Centre for Vision Research, Department of Ophthalmology and Westmead Millennium Institute, University of Sydney, Sydney, NSW, Australia.
Clin Exp Ophthalmol. 2013 Nov;41(8):746-52. doi: 10.1111/ceo.12121. Epub 2013 May 22.
The aim of this study was to assess the effect of goniosynechialysis on intraocular pressure and medication requirement in patients with angle closure.
A retrospective chart review.
51 eyes from 42 patients were included in the study. 17 had documented evidence of acute angle closure while 34 had chronic angle closure.
Examination of the medical records of patients with synechial primary angle closure who underwent combined phacoemulsification and goniosynechialysis from 2003-2011 at 3 centres.
Intraocular pressure and requirement for drops were the main outcome measures.
Mean follow-up was 25.9 months for the acute group and 25.4 months for the chronic group. Mean preoperative intraocular pressure was 23.33 ± 14.41 mmHg on an average of 2.51 ± 1.3 medications. Mean postoperative intraocular pressure was lowered to 13.67 ± 2.41 (p ≤ 0.01) and medication usage was significantly lowered to 0.65 ± 0.87 (p ≤ 0.01). Subjects with documented acute symptomatic angle closure had higher preoperative intraocular pressure and a larger intraocular pressure fall post goniosynechialysis (from 30.41 mmHg ± 23 mmHg to 12.12 mmHg ± 2.32 mmHg) compared to those without such a documented episode (19.79 mmHg ± 4.37 mmHg to 14.44 mmHg ± 2.08 mmHg, p = 0.007). Both groups have similar postoperative need for glaucoma medication, 0.65 ± 0.93 vs 0.65 ± 0.85.
Combined phacoemulsififcation and goniosynechialysis reduces intraocular pressure, medication requirements and need for further surgery in subjects with angle closure. The procedure is more effective in eyes with a previously documented acute symptomatic presentation of angle closure.
本研究旨在评估房角粘连分离术对闭角型青光眼患者眼压和药物治疗需求的影响。
回顾性病历分析。
42 例患者的 51 只眼纳入本研究。17 只眼有明确的急性闭角型青光眼病史，34 只眼有慢性闭角型青光眼病史。
对 2003 年至 2011 年在 3 家中心接受联合超声乳化白内障吸除术和房角粘连分离术的原发性房角粘连性闭角型青光眼患者的病历进行检查。
眼压和滴眼剂需求是主要观察指标。
急性组平均随访时间为 25.9 个月，慢性组为 25.4 个月。平均术前眼压为 23.33 ± 14.41mmHg，平均用药 2.51 ± 1.3 种。术后平均眼压降至 13.67 ± 2.41mmHg（p≤0.01），用药量明显降至 0.65 ± 0.87（p≤0.01）。有明确急性症状性闭角型青光眼病史的患者术前眼压较高，房角粘连分离术后眼压下降幅度较大（从 30.41mmHg ± 23mmHg 降至 12.12mmHg ± 2.32mmHg），而无此类病史记录的患者眼压下降幅度较小（从 19.79mmHg ± 4.37mmHg 降至 14.44mmHg ± 2.08mmHg，p=0.007）。两组患者术后对青光眼药物的需求相似，分别为 0.65 ± 0.93 和 0.65 ± 0.85。
超声乳化白内障吸除术联合房角粘连分离术可降低闭角型青光眼患者的眼压、药物治疗需求和再次手术需求。对于有明确急性症状性闭角型青光眼病史的患者，该手术更为有效。
