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ENGLISH ABSTRACT
周边虹膜切除联合房角分离及房角切开术治疗中晚期PACG的有效性及安全性评估
林凤彬
路平
宋云河
高新博
张英哲
聂昕
彭钰莹
黎晓燕
朱小敏
张恒丽
张懿
谢琳
唐广贤
唐莉
范肃洁
张秀兰
作者及单位信息
·
DOI： 10.3760/cma.j.cn115989-20220819-00383
Surgical outcome and safety of peripheral iridectomy plus goniosynechialysis and goniotomy in the treatment of advanced primary angle-closure glaucoma
Lin Fengbin
Lu Ping
Song Yunhe
Gao Xinbo
Zhang Yingzhe
Nie Xin
Peng Yuying
Li Xiaoyan
Zhu Xiaomin
Zhang Hengli
Zhang Yi
Xie Lin
Tang Guangxian
Tang Li
Fan Sujie
Zhang Xiulan
Authors Info & Affiliations
Lin Fengbin
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
Lu Ping
Handan City Eye Hospital (The Third Hospital of Handan), Handan 056001, China
Song Yunhe
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
Gao Xinbo
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
Zhang Yingzhe
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
Nie Xin
Department of Ophthalmology, People's Hospital of Chongqing, Chongqing 401120, China
Peng Yuying
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
Li Xiaoyan
Handan City Eye Hospital (The Third Hospital of Handan), Handan 056001, China
Zhu Xiaomin
Department of Ophthalmology, the Third Affiliated Hospital of Chongqing Medical University, Chongqing 401120, China
Zhang Hengli
Department of Ophthalmology, Shijiazhuang People's Hospital, Shijiazhuang 050000, China
Zhang Yi
Department of Ophthalmology, West China Hospital of Sichuan University, Chengdu 610041, 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
Tang Li
Department of Ophthalmology, West China Hospital of Sichuan University, Chengdu 610041, China
Fan Sujie
Handan City Eye Hospital (The Third Hospital of Handan), Handan 056001, China
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
·
DOI： 10.3760/cma.j.cn115989-20220819-00383
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摘要

目的评估周边虹膜切除(SPI)联合房角分离(GSL)及房角切开术(GT)治疗中晚期原发性闭角型青光眼(PACG)的有效性及安全性。

方法采用前瞻性多中心系列病例观察研究，对2021年8月至2022年1月在中山大学中山眼科中心、邯郸市眼科医院、石家庄市人民医院、四川大学华西医院及重庆医科大学附属第三医院完成SPI+GSL+GT的中晚期PACG患者27例35眼进行至少6个月随访，平均随访9(7，10)个月。采用ETDRS视力表及Goldmann压平眼压计分别测量患者术前和术后最佳矫正视力(BCVA)及眼压。记录患者术前和术后抗青光眼药物使用情况及术后并发症情况。计算手术成功率，手术完全成功定义为不使用任何抗青光眼药物下，眼压控制在5~18 mmHg(1 mmHg＝0.133 kPa)且眼压较基线下降20%，无威胁视力的并发症，无需接受额外的抗青光眼手术，无光感丢失；条件成功定义为使用抗青光眼药物的条件下达到完全成功的标准。

结果术眼术后6个月平均眼压为(15.69±3.70)mmHg，明显低于术前的(30.83±8.87)mmHg，差异有统计学意义( t＝8.588， P<0.001)；眼压平均降低13.00(8.00，21.00)mmHg，降幅为44.00%(34.78%，60.00%)。术后使用抗青光眼药物数量为0(0，1)种，较术前的2(0，3)种明显减少，差异有统计学意义( Z＝－3.659， P<0.001)。术前、术后6个月BCVA分别为0.80(0.63，1.00)和0.80(0.60，1.00)，差异无统计学意义( Z＝－0.283， P＝0.777)。手术完全成功率为62.86%(22/35)，条件成功率为91.43%(32/35)。手术并发症主要包括前房积血(6/35)、一过性眼压升高(3/35)和术后浅前房(4/35)，未发生威胁视力的并发症。

结论SPI+GSL+GT是治疗中晚期PACG安全、有效的方法，为PACG的治疗提供了新的思路。

闭角型青光眼;手术;多中心研究;房角切开术;房角分离术;周边虹膜切除术;有效性;安全性
ABSTRACT

ObjectiveTo evaluate the preliminary effectiveness and safety of surgical peripheral iridectomy (SPI) combined with goniosynechilysis (GSL) and goniotomy (GT) in the treatment of advanced primary angle-closure glaucoma (PACG).

MethodsA multicenter observational case series study was performed.Thirty-five eyes of 27 patients with advanced PACG, who underwent SPI+ GSL+ GT with a follow-up of at least 6 months, were included from August 2021 to January 2022 at Zhongshan Ophthalmic Center, Handan City Eye Hospital, Shijiazhuang People's Hospital, West China Hospital of Sichuan University, and the Third Affiliated Hospital of Chongqing Medical University.The mean follow-up time was 9(7, 10) months.Pre- and post-operative best corrected visual acuity (BCVA) and intraocular pressure (IOP) were measured with an ETDRS chart and a Goldmann applanation tonometer, respectively.The number of anti-glaucoma medications applied before and after surgery was recorded, and the complications after surgery were analyzed.Success rate of surgery was calculated.Complete surgical success was defined as an IOP of 5-18 mmHg (1 mmHg=0.133 kPa) and 20% reduction from baseline without anti-glaucoma medication or reoperation.Qualified success was defined as achieving criterion of complete success under anti-glaucoma medications.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Zhongshan Ophthalmic Center, Sun Yat-sen University (No.2021KYPJ177). Written informed consent was obtained from each subject.

ResultsThe mean preoperative IOP was (30.83±8.87)mmHg, which was significantly decreased to (15.69±3.70)mmHg at 6 months after the surgery ( t=8.588, P<0.001), with a 44.00% (34.78%, 60.00%) decline of 13.00(8.00, 21.00)mmHg.The median number of anti-glaucoma medications was significantly reduced from 2(0, 3) preoperatively to 0 (0, 1) postoperatively ( Z=-3.659, P<0.001). The mean preoperative and postoperative 6-month BCVA were 0.80(0.63, 1.00) and 0.80(0.60, 1.00), respectively, showing no significant difference ( Z=-0.283, P=0.777). Complete surgical success rate was 62.86%(22/35), and the qualified success rate was 91.43%(32/35). Surgical complications mainly included hyphema (6/35), IOP spike (3/35), and shallow anterior chamber (4/35). There was no vision-threatening complication.

ConclusionsSPI+ GSL+ GT is preliminarily effective and safe in the treatment of advanced PACG, which provides a new option for PACG.

Glaucoma, angle-closure;Surgery;Multicenter study;Goniotomy;Goniosynechialysis;Peripheral iridectomy;Effectiveness;Safety
Zhang Xiulan, Email: nc.defudabe.usys.liam2lxgnahz;
Fan Sujie, Email: mocdef.3ab613eijusnaf

Lin Fengbin and Lu Ping contributed equally to this study

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引用本文

林凤彬,路平,宋云河,等. 周边虹膜切除联合房角分离及房角切开术治疗中晚期PACG的有效性及安全性评估[J]. 中华实验眼科杂志,2023,41(02)：134-139.

DOI:10.3760/cma.j.cn115989-20220819-00383

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青光眼是全球主要的不可逆性致盲眼病，其致盲患者中约50%是原发性闭角型青光眼(primary angle-closure glaucoma，PACG)。中国目前约有1 010万PACG患者，约占全球发病人数的50% [ 1 , 2 ]。手术是PACG治疗的一线方案，根据是否合并白内障，早期PACG首选虹膜周边切除术(surgical peripheral iridectomy，SPI)或超声乳化白内障吸除联合人工晶状体植入术(phacoemulsification with intraocular lens implantation，PEI)，中晚期PACG首选小梁切除术或PEI联合小梁切除术 [ 3 , 4 ]。但小梁切除术存在创口较大、浅前房、恶性青光眼以及滤过泡相关并发症等可能，且术后需要长期的精细处理 [ 5 ]。因此，临床工作中对于一些特殊情况，如年轻、具有恶性青光眼特征的PACG患者，既往通常采用SPI联合术后降眼压药物替代治疗 [ 6 , 7 , 8 ]。微创青光眼手术(minimally invasive glaucoma surgery，MIGS)近年来在临床上广泛应用，其在治疗闭角型青光眼中的作用也逐渐突显，常见于各种形式的房角切开术(goniotomy，GT) [ 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 ]。研究证实，在治疗合并白内障的中晚期PACG患者时，PEI联合房角分离术(goniosynechialysis，GSL)及GT表现出良好的疗效 [ 16 , 17 , 22 , 23 , 24 ]。但对于没有白内障手术指征的中晚期PACG，透明晶状体摘出仍存在一定的争议 [ 3 , 4 ]。因此，对于这一类型中晚期PACG的治疗，可否通过SPI联合GSL+GT来达到PEI联合GSL+GT治疗合并白内障的中晚期PACG的降眼压效果，并同时减少单纯SPI治疗高危PACG术后青光眼药物的使用，目前仍缺乏相关研究证据。本研究拟评估SPI+GSL+GT治疗合并透明晶状体或无明显白内障手术指征的中晚期PACG患者的有效性及安全性，以期为这类患者手术方案的选择提供参考。
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备注信息
A
张秀兰，Email： nc.defudabe.usys.liam2lxgnahz；
B
范肃洁，Email： mocdef.3ab613eijusnaf
C

林凤彬、路平对本文有同等贡献

D

张秀兰、范肃洁：参与研究选题、研究设计、研究实施、论文修改及定稿；林凤彬、路平：参与研究资料整理、收集和分析/解释数据、论文撰写及修改；宋云河、高新博、张英哲、聂昕、彭钰莹、黎晓燕、朱小敏、张恒丽、张懿、谢琳、唐广贤、唐莉：参与患者随访、数据采集、数据整理和分析

E
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