Zuo Chengguo, Long Bing, Guo Xinxing, Chen Liming, Liu Xing
State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China.
The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
J Ophthalmol. 2020 Apr 21;2020:8720450. doi: 10.1155/2020/8720450. eCollection 2020.
To evaluate the effect of phacoemulsification and intraocular lens (IOLs) implantation in eyes with medically uncontrolled primary angle-closure glaucoma (PACG) previously treated with trabeculectomy and to quantify the anatomical changes in the anterior chamber angle by ultrasound biomicroscopy (UBM).
Forty-four eyes of 37 consecutive patients with medically uncontrolled PACG coexisting cataracts with a surgical history of trabeculectomy were included in this study. Each patient underwent phacoemulsification and IOL implantation. Indentation gonioscopy and UBM were performed preoperatively and then again 3 months after surgery. The main outcome measures were best-corrected visual acuity (BCVA), intraocular pressure (IOP), number of antiglaucoma medications and anatomical changes in the anterior chamber angle.
The mean logarithm of the minimum angle of resolution BCVA significantly improved from 0.52 ± 0.30 preoperatively to 0.26 ± 0.23 postoperatively ( < 0.001). The mean IOP significantly decreased from 24.33 ± 9.65 mmHg preoperatively to 18.04 ± 7.86 mmHg postoperatively ( < 0.05). 001). The median number of antiglaucoma medications decreased from 2 preoperatively to 1 postoperatively ( < 0.001). There was no significant difference in the extent of peripheral anterior synechia after the surgery ( > 0.05). Some parameters, including anterior central chamber depth, angle opening distance at 500 m, trabecular-iris angle, and scleral ciliary process angle, were significantly higher after than before surgery ( < 0.001). However, the crystalline lens rise was significantly smaller following the surgery ( < 0.001).
Phacoemulsification and IOL implantation reduced the IOP and improved vision in eyes with medically uncontrolled filtered PACG. The mechanism underlying the outcomes observed following surgery might be related to the anterior chamber deepening, widened drainage angle, and improved aqueous fluid flow to the trabecular meshwork.
评估超声乳化白内障吸除联合人工晶状体（IOL）植入术对药物治疗无法控制的原发性闭角型青光眼（PACG）且既往接受过小梁切除术患者眼睛的疗效，并通过超声生物显微镜检查（UBM）量化前房角的解剖学变化。
本研究纳入了37例连续的药物治疗无法控制的PACG合并白内障且有小梁切除术手术史的患者的44只眼睛。每位患者均接受了超声乳化白内障吸除联合IOL植入术。术前及术后3个月分别进行压陷式前房角镜检查和UBM检查。主要观察指标为最佳矫正视力（BCVA）、眼压（IOP）、抗青光眼药物使用数量以及前房角的解剖学变化。
最小分辨角对数BCVA的平均值术前为0.52±0.30，术后显著提高至0.26±0.23（<0.001）。平均IOP术前为24.33±9.65mmHg，术后显著降至18.04±7.86mmHg（<0.05）。抗青光眼药物使用数量的中位数术前为2种，术后降至1种（<0.001）。术后周边前粘连的程度无显著差异（>0.05）。一些参数，包括中央前房深度、500μm处房角开放距离、小梁-虹膜夹角和巩膜睫状体夹角，术后显著高于术前（<0.001）。然而，术后晶状体上升幅度显著较小（<0.001）。
超声乳化白内障吸除联合IOL植入术可降低药物治疗无法控制的小梁切除术后PACG患者的眼压并改善视力。手术观察到的结果的潜在机制可能与前房加深、引流角增宽以及房水向小梁网的流动改善有关。
