摘要目的 将解剖学特征纳入手术方式选择的参考条件,观察3种手术治疗PACG的临床效果,探讨其手术适应证选择及其相关影响因素,为临床治疗提供参考.方法 回顾性系列病例研究.排除高血压病、糖尿病等其他引起眼部病变的疾病,选择2008年2月至2009年1月于青岛眼科医院就诊并诊断为PACG患者164例(191眼),根据发病性质分为急性组与慢性组,急性组91例(91眼),慢性组73例(100眼),每次随访失访患者比例小于3.2％.按照青光眼诊断及治疗专家共识及解剖学参数[晶状体厚度(LT)、眼轴长度]作为手术方式选择的参考条件分别行单纯小梁切除术[54例,LT=(4.77±0.50)mm]、青白联合术[57例,LT=(5.02±0.61) mm]、单纯白内障手术[53例,LT=(5.02 ±0.37) mm],平均随访(3.05±0.12)年,观察术后眼压、BCVA、视野、术后滤过泡、并发症等.3种术式解剖学参数及术后眼压波动比较采用Kruskal-Wallis检验;3种术式术前与术后各观察指标比较采用配对样本秩和检验;定性资料采用Fisher's确切概率法及卡方检验.结果 急性组与慢性组术后眼压均较术前明显下降,差异有统计学意义(Z=2.201,P＜0.05),联合手术术后眼压控制水平低于其他2种术式,差异有统计学意义(P＜0.05).3种手术术后眼压波动差异无统计学意义.急性组行单纯白内障及青白联合手术术后分别有38％、22％的房角进一步开放,高于慢性组,差异有统计学意义(x2=6.310,P＜0.05).平均视野缺损(MD)、模式标准差(PSD)术前与术后差异无统计学意义.术后各种并发症的发生率差异无统计学意义;青白联合手术与单纯小梁切除术后滤过泡形态差异无统计学意义,术后约1/2无滤过形态,但眼压控制低于21 mmHg.单纯小梁切除术急性组与慢性组分别有10％、6％,青白联合手术术后急性组与慢性组分别有4％、2％行2次小梁切除术,差异无统计学意义.结论 PACG患者若具有眼轴较短、晶状体相对偏厚的特点,行小梁切除术时可联合晶状体一并摘除,青白联合手术对术后眼压控制的效果更好.

abstractsObjective To use anatomical parameters as one of the references for primary angle-closure glaucoma (PACG) surgery; to discuss surgical indications by monitoring the clinical results from three surgical methods and related factors.Methods This was a retrospective case series study.One hundred ninety-one eyes of 164 patients who were diagnosed with PACG between February 2008 and January 2009 in Qingdao Eye Hospital were divided into an acute group (91 patients,91 eyes) and a chronic group (73 patients,100 eyes).Patients with conditions such as hypertension,diabetes,and other causes of eye disease were excluded from the study.Fewer than 3.2％ of the patients were lost at the time of any follow-up visit.Based on expert consensus and differences in anatomical parameters,all groups included patients who underwent trabeculectomy (54 cases,LT=4.77±0.50 mm),phacotrabeculectomy (57 cases,LT=5.02±0.61 mm) and phacoemulsification (53 cases,LT=5.02±0.37 mm).The mean follow-up period was 3.05±0.12 years.Statistical data included age,gender,course of disease,anatomical parameters,follow-up visual acuity,intraocular pressure,and complications after surgery.SPSS 17.0 was used to analyze the anatomical parameters,the Kruskal-Wallis test was used to analyze IOP fluctuation from the three surgeries,the Wilcoxon matched pairs signed-ranks test was used to compare preoperative and postoperative indices,a chi square test or Fisher's exact test were used to compare postoperative filtering bleb and complications.Results Postoperative intraocular pressure decreased significantly with the three surgeries,and the differences were statistically significant (Z=2.201,P＜0.05).Postoperative IOP with phacotrabeculectomy was lower than with the other two procedures and the difference was statistically significant (LSD-t:P＜0.05).There were no significant differences in postoperative IOP fluctuation for the three surgeries.The reopening angle accounted for 38％ (phacoemulsification) and 22％ (phacotrabeculectomy) and the acute group was higher than the chronic group (x2=6.310,P＜0.05).MD and PSD were not significantly different compared to preoperative levels.Complications were not significantly different among the three operations nor was bleb morphology different between phacotrabulectomy and trabulectomy.Although half the patients had no obvious filtering bleb,IOP was lower than 21 mmHg.Conclusion In PACG,with a shorter axial length and thicker lens,the lens can be removed when combined with trabeculectomy.IOP control is better in phacotrabeculectomy.The residual subscleral filtration tract may have a real function in the outflow of aqueous humor.