目的:观察超声乳化白内障吸除人工晶状体植入术(phacoemulsification with intraocular lens implantation, PEI)联合房角分离术(goniosynechialysis, GSL)及房角切开术(goniotomy, GT)治疗中晚期原发性慢性闭角型青光眼(chronic primary angle-closure glaucoma , CPACG)合并白内障的安全性和有效性。方法:采用回顾性病例研究。收集2020年6月至2024年1月在成都市中西医结合医院行PEI联合GSL及GT的中晚期CPACG合并白内障患者94例133眼,观察最佳矫正视力(best corrected visual acuity, BCVA)、眼压、抗青光眼药物使用数量及术后并发症等情况。采用重复测量方差分析、Wilcoxon秩检验进行统计学处理。结果:术后1天,1周,1、3、6个月94例患者133眼的BCVA(logMAR)均较术前有所提升(P<0.05);从术后1天到6个月的所有随访时间点眼压均较术前明显下降(F = 189.79,P<0.001);术后6个月,患者使用的降眼压药物数量明显低于术前 ( Z = -2.392,P<0.001)。术后1周中31眼(23%)出现角膜水肿,15眼(11%)出现前房积血,均在1周内消退;术后1个月内1眼出现眼压反跳,予以前房穿刺放液等治疗后眼压恢复到正常范围。术后6个月,121眼(91%)手术完全成功,10眼(8%)手术条件成功。结论:PEI联合GSL及GT治疗中晚期CPACG合并白内障可有效地提高视力、降低眼压,且无严重并发症。
Objective: To observe the safety and efficacy of phacoemulsification with intraocular lens implantation (PEI) combined with goniosynechialysis (GSL) and goniotomy (GT) in treating advanced chronic primary angle-closure glaucoma (CPACG) complicated by cataract. Methods: This was a retrospective case series study. We collected data from a total of 94 patients (133 eyes) who had advanced CPACG along with cataract and underwent PEI+GSL+GT at Chengdu Integrated TCM&Western Medicine Hospital between June 2020 and January 2024. We observed the best corrected visual acuity (BCVA), intraocular pressure (IOP), the number of anti-glaucoma drugs used, and postoperative complications. Repeated measures ANOVA and Wilcoxon rank test were used for statistical analysis. Results: The BCVA (logMAR) at 1 day, 1 week, 1, 3, and 6 months after surgery showed significant improvement compared to the pre-surgical values (F = 189.79,P < 0.001); The IOP at 1 day, 1 week, 1, 3, and 6 months post-surgery was significantly lower than that pre-surgical IOP (P < 0.001). The number of IOP-lowering drugs used at 6 months after surgery was also significantly reduced compared to the pre-surgical (Z = -2.392, P < 0.001). One week after surgery, corneal edema occurred in 31 eyes (23%) and hyphema in 15 eyes (11%) , both of which resolved spontaneously within 1 week. Within one month after surgery, 1 eye experienced an IOP spike, and the intraocular pressure returned to normal range after treatments such as anterior chamber puncture and drainage. Six months after surgery, the operation was completely successful in 121 eyes (91%), and conditionally successful in 10 eyes (8%), resulting in an overall surgical success rate of 99%. Conclusions: PEI combined with GSL and GT can effectively improve vision and reduce IOP in patients with advanced CPACG complicated by cataract, without causing serious complications.
青光眼是世界范围内致盲和引起视力损害的主要眼病,也是不可逆性致盲性眼病之一。眼压是青光眼发生发展的重要危险因素,但除眼压外,血压在青光眼进展引起的影响也不可忽视。眼灌注压是血压和眼压的差值,可调节视神经的血液供应。眼压、血压、灌注压在青光眼发生发展中有一定相关性。本文通过对眼压和血压在青光眼中的影响以及24 h眼压和血压监测在青光眼中的应用进行文献索引,分析青光眼24h眼压和血压同步监测的意义。
Glaucoma is a major eye disease causing blindness and visual damage worldwide, and it is also one of the irreversible eye diseases causing blindness. Intraocular pressure (IOP) is an important risk factor for the development of glaucoma, and the influence of blood pressure (BP) on the progression of glaucoma also cannot be ignored. Eye perfusion pressure is the difference between blood pressure and intraocular pressure, regulating the blood supply to the optic nerves. IOP, BP and perfusion pressure are related to the occurrence and the progression of glaucoma. Literature review was performed related to the effects of IOP and BP on glaucoma, and the application of 24-hour IOP and BP monitoring in glaucoma, aiming to analyze the significance of simultaneous monitoring of IOP and BP for 24 hours.
青光眼是世界范围内致盲和引起视力损害的主要眼病,也是不可逆性致盲性眼病之一。眼压是青光眼发生发展的重要危险因素,但除眼压外,血压在青光眼进展引起的影响也不可忽视。眼灌注压是血压和眼压的差值,可调节视神经的血液供应。眼压、血压、灌注压在青光眼发生发展中有一定相关性。本文通过对眼压和血压在青光眼中的影响以及24 h眼压和血压监测在青光眼中的应用进行文献索引,分析青光眼24 h眼压和血压同步监测的意义。
Glaucoma is a major eye disease causing blindness and visual damage worldwide, and it is also one of the irreversible eye diseases causing blindness. Intraocular pressure (IOP) is an important risk factor for the development of glaucoma, and the influence of blood pressure (BP) on the progression of glaucoma also cannot be ignored. Eye perfusion pressure is the difference between blood pressure and intraocular pressure, regulating the blood supply to the optic nerves. IOP, BP and perfusion pressure are related to the occurrence and the progression of glaucoma. Literature review was performed related to the effects of IOP and BP on glaucoma, and the application of 24-hour IOP and BP monitoring in glaucoma, aiming to analyze the significance of simultaneous monitoring of IOP and BP for 24 hours.