超声乳化手术治疗原发性闭角型青光眼合并白内障的多中心试验被引量：83

Multicentre Trial of Phacoemulsification on Patients with Primary Angle-closure Glaucoma and Co-existing Cataract

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摘要目的对原发性闭角型青光眼（PACG）合并白内障的患者，采用超声乳化白内障摘除、折叠人工晶状体种植手术治疗，评估超声乳化手术治疗PACG的临床效果及预后影响因素。方法本研究为前瞻性、多中心、平行对照设计。资料收集于2005年6月～2007年2月期间的PACG合并白内障患者，共129只眼（129例），男性42例，女性87例，平均年龄67．36±8．41岁（42～86岁）。患者分为两组：超乳手术组和小梁切除手术对照组，每组再分为急闭组和慢闭组。手术前后检查记录项目：青光眼病程及抗青光眼用药情况、视力、眼压、房角镜检查。术后随访时间为：术后1周、1个月、3个月、6个月。结果超声乳化手术可以降低眼压（X^2=22．915，P=0．000）、部分开放粘连房角（X^2=54．345，P=0．000）、减少抗青光眼用药（X^2=90．819，P=0．000），但超乳慢闭组患者的眼压与术前比较，差异没有统计学意义（F=1．328，P=0．263）。与小梁切除手术比较，超声乳化手术在开放房角粘连方面好于小梁切除手术（Z=-6．509，P=0．000），但是，其降低眼压不如小梁切除手术（Z=-2．346，P=0．019），其减少抗青光眼用药不如小梁切除手术（Z=-3．869，P=0．000）。超乳慢闭组与其他3组比较，在减少抗青光眼用药方面不如其他3组，差异具有统计学意义（X^2=58．63I，P=0．000）。晶状体摘除以后的房角粘连和抗青光眼用药，与病程长短均有关（P〈0．01），病程较长的患者（≥6个月），术后房角粘连和抗青光眼用药较多。结论超声乳化手术对急闭患者治疗的效果较好，而对慢闭患者治疗的效果差些。仅靠超声乳化手术并不能控制所有PACG患者的眼压，但是摘除晶状体对治疗PACG有帮助。对房角粘连超过6个月的PACG患者，仅行超声乳化手术难以开放其粘连的房角，且降眼压作用不明显。 Objective To evaluate the clinical outcomes and affected factors of prognosis of cataract extraction by phacoemulsification with intraocular lens implantation in eyes with primary angle - closure glaucoma （PACG） and co - existing cataract. Methods A muhi - center, prospective, concurrent controlled study was conducted. 129 eyes of 129 consecutive patients with PACG and co - existing cataract were recruited in the study from Jun 2005 to Feb 2007. 42 patients were male and 87 were female. Mean age was 67.36 ±8.41 （42 - 86） years old. Included patients were mainly divided into two groups： phacoemulsification group and trabeculectomy group. Each group was then divided into acute ACG group and chronic ACG group. The main outcome measures included ： course of diseases and number of anti- glaucoma medications, visual acuity, intraocular pressure, gonioscopy. Patients were examined 1 day, 1 week, 1 month, 3 months and 6 months after surgery. Results After phacoemulsification, the mean lOP of PACG eyes was decreased （x2 = 22. 915, P = 0. 000） , the mean extent of goniosyneehia was reduced （X^2 = 54. 345, P = 0. 000） , the number of anti - glaucoma medications required was decreased（x^2 = 90. 819, P = 0. 000）. But there was no statistical difference of the mean lOP in chronic PACG group（ F = 1. 328, P = 0. 263 ）. Phacoemulsification showed less effective in IOP lowering （Z = -2. 346, P = 0. 019） and anti -glaucoma medications decrease （ Z = - 3. 869, P = 0. 000 ） , but more effective in goniosynechia opening （ Z = - 6. 509, P = 0. 000） as compared to trabeeulecto- my. In chronic PACG group, phaeoemulsification showed less effective in anti - glaucoma medications decrease as compared with other three groups （X^2 = 58.631, P = 0. 000）. Postoperative goniosynechia and the number of anti - glaucoma medications were positively correlated with the course of glaucoma （ P 〈 0.01 ）. The patients with more than 6 months PACG course required more anti - glaucoma mediea-tions and had more goniosynechia postoperatively. Conclusion Phacoemulsifieation is more effective for acute PACG eyes than for ehronic cases. Phaeoemulsification alone could not provide enough lOP control for all PACG eyes, but cataract extraction is good for PACG eyes, Phaeoemulsifieation alone is not enough for eyes with more than 6 months＇ history of goniosynechia.

作者宋旭东王宁利唐广贤李筱荣张舒心吕建华季建杨文利梁远波郑瑜

机构地区首都医科大学附属北京同仁医院/北京同仁眼科中心/北京市眼科学与视觉科学重点实验室河北省邢台市眼科医院天津医科大学天津眼科中心

出处《医学研究杂志》 2010年第3期17-22,共6页 Journal of Medical Research

基金 "十一五"国家科技攻关计划项目

关键词白内障闭角型青光眼超声乳化手术人工晶体 Cataract Angle - closure glaucoma Phacoemulsification Intraocular lens

分类号 R775.2 [医药卫生—眼科]

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参考文献15

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