超声乳化白内障吸除人工晶状体植入联合房角分离及房角切开术操作规范专家推荐意见

张秀兰; 宋云河; 范肃洁; 唐莉; 卢岚; 谢琳; 唐广贤; 原慧萍; 周民稳

doi:10.3760/cma.j.cn115989-20221127-00550

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中华实验眼科杂志

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ENGLISH ABSTRACT

超声乳化白内障吸除人工晶状体植入联合房角分离及房角切开术操作规范专家推荐意见

作者及单位信息

出版日期： 2023 -02 -10 ·

DOI： 10.3760/cma.j.cn115989-20221127-00550

Expert recommendations of phacoemulsification cataract extraction and intraocular lens implantation combined with goniosynechialysis and goniotomy for advanced PACG with cataract

Authors Info & Affiliations

Zhang Xiulan

State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, China

Song Yunhe

Fan Sujie

Handan City Eye Hospital, Handan 056001, China

Tang Li

Department of Ophthalmology, West China Hospital of Sichuan University, Chengdu 610041, China

Lu Lan

Department of Ophthalmology, Fujian Medical University Union Hospital, Fuzhou 350001, China

Xie Lin

Department of Ophthalmology, The Third Affiliated Hospital of Chongqing Medical University, Chongqing 401120, China

Tang Guangxian

Department of Ophthalmology, Shijiazhuang People's Hospital, Shijiazhuang 050000, China

Yuan Huiping

Department of Ophthalmology, The 2nd Affiliated Hospital, Harbin Medical University, Harbin 150086, China

Zhou Minwen

Department of Ophthalmology, Shanghai General Hospital, Shanghai 200080, China

Published： 2023 -02 -10 ·

DOI： 10.3760/cma.j.cn115989-20221127-00550

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摘要

合并白内障的中晚期原发性闭角型青光眼(PACG)在中国是发病率高、致残率高且严重影响患者生活质量的严重眼病，手术是其主要治疗方法。既往治疗合并白内障的中晚期PACG的手术方式是超声乳化白内障吸除人工晶状体植入术(PEI)联合小梁切除术，术后并发症较多。近年来PEI联合房角分离(GSL)及房角切开术(GT)治疗合并白内障的中晚期PACG被证实是安全和有效的，目前受到关注并且在我国已广泛开展，然而，PEI+GSL+GT手术治疗方案仍缺乏统一的规范。国内部分青光眼专家根据PEI+GSL+GT手术治疗合并白内障的中晚期PACG过程中存在的问题进行分析，制定详细、完整的手术操作规范，对手术适应证和禁忌证、麻醉方法、手术操作技术和围手术期用药方法提出推荐意见，使临床医生对该治疗方法的应用过程进行规范。

关键词：原发性闭角型青光眼;微创青光眼手术;超声乳化白内障吸除术;房角分离术;房角切开术;青光眼/手术疗法;推荐意见

ABSTRACT

With high incidence, high disability rate and serious impact on patients' quality of life, advanced primary angle-closure glaucoma (PACG) with cataract is a severe eye disease in China and its main treatment method is surgery.Phacoemulsification cataract extraction and intraocular lens implantation (PEI) combined with trabeculectomy has been used to treat advanced PACG with cataract, but there are many postoperative complications.Recently, combined PEI, goniosynechialysis (GSL) and goniotomy (GT) has been proven to be a safe and effective surgical treatment for advanced PACG with cataract.At present, the combined PEI+ GSL+ GT surgery has been widely applied, but there is still a lack of uniform standards for its clinical application.Therefore, it is necessary to formulate a detailed and complete recommendation of the surgical procedures for PEI+ GSL+ GT, to standardize its application in clinical practice.Based on the analysis of the existing problems, some glaucoma experts in China have formulated detailed and complete operation norms, as well as expert recommendations on surgical indications and contraindications, anesthetic methods, surgical techniques and perioperative medication to standardize the application process of PEI+ GSL+ GT in clinical practice.

KEYWORDS： Primary angel-closure glaucoma;Minimally invasive glaucoma surgery;Phacoemulsification;Goniosynechialysis;Goniotomy;Glaucoma/surgery;Expert recommendation

Corresponding author: Zhang Xiulan, Email: nc.defudabe.usys.liam2lxgnahz

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All articles published represent the opinions of the authors, and do not reflect the official policy of the Chinese Medical Association or the Editorial Board, unless this is clearly specified.

引用本文

张秀兰,宋云河,范肃洁,等. 超声乳化白内障吸除人工晶状体植入联合房角分离及房角切开术操作规范专家推荐意见[J]. 中华实验眼科杂志,2023,41(02)：97-100.

DOI:10.3760/cma.j.cn115989-20221127-00550

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未经授权，不得转载、摘编本刊文章，不得使用本刊的版式设计。

除非特别声明，本刊刊出的所有文章不代表中华医学会和本刊编委会的观点。

原发性闭角型青光眼(primary angle-closure glaucoma，PACG)在亚洲地区患病率、致盲率均高，中国PACG的患病人数约占全世界总病例数的50% ^{[
1
]}，目前手术疗法仍然是PACG的一线治疗方法。既往治疗合并白内障的中晚期PACG的首选手术方案是"青白联合"手术，即超声乳化白内障吸除人工晶状体植入术(phacoemulsification cataract extraction with intraocular lens implantation，PEI)联合小梁切除术 ^{[
2
]}。然而，临床实践和临床研究结果均证实，小梁切除术并发症较多，如手术创伤大及易导致浅前房、恶性青光眼、持续性低眼压及滤过泡相关并发症等 ^{[
3
]}，影响手术效果、患者的预后及生活质量。此外，小梁切除术术后术眼需要长期精细护理，手术操作和术后管理学习曲线长，并非理想的手术方式。随着微创青光眼手术的开展，PEI联合房角分离(goniosynechialysis，GSL)及房角切开术(goniotomy，GT)(同内路Schlemm管切开术，ab interno trabeculotomy)作为新型的微创联合术式已受到广泛关注，临床研究和实践均表明其在合并白内障的中晚期PACG治疗中的良好疗效及安全性 ^{[
4
,

5
,

6
,

7
,

8
,

9
,

10
,

11
,

12
]}。由于其手术操作简单、快捷且并发症少，有望替代传统"青白联合"手术并成为中晚期PACG合并白内障患者的优选手术方式。然而，PEI+GSL+GT手术虽然广泛开展，其治疗过程仍缺乏统一的规范。国内有关部分专家对该方法应用中存在的问题进行调查和讨论并制定完整详细的手术操作规范，为临床医生的相关临床实践提供专家指导意见。

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摘要
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备注信息

通信作者：张秀兰，Email： nc.defudabe.usys.liam2lxgnahz

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