摘要
目的:探讨经内路房水通路重建术(ABiC)联合微切口超声乳化白内障吸除术治疗原发性开角型青光眼(POAG)合并白内障的短期疗效和安全性。方法:前瞻性病例系列研究。选取2018年6月至2019年10月于浙江大学医学院附属第二医院眼科中心确诊为POAG(早、中、晚期)合并白内障,拟行ABiC联合微切口超声乳化白内障吸除联合人工晶状体植入术患者,按术前眼压控制情况、视野平均缺损、小梁网色素分级评分进行分组,记录术前和术后1 d、1周、1个月、3个月、6个月、12个月各组术眼的眼压、视野、视神经情况及抗青光眼药物使用数量,统计手术成功率、术中及术后并发症情况。采用 χ2检验、 t检验、方差分析、最小显著性差异法、秩和检验进行统计学分析。 结果:42例患者(68只眼)完成为期12个月的术后随访。与术前使用抗青光眼药物控制的眼压[(18.25±2.65)mmHg(1 mmHg=0.133 kPa)]相比,术后1个月[(14.31±3.25)mmHg]、3个月[(14.00±3.09)mmHg]、6个月[(14.58±2.93)mmHg]、12个月[(14.84±2.73)mmHg]眼压明显下降,差异具有统计学意义( P<0.05)。抗青光眼药物使用数量中位数术前为2.5(2,3)种,术后1个月为0(0,1)种,术后3、6、12个月均为0(0,0)种,术后较术前显著减少( P<0.05)。术后12个月手术完全成功率和条件成功率分别为80.88%(55/68)和89.71%(61/68)。术后12个月术眼视野缺损及视神经损伤情况总体无明显进展。主要手术并发症包括术后早期前房出血(26只眼,38.24%)及一过性眼压升高(23只眼,33.82%),均对预后无不良影响。 结论:ABiC联合微切口超声乳化白内障吸除术治疗POAG合并白内障短期疗效和安全性可靠。
Objective To evaluate the preliminary efficacy and safety of ab interno canaloplasty(ABiC)combined with micro-incision cataract surgery for treating primary open angle glaucoma(POAG)combined with cataract.Methods Prospective case series study.Patients diagnosed with POAG and concurrent cataract were enrolled to receive ABiC combined with micro-incision phacoemulsification and intraocular lens implantation in the Eye Center of the Second Affiliated Hospital of Zhejiang University School of Medicine from June 2018 to October 2019.Intraocular pressure(IOP),use of hypotensive medications,visual acuity,visual field,and optic nerve at baseline as well as at 1 day,1 week,1 month,3 months,6 months,and 12 months postoperatively were assessed.Subgroup analyses were further performed to evaluate these data between controlled and uncontrolled POAG,as well as among mild,moderate,and advanced POAG.Success rate and complications were analyzed.Results A total of 68 eyes in 42 patients completed a follow-up of 12 months.Compared to the baseline IOP under medical control[(18.25±2.65)mmHg(1 mmHg=0.133 kPa)],the mean postoperative IOP at 1 month[(14.31±3.25)mmHg],3 months[(14.00±3.09)mmHg],6 months[(14.58±2.93)mmHg],and 12 months[(14.84±2.73)mmHg]was all significantly reduced(P<0.05).The median(upper quadrant,lower quadrant)of the hypotensive medication number was 2.5(2,3)at baseline,which was significantly reduced to 0(0,1)at 1 month,and 0(0,0)at 3,6,and 12 months(P<0.05).The complete success rate and qualified success rate at 12 months were 80.88%(55/68)and 89.71%(61/68),respectively.No deterioration in the visual field or optical coherence tomography scan of the optic nerve was observed at 12 months compared to the baseline status.Hyphema(26 eyes,38.24%)and transient IOP spike(23 eyes,33.82%)were the most common complications,but no severe case was present.Conclusion ABiC combined with micro-incision cataract surgery is considerably effective and safe in the treatment of POAG combined with cataract in the Chinese population.
作者
吕丹旎
卢冰
张丽芳
尹金福
陈敏
王凯军
吴炜
姚克
Lyu Danni;Lu Bing;Zhang Lifang;Yin Jinfu;Chen Min;Wang Kaijun;Wu Wei;Yao Ke(Eye Center,Second Affiliated Hospital of Zhejiang University School of Medicine,Hangzhou 310009,China)
出处
《中华眼科杂志》
CAS
CSCD
北大核心
2022年第4期279-288,共10页
Chinese Journal of Ophthalmology
基金
浙江省重点研发项目(2020C03035)。
