摘要
目的分析飞秒激光辅助白内障超声乳化联合不同方式房角分离术治疗原发性急性闭角型青光眼(APACG)急性发作期合并白内障的临床疗效。方法前瞻性病例对照研究。选取2023年1月至2024年6月我院收治的APACG合并白内障的急性发作期患者44例(48只眼),根据手术方式进行分组,研究组22例(26只眼)行飞秒激光辅助白内障超声乳化摘除联合术中房角镜直视下房角分离术,称为“直分组”(A组);对照组22例(22只眼)行飞秒激光辅助白内障超声乳化摘除联合无术中房角镜辅助下房角分离术,称为“盲分组”(B组)。分析术前、术后最佳矫正视力(BCVA)、眼压、房角开放范围及角度、前房容积、中央前房深度变化;并分析术中、术后并发症情况。结果两组患者术后眼压均较术前明显降低(P<0.05),A组患者术后1 d后眼压趋于稳定,B组患者术后1周后眼压趋于稳定,术后各个随访时间点眼压A组均低于B组(P<0.05)。A、B两组术后各个时间点BCVA较术前均有改善(P<0.05);两组间BCVA比较,差异无统计学意义(P>0.05)。两组患者术后房角宽度及前房容积均较术前明显增加(P<0.05)。术前及术后A、B两组患者房角宽度及前房容积比较,差异均无统计学意义(P>0.05)。房角开放范围比较,两种术式均有疗效;A组术式优于B组。在并发症方面,直分组易引起前房角出血,两组患者术后瞳孔散大及虹膜损伤差异无统计学意义。飞秒激光撕囊连续性及居中性两组间差异无统计学意义,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,在降低浅前房环形撕囊难度及手术风险同时,也提高手术安全性及成功率;术中房角镜直视下的分离房角,更能保障房角分离范围及程度,确保房角开放范围达180度以上,有利恢复生理性房水引流功能。
Objective To analyze the clinical efficacy of femtosecond laser-assisted cataract phacoemulsification combined with different methods of angle separation surgery in treating acute attacks of acute primary angle-closure glaucoma complicated with cataracts.Methods The prospective case-control study.48 eyes of 44 patients with acute attacks of primary acute angle-closure glaucoma complicated with cataracts admitted to our hospital from January 2023 to June 2024 were selected.Patients were grouped based on the surgical method:the study group included 22 patients(26 eyes)who underwent femtosecond laser-assisted cataract phacoemulsification combined with intraoperative gonioscopy-guided angle separation surgery,referred to as the"Direct Group".The control group included 22 patients(22 eyes)who underwent femtosecond laser-assisted cataract phacoemulsification combined with angle separation surgery without intraoperative gonioscopy assistance,referred to as the"Blind Group".The best corrected visual acuity,intraocular pressure,angle opening range and angle,anterior chamber volume,and central anterior chamber depth were analyzed before and after the surgery,along with intraoperative and postoperative complications.Results Intraocular pressure comparisons within each group before and after the surgery showed changes at each time point for both groups.Inter group comparisons indicated no differences preoperative,but postoperative intraocular pressure in the A group was lower than in the B group(P<0.05).The postoperative intraocular pressure was significantly lower as compared to the preoperative intraocular pressure in the A group.Best corrected visual acuity comparisons within each group before and after the surgery showed improvement at each time point postoperatively for both groups.Inter group comparisons revealed no differences preoperative and at 1 day,1 week,and 1 month postoperatively,but at 3 months postoperatively,visual acuity in the A group was superior to that in the B group(P<0.05).The postoperative visual acuity was superior to that preoperative in the A group.Comparisons of angle width and anterior chamber volume before and after the surgery showed no differences for either surgical method.However,within-group comparisons indicated a significant increase in angle width and volume postoperatively.The postoperative angle width and anterior chamber volume were significantly increased as compared to the preoperative in the A group.Both surgical methods were effective in terms of angle opening range,with the A group showing superior results compared to B group.Regarding complications,the Direct group was more prone to anterior chamber angle bleeding,while there were no statistical differences in postoperative pupil dilation and iris damage between the two groups.There were no statistical differences in the continuity and centration of the femtosecond laser capsulotomy between the two groups,and no serious complications occurred during or after the surgery,with high postoperative satisfaction.Conclusions Femtosecond laser-assisted cataract phacoemulsification combined with angle separation surgery is effective in treating acute angleclosure glaucoma complicated with cataracts.It also reduces the risk of shallow anterior chamber circular capsulotomy and surgical risks,enhancing surgical safety and success rates.The direct visualization of the angle during surgery ensures a wider and more effective angle separation,achieving an angle opening range of over 180 degrees,which is beneficial for restoring physiological aqueous humor drainage function.
作者
李凯
陈亚茹
周围
刘秀云
Li Kai;Chen Yaru;Zhou Wei;Liu Xiuyun(Aier Eye Medical Center Affiliated to Anhui Medical University,Hefei 230031,Anhui Province,China)
出处
《临床眼科杂志》
2025年第3期209-215,共7页
Journal of Clinical Ophthalmology
基金
安徽医科大学校基金资助项目(2021xkj253)。
关键词
飞秒激光辅助白内障
急性闭角型青光眼
前房容积
前房深度、术中房角镜、房角分离术。
Femtosecond laser-assisted cataract surgery
Acute angle-closure glaucoma
Anterior chamber volume
Anterior chamber depth
Intraoperative gonioscopy
Goniosynechialysis
