飞秒激光辅助超声乳化联合房角分离术治疗急性闭角型青光眼合并白内障

Femtosecond laser-assisted phacoemulsification combined with goniosynechialysis in the management of acute angle-closure glaucoma with cataract

摘要:

目的：观察飞秒激光辅助白内障超声乳化联合房角分离术治疗急性闭角型青光眼合并白内障患者的临床疗效。

方法：回顾性分析。选取我院2019-03/2021-04期间收治的实施飞秒激光辅助白内障超声乳化联合房角分离术的合并白内障的急性闭角型青光眼患者29例34眼，观察手术前后最佳矫正视力、眼压、房角形态、中央前房深度、角膜内皮细胞计数、中央角膜厚度的变化并分析术后并发症情况。

结果：术后最佳矫正视力较术前明显提高，术前与术后1mo最佳矫正视力具有差异(Z=-5.126，P<0.01)。术后1d，1wk，1mo眼压分别为16.72±2.12、13.73±1.68、12.87±3.54mmHg，与术前眼压28.67±4.13mmHg比较有差异(均P<0.01)。房角镜检查术后1mo的房角黏连范围与术前比较明显减少(t=21.32，P<0.01)，术后1mo中央前房深度、房角开放距离及小梁虹膜夹角均显著大于术前(t=-3.37、-3.68、-5.61，均P<0.01)。角膜内皮细胞计数、中央角膜厚度与术前比较均无差异(P>0.05)。术中术后均未出现相关严重并发症，术后满意度高。

结论：飞秒激光辅助白内障超声乳化联合房角分离术可有效治疗合并白内障的急性闭角型青光眼，同时降低手术风险，提高手术安全性及成功率。

Abstract:

AIM: To observe the clinical effect of femtosecond laser-assisted phacoemulsification combined with goniosynechialysis in the management of acute angle-closure glaucoma with cataract.

METHODS:Retrospective study. From March 2019 to April 2021, 34 eyes of 29 acute angle-closure glaucoma with cataract patients were performed femtosecond laser-assisted phacoemulsification combined with goniosynechialysis. Best corrected visual acuity(BCVA), intraocular pressure(IOP), grading of chamber angle, central anterior chamber depth, corneal endothelial cell count and central corneal thickness were mesaured and analyzed preoperatively and at 1d, 1wk, 1mo.The postoperative complications were analyzed.

RESULTS: There was a statistically significant difference between preoperative and postoperative BCVA at 1mo(Z= -5.126, P<0.01). IOP at 1d, 1wk and 1mo were 16.72±2.12mmHg, 13.73±1.68mmHg and 12.87±3.54mmHg respectively, which were different from 28.67±4.13mmHg before surgery(all P<0.01). The range of atrial angle adhesion at 1mo after the surgery was significantly reduced compared with preoperative(t=21.32, P<0.01). The depth of central anterior chamber, the open distance of atrial angle and the included angle of trabecular iris at 1mo after the surgery were significantly greater than preoperative(t= -3.37,-3.68, -5.61, all P<0.01). There were no significant differences in corneal endothelial cell count and central corneal thickness(P>0.05). Postoperative satisfaction was high without serious complications.

CONCLUSION:Femtosecond laser-assisted phacoemulsification combined with goniosynechialysis may be an effective treatment option for acute angle-closure glaucoma complicated with cataract, is safe, effective and has fewer complications.