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术前甘露醇在原发性闭角型青光眼手术中撕囊及减少术中并发症作用的前瞻性研究。

Prospective study on the role of preoperative mannitol in capsulorhexis and reducing intraoperative complications in primary angle-closure disease surgery.

作者信息

Liang Zhiqiao, Li Hongyan, Hou Xianru, Yang Kangyi, Lv Kun, Ma Yao, Lu Ye, Wu Kuankuan, Wu Huijuan

机构信息

Department of Ophthalmology, Peking University People's Hospital; Eye Diseases and Optometry Institute; Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases; College of Optometry, Peking University Health Science Center. Address: No. 11 Xizhimen South Street, Xicheng District, Beijing, China.

出版信息

J Int Med Res. 2025 Jan;53(1):3000605241310106. doi: 10.1177/03000605241310106.

DOI:10.1177/03000605241310106
PMID:39817367
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11736754/
Abstract

OBJECTIVE

To evaluate the effect of preoperative intravenous mannitol on the capsulorhexis process and intraoperative complications in patients with primary angle-closure glaucoma (PACG).

METHODS

In this prospective randomized controlled trial, 65 PACG eyes were randomized into the mannitol and control groups. The capsulorhexis duration, number of forceps grasps, need for viscoelastic re-injection, and intraoperative complications were recorded.

RESULTS

The mannitol group had a significantly shorter capsulorhexis duration and fewer forceps grasps of the capsule. All intraoperative complications (18.2%) occurred in the control group. The patients with intraoperative complications had significantly higher intraocular pressure and lower best-corrected visual acuity than those without complications after surgery. Multivariate analysis found that intravenous mannitol (odds ratio [OR] = -14.263; 95% confidence interval [CI] =-26.713 to -1.813) reduced the capsulorhexis duration, whereas zonulopathy (OR = 14.477, 95% CI = 2.622-26.331) prolonged the duration.

CONCLUSION

Preoperative intravenous mannitol can reduce the risk of intraoperative complications and improve postoperative outcomes in patients with PACG. Factors including anterior chamber depth, incision location and method, and the zonule status significantly influence the capsulorhexis process.

摘要

目的

评估术前静脉注射甘露醇对原发性闭角型青光眼（PACG）患者撕囊过程及术中并发症的影响。

方法

在这项前瞻性随机对照试验中，将65只PACG患眼随机分为甘露醇组和对照组。记录撕囊持续时间、镊子夹持次数、粘弹剂再次注射需求及术中并发症。

结果

甘露醇组撕囊持续时间显著缩短，对晶状体囊膜的镊子夹持次数减少。所有术中并发症（18.2%）均发生在对照组。术中出现并发症的患者术后眼压显著高于未出现并发症的患者，最佳矫正视力则显著低于未出现并发症的患者。多因素分析发现，静脉注射甘露醇（比值比[OR]=-14.263；95%置信区间[CI]=-26.713至-1.813）可缩短撕囊持续时间，而悬韧带病变（OR=14.477，95%CI=2.622-26.331）则会延长该持续时间。

结论

术前静脉注射甘露醇可降低PACG患者术中并发症风险并改善术后结局。前房深度、切口位置及方式、悬韧带状态等因素对撕囊过程有显著影响。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ce43/11736754/2c8df731abfd/10.1177_03000605241310106-fig2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ce43/11736754/ced5a294f666/10.1177_03000605241310106-fig1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ce43/11736754/2c8df731abfd/10.1177_03000605241310106-fig2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ce43/11736754/ced5a294f666/10.1177_03000605241310106-fig1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ce43/11736754/2c8df731abfd/10.1177_03000605241310106-fig2.jpg

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本文引用的文献

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Zonulopathy Identified During Cataract Extraction in Patients With Primary Angle Closure Disease.白内障摘除术中原发性闭角型青光眼患者的后囊膜病变。
J Glaucoma. 2023 Sep 1;32(9):783-791. doi: 10.1097/IJG.0000000000002247. Epub 2023 May 29.
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[Angle-closure glaucoma].
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Comparison of Laser Iridotomy and Lensectomy Outcomes for Acute Primary Angle Closure.急性原发性闭角型青光眼激光虹膜切开术与晶状体切除术效果比较
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