超聲乳化聯合前房角分離術對伴有白內障的閉角型青光眼角膜內皮細胞的影響

汪　濤，顏　華

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超聲乳化聯合前房角分離術對伴有白內障的閉角型青光眼角膜內皮細胞的影響

汪濤1，顏華2

1Fushun Ophthalmic Hospital, Fushun 113006, Liaoning Province, China;2Department of Ophthalmology, General Hospital of Tianjin Medical University, Tianjin 300052, China

?METHODS: Ninety-five eyes of 95 patients with PACG combined cataract were documented in this study. Twenty-two patients were male, and 73 were female. The age ranged from 46 to 85y old with a mean of(66±7)y. All patients were examined for endothelial cell count(ECC), intraocular pressure(IOP) and best corrected visual acuity(BCVA) 1wk, 1, 2, 3 and 6mo after operation. Meanwhile, the range of anterior chamber closure and anterior chamber depth(ACD) were recorded before operation and postoperative 6mo.

?RESULTS: The mean IOP was 36.1±4.3mmHg(28-42mmHg) preoperatively and 15.8±3.5mmHg(8-28 mmHg)(1mmHg=0.133kPa) 6mo after operation. There was a decreasing trend in IOP after operation(t=17.173,P<0.01). There was an increased trend in BCVA after operation(Z=-8.351,P<0.01). The mean ACD was 1.95±0.34mm preoperatively and 3.11±0.33mm 6mo after operation. There was an increased trend in ACD after operation(t=11.483,P<0.01). There were 74 eyes in the range from 90° to 180° of anterior chamber and 21 eyes less than 90° before operation. There were 12 eyes in the range from 90° to 180° of anterior chamber and 83 eyes less than 90° postoperatively. The most of anterior chamber were open(Z=-9.013,P<0.01). ECC was 2304±135 cells/mm2before operation and 2243±152 cells/mm2, 2135±177 cells/mm2, 2028±172 cells/mm2, 2017±181 cells/mm2, 2006±143 cells/mm21wk, 1, 2, 3 and 6mo after operation respectively. ECC loss rates were 2.6%, 7.3%, 12.0%, 12.5% and 13.0%. ECC had a decreased trend 2mo after operation(F=5.568,P<0.01) and then kept stable(P3mo=0.067,P6mo=0.073).

?CONCLUSION: Phacoemulsification and IOL-implantation combined with goniosynechialysis is an effective method to treat PACG combined cataract. It can increase BCVA and decrease IOP. ECC decreases after operation, but it is in the normal range. It is a safe and effective operation mode.

目的:探討伴有白內障的原發性閉角型青光眼(primary angle closure glaucoma ，PACG)采用超聲乳化白內障吸出(phacoemulsification，Phaco)人工晶狀體(IOL)植入聯合前房角分離術治療后角膜內皮細胞的變化，并分析相關影響因素。

方法:回顧分析接受Phaco+IOL聯合前房角分離術治療的PACG合并白內障患者95例95眼，其中女73例，男22例，年齡46～85(平均66±7)歲。記錄并分析術前及術后1wk，1、2、3、6mo最佳矯正視力(BCVA)、眼內壓(IOP)及角膜內皮細胞計數(endothelial cell count，ECC)，同時記錄術前及術后6mo前房深度(anterior chamber depth，ACD)以及前房角關閉范圍。隨訪8mo～2a。

結果:術前IOP平均為36.1±4.3(28～42)mmHg，術后6mo IOP平均為15.8±3.5(8～28)mmHg(1mmHg=0.133kPa)，術后IOP較術前顯著降低，差異有統計學意義(t=17.173，P<0.01)。術后BCVA較術前顯著提高，差異有統計學意義(Z=-8.351，P<0.01)。術前ACD平均為1.95±0.34mm，術后6mo ACD平均為3.11±0.33mm，術后ACD較術前顯著加深，差異有統計學意義(t=11.483，P<0.01)。術前前房角關閉范圍90°～180°者74眼，<90°者21眼；術后前房角關閉范圍90°～180°者12眼，<90°者83眼，差異有統計學意義(Z=-9.013，P<0.01)。術前ECC平均為2304±135個/mm2，術后1wk，1、2、3、6mo ECC平均分別為2243±152個/mm2、2135±177個/mm2、2028±172個/mm2、2017±181個/mm2、2006±143個/mm2，分別減少了2.6%、7.3%、12.0%、12.5%、13.0%。術后2mo內ECC較術前顯著減少，差異有統計學意義(F=5.568，P<0.01)，于2mo后趨于穩定(P3mo=0.067,P6mo=0.073)。

結論:伴有白內障的PACG采用Phaco+IOL聯合前房角分離術治療可有效提高視力，使IOP恢復正常。術后ECC有所減少，但仍在正常范圍內。Phaco+IOL聯合前房角分離術是治療伴有白內障的PACG一種安全有效方法。

超聲乳化白內障吸出; 前房角分離術;原發性閉角型青光眼;角膜內皮細胞

引用：汪濤，顏華.超聲乳化聯合前房角分離術對伴有白內障的閉角型青光眼角膜內皮細胞的影響.國際眼科雜志2016;16(11):2142-2144

0　引言

原發性閉角型青光眼(primary angle closure glaucoma，PACG)采用超聲乳化白內障吸出(phacoemulsification，Phaco)人工晶狀體(IOL)植入聯合前房角分離術的療效已得到認可[4]。Phaco+IOL聯合前房角分離術治療PACG與傳統小梁切除聯合白內障摘除術(青白聯合術)相比，對術后前房積血、低眼壓、脈絡膜上腔出血或脫離等，尤其是淺前房的發生有較好效果，并且損傷小[5]。目前對Phaco+IOL聯合前房角分離術治療伴有白內障的PACG術后角膜內皮細胞計數(ECC)發生哪些變化及規律如何鮮見報道。……