手术治疗的原发性闭角型青光眼急性大发作期的病历资料。根据术前眼压，将病人分为三组，术前用全身及局部药物眼压可基本控制在正常范围内的(组1)，共188例； 术前眼压不能用药控制在正常范围，但行一次前房穿刺治疗后，眼压在用药物或不用药下可控制在正常范围的(组2)，共61例； 术前多次前房穿刺放液仍不能维持正常眼压(组3)，共44例。组1行白内障摘除联合人工晶体植入术，组2和组3行白内障摘除和房角分离联合人工晶体植入术。分析手术前后视力、眼压、中央前房深度、黄斑中心凹下脉络膜厚度以及房角镜检查结果。术前及术后测量数据采用非参数检验。

结果：各组术后一周眼压控制率分别为：组1(100%)，组2(95%)，组3(82%)(组2眼压控制率高于组3， χ²=4.795，P<0.05)。视力提高率分别为：组1(92%)，组2(84%)； 组3(52%)。各组术后中央前房深度均较术前明显加深，但组3中术后房角粘连范围显著高于组1和组2。组1和组2未出现术后前房积血，而组3中18%患者术后出现前房积血。

结论：对于持续高眼压的原发性闭角型青光眼急性大发作术前各种措施将眼压降至正常后再行白内障手术有较好的疗效，但是术前多次前房穿刺放液仍不能维持正常眼压眼，术后存在较大的房角粘连和前房出血风险。

Abstract:

AIM: To explore the effect of persistent high intraocular pressure(IOP)on cataract surgery in eyes with acute primary angle-closure glaucoma(PACG)and its correlative factor, and to discuss the choice of treatment for persistent high IOP.

METHODS: Totally 284 cases(293 eyes)were diagnosed as acute PACG and underwent cataract surgery. According to preoperative IOP, these patients were divided into three groups: Group 1(188 eyes), Group 2(61 eyes)and Group 3(44 eyes). Group 1 was defined that preoperative IOP can be controlled within the normal range under systemic and local drug. Group 2 was defined that preoperative IOP higher than 40 mmHg after drug therapy, which can be controlled after an anterior chamber puncture treatment. Group 3 was defined that preoperative IOP higher than 40 mmHg after multiple anterior chamber puncture. Group 1 underwent cataract extraction and intraocular lens(IOL)implantation. Group 2 and Group 3 underwent cataract extraction and IOL implantation with goniosynechiolysis. The preoperative and postoperative visual acuity, IOP, anterior chamber depth(ACD)and subfoveal choroidal thickness were obtained, and gonioscopic measurement of chamber angle was recorded. Preoperative and postoperative measurements were compared using non-parametric tests.

RESULTS: After surgical treatment, the rate of postoperative one-week IOP control rate was respectively: Group 1(100%), Group 2(95%), Group 3(82%)(the rate of Group 2 is higher than Group 3, χ²=4.795, P<0.05). The rate of the improved postoperative vision was respectively: Group 1(92%), Group 2(84%)and Group 3(52%). Postoperative central anterior chamber depth of each group deepened obviously compared to preoperative, but the postoperative goniosynechia range of Group 3 was significantly wider than that of Group 1 and Group 2. Group 1 and Group 2 did not record postoperative hyphema, while 18% of Group 3 had recorded hyphema.

CONCLUSION: Acute PACG eyes with persistent high preoperative IOP had good effects after cataract surgery, but demonstrated wider goniosynechia range and higher risk of hyphema compared to eyes with normal preoperative IOP.