摘要
目的探析飞秒激光辅助手术[超声乳化术+房角分离术(GSL)+人工晶状体(IOL)植入术]治疗急性闭角型青光眼(AACG)合并白内障的优势。方法选取60例AACG合并白内障患者,以治疗手段的不同分为对照组与观察组,每组30例。对照组接受超声乳化术+GSL+IOL植入术治疗,观察组接受飞秒激光辅助超声乳化术+GSL+IOL植入术治疗。对比两组眼压、矫正视力、中央前房深度、周边前房深度、房角、眼轴、角膜内皮细胞计数、中央角膜厚度。结果①治疗后,观察组眼压、矫正视力分别为(10.7±4.2)mm Hg(1 mm Hg=0.133 kPa)、(0.65±0.26),对照组分别为(12.1±4.6)mm Hg、(0.41±0.18)。治疗后,两组眼压对比无差异(P>0.05);观察组治疗后矫正视力高于对照组(P<0.05)。②治疗后,观察组中央前房深度、周边前房深度分别为(3.70±0.22)、(0.88±0.10)mm,对照组分别为(3.64±0.27)、(0.83±0.12)mm。治疗后,两组中央前房深度、周边前房深度均明显升高(P<0.05),但组间对比无差异(P>0.05)。③治疗后,观察组房角、眼轴分别为(27.10±7.68)°、(20.63±0.70)mm,对照组分别为(25.10±7.59)°、(20.62±0.68)mm。治疗后,两组房角均明显增大,眼轴均明显缩短(P<0.05),但组间对比无差异(P>0.05)。④治疗后,观察组角膜内皮细胞计数、中央角膜厚度分别为(2382.54±423.11)个/mm^(2)、(537.09±42.34)μm,对照组分别为(1941.00±254.14)个/mm^(2)、(539.66±41.82)μm。治疗后,观察组角膜内皮细胞计数高于对照组(P<0.05);两组治疗后中央角膜厚度对比无差异(P>0.05)。结论AACG伴白内障选择飞秒激光辅助超声乳化术+GSL+IOL植入术除了能开放房角、解除瞳孔阻滞、有效降低眼压以外,还具有术后眼前节反应轻、角膜内皮细胞损失少、IOL居中性好等优势,是一种安全有效的手术方式,值得推广。
Objective To explore the advantages of femtosecond laser-assisted surgery[phacoemulsification+goniosynechialysis(GSL)+intraocular lens(IOL)implantation]in the treatment of acute angle-closure glaucoma(AACG)complicated with cataract.Methods 60 patients with AACG complicated with cataract were divided into a control group and an observation group according to different treatment methods,with 30 cases in each group.The control group was treated with phacoemulsification+GSL+IOL implantation,and the observation group was treated with femtosecond laser-assisted phacoemulsification+GSL+IOL implantation.The intraocular pressure,corrected visual acuity,central anterior chamber depth,peripheral anterior chamber depth,anterior chamber angle,ocular axis,corneal endothelial cell count and central corneal thickness were compared between the two groups.Results(i)Before treatment,the intraocular pressure and corrected visual acuity were(18.6±2.3)mm Hg(1 mm Hg=0.133 kPa)and(0.33±0.19)in the observation group,and(19.2±1.9)mm Hg and(0.36±0.17)in the control group.After treatment,the intraocular pressure and corrected visual acuity were(10.7±4.2)mm Hg and(0.65±0.26)in the observation group,and(12.1±4.6)mm Hg and(0.41±0.18)in the control group.Before treatment,there was no difference in the comparison of intraocular pressure and corrected visual acuity between the two groups(P>0.05).After treatment,there was no difference in the comparison of intraocular pressure between the two groups(P>0.05).The corrected visual acuity of the observation group was higher than that of the control group after treatment(P<0.05).(ii)Before treatment,the central anterior chamber depth and peripheral anterior chamber depth were(2.56±0.28)and(0.80±0.18)mm in the observation group,and(2.57±0.24)and(0.73±0.15)mm in the control group.After treatment,the central anterior chamber depth and peripheral anterior chamber depth were(3.70±0.22)and(0.88±0.10)mm in the observation group,and(3.64±0.27)and(0.83±0.12)mm in the control group.Before treatment,there was no difference in central anterior chamber depth and peripheral anterior chamber depth between the two groups(P>0.05).After treatment,the central anterior chamber depth and peripheral anterior chamber depth increased significantly in both groups(P<0.05),but there was no difference between the two groups(P>0.05).(iii)Before treatment,the anterior chamber angle and ocular axis were(11.02±8.22)°and(21.78±0.51)mm in the observation group,and(12.10±7.59)°and(21.55±0.49)mm in the control group.After treatment,the anterior chamber angle and ocular axis were(27.10±7.68)°and(20.63±0.70)mm in the observation group,and(25.10±7.59)°and(20.62±0.68)mm in the control group.Before treatment,there was no difference between the two groups in anterior chamber angle and ocular axis(P>0.05).After treatment,the anterior chamber angle was obviously enlarged and the ocular axis was obviously shortened in both groups(P<0.05),but there was no difference between the two groups(P>0.05).(iv)Before treatment,the corneal endothelial cell count and central corneal thickness were(2413.13±347.24)/mm^(2) and(514.41±52.21)μm in the observation group,and(2414.00±348.36)/mm^(2) and(536.51±53.24)μm in the control group.After treatment,the corneal endothelial cell count and central corneal thickness were(2382.54±423.11)/mm^(2) and(537.09±42.34)μm in the observation group,and(1941.00±254.14)/mm^(2) and(539.66±41.82)μm in the control group.Before treatment,there were no differences in corneal endothelial cell count and central corneal thickness between the two groups(P>0.05).After treatment,the corneal endothelial cell count in the observation group was higher than that in the control group(P<0.05).There was no difference in the central corneal thickness between the two groups after treatment(P>0.05).Conclusion In the case of AACG with cataract,femtosecond laser-assisted phacoemulsification+GSL+IOL implantation can not only open the anterior chamber angle,relieve the pupillary block,and effectively reduce the intraocular pressure,but also has the advantages of light postoperative anterior segment reaction,less loss of corneal endothelial cells,and good IOL centration.It is a safe and effective surgical method,and is worthy of promotion.
作者
刘云
LIU Yun(Xiangjiang Aier Ophthalmology Hospital,Changsha 410000,China)
出处
《中国现代药物应用》
2024年第9期51-54,共4页
Chinese Journal of Modern Drug Application
关键词
急性闭角型青光眼
飞秒激光
房角分离术
超声乳化
白内障
角膜内皮细胞损失
Acute angle-closure glaucoma
Femtosecond laser
Goniosynechialysis
Phacoemulsification
Cataract
Corneal endothelial cell loss
