基于BCVA和角膜水肿程度探讨改良与常规小梁切除术治疗急性闭角型青光眼的临床价值

doi:10.20223/j.cnki.1000-8535.2025.03.012

摘要/Abstract

摘要： 目的基于最佳矫正视力（BCVA）、角膜水肿程度对比改良与常规小梁切除术治疗急性闭角型青光眼（AACG）的疗效。方法回顾性收集2021年12月—2023年6月期间信阳爱尔眼科医院收治的112例AACG患者作为研究对象,依据1∶1匹配原则,将接受常规小梁切除术的56例患者作为对照组,接受改良小梁切除术的56例患者作为观察组,统计两组围术期BCVA、眼压、术后浅前房形成状况、角膜水肿程度以及并发症状况。结果术后3个月,观察组视力为（0.63±0.04）logMAR,高于对照组（0.50±0.03）logMAR,眼压为（16.22±2.28）mmHg,低于对照组（19.95±2.31）mmHg（t=19.457、8.600,均P<0.05）;观察组浅前房发生率为8.93%,低于对照组的26.79%（χ²=6.087,P=0.014）;观察组角膜水肿状况优于对照组（Z=2.737,P=0.006）;观察组脉络膜脱离率、滤道阻塞率、前房积血率、虹膜炎症率依次为1.79%、5.36%、16.07%、10.71%,均低于对照组17.86%、23.21%、32.14%、35.71%（χ²=8.166、7.292、3.953、9.818,均P<0.05）。结论较常规小梁切除术,改良小梁切除术治疗AACG患者,有助于改善视力、降低眼压、减轻角膜水肿、减少浅前房发生,且安全性较高。

关键词: 视力, 角膜水肿, 小梁切除术, 急性闭角型青光眼, 安全性

Abstract: Objective To compare the efficacy of modified and conventional trabeculectomy in the treatment of acute angle-closure glaucoma（AACG）based on best-corrected visual acuity（BCVA）and degree of corneal edema．Methods A total of 112 patients with AACG admitted to the hospital during December 2021 to June 2023 were retrospectively selected as study objects． According to the 1∶1 matching principle,56 patients receiving conventional trabeculectomy were selected as control group,and 56 patients receiving modified trabeculectomy were selected as observation group．Perioperative BCVA,intraocular pressure,postoperative shallow anterior chamber formation,degree of corneal edema and complications were analyzed．Results At three months postoperatively,visual acuity in the observation group was（0.63±0.04）logMAR,which was higher than that in the control group（0.50±0.03）logMAR,and intraocular pressure was（16.22±2.28）mmHg,which was lower than that in the control group（19.95±2.31）mmHg（t=19.457,8.600,P<0.05）;the incidence of shallow anterior chamber in the observation group was 8.93%,which was lower than that of the control group（26.79%）（χ²=6.087,P=0.014）;the corneal edema status in the observation group was better than that of the control group（Z=2.737,P=0.006）;the rates of choroidal detachment,filtering channel obstruction,hyphema,and iris inflammation in the observation group were 1.79%,5.36%,16.07%,and 10.71%,respectively,which were lower than those of the control group（17.86%,23.21%,32.14%,and 35.71%）（χ²=8.166,7.292,3.953,and 9.818,P<0.05）．Conclusions Compared with conventional trabeculectomy,modified trabeculectomy can improve visual acuity,reduce intraocular pressure,relieve corneal edema,and reduce the occurrence of shallow anterior chamber in patients with AACG,with higher safety．

Key words: vision, corneal edema, trabeculectomy, acute angle-closure glaucoma, security

李莉, 叶青, 理珂, 方明喜, 祁晨顾. 基于BCVA和角膜水肿程度探讨改良与常规小梁切除术治疗急性闭角型青光眼的临床价值[J]. 广州医药, 2025, 56(3): 366-371.

LI Li, YE Qing, LI Ke, FANG Mingxi, QI Chengu. Based on BCVA and modified with conventional corneal edema degree to explore the clinical value of treatment of acute angle-closure glaucoma trabeculectomy[J]. Guangzhou Medical Journal, 2025, 56(3): 366-371.

参考文献

[1] 苏安乐,赵帅,王昞.PHACO+IOL分别联合小梁切除术、房角分离术治疗急性原发性闭角型青光眼合并年龄相关性白内障的效果比较[J].海南医学,2022,33(21):2788-2791.
[2] FRIEDMAN D S,CHANG D S,JIANG Y Z,et al.Acute angle-closure attacks are uncommon in primary angle-closure suspects after pharmacologic mydriasis:The Zhongshan angle-closure prevention trial[J].Ophthalmol Glaucoma,2022,5(6):581-586.
[3] SUWAN Y,AGHSAEI FARD M,VILAINERUN N,et al.Parapapillary choroidal microvascular density in acute primary angle-closure and primary open-angle glaucoma:An optical coherence tomography angiography study[J].Br J Ophthalmol,2023,107(10):1438-1443.
[4] 霍伊明,武赛月,马丽华,等.原发性开角型青光眼与原发性慢性闭角型青光眼的黄斑区脉络膜厚度的比较[J].中华眼视光学与视觉科学杂志,2023,25(12):900-906.
[5] 韦斌,连浩,邓彦,等.脉络膜上腔引流术联合白内障超声乳化人工晶状体植入术治疗合并白内障的闭角型青光眼[J].中国现代手术学杂志,2022,26(4):299-303.
[6] LI C,TAN L,XU X,et al.Changes of optic disc and macular vessel perfusion density in primary angle closure glaucoma:A quantitative study using optical coherence tomography angiograph[J].Ophthalmic Res,2023,66(1):1245-1253.
[7] 郭彬,李金金.经小梁切除术联合玻璃体腔内注射雷珠单抗治疗新生血管性青光眼临床效果及对视力和眼压的影响[J].河北医学,2023,29(4):626-630.
[8] 赵波,张勤,刘君.经小梁切除术、玻璃体腔内注射雷珠单抗联合治疗新生血管性青光眼临床效果及对视力和眼压的影响[J].解放军医药杂志,2022,34(4):81-83.
[9] 中华医学会眼科学分会青光眼学组,中国医师协会眼科医师分会青光眼学组.中国青光眼指南(2020年)[J].中华眼科杂志,2020,56(8):573-586.
[10] 杜晓芳. 不同直径微切口超声乳化吸除术治疗急性闭角型青光眼患者的疗效比较[J].国际医药卫生导报,2021,27(18):2920-2923.
[11] 徐静,储昭节,范晶晶,等.巩膜瓣下25G前段玻璃体切除术在超声乳化联合小梁切除术治疗极浅前房青光眼合并白内障中的有效性及安全性[J].临床和实验医学杂志,2022,21(12):1307-1311.
[12] ANBAR M A,MAHMOUD H A,ABDELLAH M M.Angle,anterior chamber parameters,and intraocular pressure changes after early phacoemulsification in acute angle-closure glaucoma[J].J Cataract Refract Surg,2023,49(11):1147-1152.
[13] 张小平. 复合式小梁切除术在治疗原发性闭角型青光眼中的疗效观察[J].广州医药,2021,52(2):123-126.
[14] MOU D P,LIANG Y B,FAN S J,et al.Progression rate to primary angle closure following laser peripheral iridotomy in primary angle-closure suspects:A randomised study[J].Int J Ophthalmol,2021,14(8):1179-1184.
[15] 党江波,周美娇,李钢锋.虹膜周边前后节沟通术治疗恶性青光眼及具有恶性青光眼倾向的原发性闭角型青光眼[J].临床和实验医学杂志,2023,22(4):418-421.
[16] JERSEY A,PERICE L,LI N,et al.Acute angle-closure glaucoma secondary to vitreous hemorrhage diagnosed with the aid of point-of-care ultrasound[J].J Emerg Med,2020,59(6):e235-e237.
[17] CHEN G,CHEN P,PENG X.A system review and meta-analysis of the treatment of acute angle-closure glaucoma under optical coherence tomography[J].Ann Palliat Med,2021,10(5):5659-5670.
[18] 刘勇,侯乐美.Phaco及人工晶状体植入联合小梁切除术治疗白内障并发闭眼角型青光眼的临床效果[J].国际医药卫生导报,2021,27(4):589-592.
[19] 郭莹,杨世琳,杨冬妮,等.光学相干断层扫描血管成像在慢性闭角型青光眼小梁切除术后患者视盘周围血流监测中的应用价值[J].解放军医药杂志,2022,34(5):117-119.
[20] 赵莹. 改良小梁切除术对急性闭角型青光眼疗效及安全性分析[J].中国医药指南,2022,20(15):74-76.
[21] 杨玉春. 雷珠单抗注射液联合改良小梁切除术治疗新生血管性青光眼的疗效及对血液流变学的影响[J].血栓与止血学,2020,26(3):441-443.
[22] MANDAL A K.Illuminated Microcatheter Passage Assisted Circumferential Trabeculotomy and Trabeculectomy(IMPACTT):An improved surgical procedure for Primary Congenital Glaucoma[J].Semin Ophthalmol,2022,37(6):786-789.
[23] 邹捷敏,李娴,孙建华.HbA1c水平对糖尿病患者白内障超声乳化术后角膜内皮细胞的影响[J].中国卫生标准管理,2018,9(3):37-39.
[24] ARTUÇ T,BATUR M.Comparison of central corneal thickness in corneal edema by ultrasound pachymetry,specular microscopy,and anterior segment optical coherence tomography[J].Saudi J Ophthalmol,2023,37(1):1-5.
[25] 邓嘉静. 静默疗法在急性闭角型青光眼急性发作期患者中的效果[J].眼科学报,2020,35(3):204-209.