[1]牛科,刘姗姗,范晓军,等.植入不同尺寸囊袋张力环对合并悬韧带松弛急性闭角型青光眼患者术后疗效的影响[J].眼科新进展,2020,40(9):867-870.[doi:10.13389/j.cnki.rao.2020.0197]
 NIU Ke,LIU Shanshan,FAN Xiaojun,et al.Different size capsular tension ring implantation treatment for acute angle-closure glaucoma with zounle relaxation[J].Recent Advances in Ophthalmology,2020,40(9):867-870.[doi:10.13389/j.cnki.rao.2020.0197]
点击复制

植入不同尺寸囊袋张力环对合并悬韧带松弛急性闭角型青光眼患者术后疗效的影响/HTML
分享到:

《眼科新进展》[ISSN:1003-5141/CN:41-1105/R]

卷:
40卷
期数:
2020年9期
页码:
867-870
栏目:
应用研究
出版日期:
2020-09-05

文章信息/Info

Title:
Different size capsular tension ring implantation treatment for acute angle-closure glaucoma with zounle relaxation
作者:
牛科刘姗姗范晓军陈思源彭俊杰王继兵
261000 山东省潍坊市,潍坊医学院(牛科);261000 山东省潍坊市,潍坊眼科医院(刘姗姗,范晓军,陈思源,彭俊杰,王继兵)
Author(s):
NIU Ke1LIU Shanshan2FAN Xiaojun2CHEN Siyuan2PENG Junjie2WANG Jibing2
1.Weifang Medical University,Weifang 261000,Shandong Province,China
2.Weifang Eye Hospital,Weifang 261000,Shandong Province,China
关键词:
急性闭角型青光眼囊袋张力环悬韧带松弛白内障
Keywords:
acute angle closure glaucoma capsular tension ring zounlar relaxation cataract
分类号:
R775
DOI:
10.13389/j.cnki.rao.2020.0197
文献标志码:
A
摘要:
目的 探讨植入不同尺寸囊袋张力环(CTR)对合并悬韧带松弛急性闭角型青光眼(AACG)患者术后疗效的影响。方法 该研究为前瞻性研究。选取2018年1月至12月就诊于潍坊眼科医院的合并悬韧带松弛AACG患者34例(40眼),所有患者均行超声乳化白内障吸出联合人工晶状体植入+房角分离手术。随机选取20眼植入大尺寸CTR(13 mm×11 mm),作为大尺寸组;20眼植入小尺寸CTR(12 mm×10 mm),作为小尺寸组。术后观察各组患者最佳矫正视力、眼压、有效晶状体位置(人工晶状体倾斜度和偏中心距离)、CTR直径、后囊膜平整程度、撕囊口形状以及是否发生后发性白内障等。结果 术前和术后3个月两组患者最佳矫正视力差异均无统计学意义(均为P>0.05);两组患者术后3个月最佳矫正视力均高于术前,差异均有统计学意义(均为P<0.05)。术前和术后3个月两组患者眼压差异均无统计学意义(均为P>0.05);两组患者术后3个月眼压均低于术前,差异均有统计学意义(均为P<0.05)。随访期间两组患者均未见眼压明显波动。两组患者术后3个月37眼人工晶状体均保持正位,小尺寸组3眼发生轻度人工晶状体偏位。术后1个月及3个月大尺寸组人工晶状体偏中心距离及倾斜度均小于小尺寸组,差异均有统计学意义(均为P<0.05)。两组患者术中CTR两端睫状突数量和术后3个月CTR直径均与眼轴长度和白到白距离呈显著正相关(均为P<0.05)。小尺寸组长眼轴患者CTR直径大于短眼轴患者,差异有统计学意义(P<0.05)。两组患者均顺利植入人工晶状体和CTR,术中无并发症发生。术后观察无明显角膜水肿、葡萄膜炎等并发症。术后3个月随访发现2眼(大尺寸组、小尺寸组各1眼)有轻度后囊膜混浊。术后3个月小尺寸组9眼出现后囊膜皱褶,其中3眼发生撕囊口形状改变。结论 超声乳化白内障吸出联合人工晶状体植入+房角分离手术植入CTR对合并悬韧带松弛AACG患者治疗效果较好,眼轴长度和白到白距离可以作为选择不同尺寸的CTR的参考依据,眼轴较长(大于23.00 mm)选择相对较大尺寸CTR,对人工晶状体-囊袋复合体有较好的稳定作用。
Abstract:
Objective To investigate the clinical efficacy and the effect of intraocular lens(IOL)-capsular complex of different size capsular tension ring(CTR)implantation on acute angle-closure glaucoma(AACG)with zounle relaxation.Methods A prospective randomized case series study. From January to December 2018, 34 patients(40 eyes)of AACG with zounle relaxation were treated in Weifang Eye Hospital. All patients underwent phacoemulsification(Phaco)and IOL implantation with CTR implantation, combined with goniosynechialysis surgery, and they were randomized with two groups, of which 20 eyes in large size group were implanted with CTR(13 mm×11 mm), and 20 eyes in small size group were implanted with CTR(12 mm×10 mm). The postoperative best corrected visual acuity, intraocular pressure, the position of the IOL (IOL tilt and off-center distance), the diameter of CTR were observed, and the posterior capsular flatness, shape of the capsulotomy, posterior capsular opacification were also observed.Results There were no significant difference in the best corrected visual acuity in two groups of 3 months postoperatively(both P>0.05). The best corrected visual acuity of the two groups of patients at 3 months after operation was higher than that before operation, and the difference was statistically significant (both P<0.05). There was no significant difference in intraocular pressure between the two groups of patients before and 3 months after the operation (both P>0.05). The intraocular pressure of the two groups of patients 3 months after operation was lower than that before preoperation, and the difference was statistically significant (both P<0.05). There was no significant fluctuation in intraocular pressure during follow-up. At 3 months postoperatively, 37 eyes of the IOL were in good position, and 3 eyes of group small size had IOL deviation. The eccentric distance and inclination of the IOL in the large size group were smaller than those in the small size group 1 month and 3 months after surgery, and the differences were statistically significant (both P<0.05). The number of ciliary processes after viscoelasticity aspiration at both ends of the CTR, and the diameter of CTR were both positively related to the axial length and white-to-white distance in two groups(all P<0.05). The CTR diameter of the long axis patients in the small size group was larger than that of the short axis patients, and the difference was statistically significant (P<0.05). Both groups of patients were successfully implanted with IOL and CTR without complications during the operation. No obvious corneal edema, uveitis and other complications were observed after operation. In the follow-up for 3 months, 2 eyes (1 eye in the large size group and the other eye in the small size group) had mild posterior capsule opacity. In small size group, 9 eyes developed posterior capsular fold, among which 3 eyes suffered from the shape of capsulorhexis.Conclusion Phaco combined with CTR implantation has a better therapeutic effect on AACG patients with zounlar relaxation. The axial length and white-to-white distance can provide reference for selecting different sizes of CTR. If the eye axis is longer (more than 23 mm), choosing a relatively large size CTR has a good stabilizing effect on the IOL-capsular complex.

参考文献/References:

[1]SHEN M,CUI L,LI M,ZHU D,WANG M R,WANG J.Extended scan depth optical co-herence tomography for evaluating ocular surface shape[J].J Biomed Opt,201l,16(5):056007.
[2] AZUARA-BLANCO A,BURR J,RAMSAY C,COOPER D,FOSTER P J,FRIEDMAN D S.Effectiveness of early lens extraction for the treatment of primary angle-closure glaucoma(EAGL-E):a randomised controlled trial[J].Lancet,2016,388(10052):1389-1397.
[3] 吴文捷,郑丹莹,郑颖丰,蔡小于.虹膜拉钩联合可缝合囊袋张力环在马方综合征晶状体半脱位患者中的应用[J].中华眼科杂志,2007,43(2):108-111.
WU W J,ZHENG D Y,ZHENG Y F,CAI X Y.Iris hooks and modified capsular t-ension ring for subluxation lens in patients with Marfan’s syndrome[J].Chin J Ophthalmol,2007,43(2):108-111.
[4] 邢晓杰,汤欣,宋慧,李威威.四种非球面人工晶状体植入术后倾斜和偏心的比较[J].中华眼科杂志,2010,46(4):332-336.
XING X J,TANG X,SONG H,LI W W.Comparison of tilt and decentration of four different kinds of aspheric intraocular lenses implantation[J].Chin J Ophthalmol,2010,46(4):332-336.
[5] 彭显耀,孙瑞竹,江俊宏,吕帆,梁远波.原发性闭角型青光眼晶状体悬韧带松弛度与房角关闭的关系[J].温州医科大学学报,2017,47(8):590-594.
PENG X Y,SUN R Z,JIANG J H,LYU F,LING Y B.The correlation between the relaxation extent of zonule and the closure of eye chamber angle in primary angle-closure glaucoma[J].J Wenzhou Med Univ,2017,47(8):590-594.
[6] 郭竞敏,李木,严晓琴,张虹,王军明.可疑性原发房角关闭的晶状体悬韧带松弛度研究 [J].眼科新进展,2018,38(5):461-463,467.
GUO J M,LI M,YAN X Q,ZHANG H,WANG J M.The relaxation of zonule in primary angle closure suspects[J].Rec Adv Ophthalmol,2018,38(5):461-463,467.
[7] C ANOVI C S,KOVA C EVI C S,KOLEGA M ,ANA DIDOVI C P,BASI C J K.Capsular tension ring in damage zonules[J].Coll Antropol,2015,39(1):237-238.
[8] WEBER C H,CIONNI R J.All about capsular tension rings[J].Curr Opin Ophthalmol,2015,26(1):10-15.
[9] BAUMEISTER M,BHREN J,KOHNEN T.Tilt and decentration of spherical and aspheric i-ntraocular lenses:effect on higher-order aberrations[J].J Cataract Refract Surg,2009,35(6):1006-1012.
[10] LEE D H,SHIN S C,JOO C K.Effect of a capsular tension ring on intraocular lensdecentration and tilting after cataract surgery[J].J Cataract Refract Surg,2002,28(5):843-846.
[11] TAKIMOTO M,HAYASHI K,HAYASHI H.Effect of a capsular tension ring on prevention of intraocular lens decentration and tilt and on anterior capsule contraction after cataract surgery[J].Jpn J Ophthalmol,2008,52(5):363-367.
[12] DONG E Y,JOO C K.Predictability for proper capsular tension ring size and intraocular lens size[J].Korean J Ophthalmol,2001,15(1):22-26.
[13] ERB-EIGNER K,HIRNSCHALL N,HACKL C,SCHMIDT C,ASBACH P,FINDL O.Predicting lens diameter:ocular biometry with high-resolution MRI[J].Invest Ophthalmol Vis Sci,2015,56(11):6847-6854.

相似文献/References:

[1]王珏 王于蓝 盛耀华.疏水丙烯酸酯囊袋张力环的制作及其对晶状体上皮细胞生长和后囊膜混浊的抑制作用[J].眼科新进展,2012,32(2):000.
[2]林涛.囊袋张力环在高度近视眼后发性白内障手术中的应用[J].眼科新进展,2012,32(9):000.
[3]赵玉新 吴明星.可生物降解载药性晶状体囊袋张力环抑制后发性白内障的研究进展[J].眼科新进展,2009,29(1):000.
[4]宋五德,梁章海. 不同前房深度急性闭角型青光眼持续高眼压患者的手术疗效分析[J].眼科新进展,2014,34(4):366.[doi:10.13389/j.cnki.rao.2014.0100]
[5]廖文江,刘贤升,闫亚红,等.超声乳化联合小梁切除术治疗急性闭角型青光眼合并年龄相关性白内障的疗效分析[J].眼科新进展,2014,34(12):1184.[doi:10.13389/j.cnki.rao.2014.0329]
 LIAO Wen-Jiang,LIU Xian-Sheng,YAN Ya-Hong,et al.Clinical efficacy of phacoemulsification with trabeculectomy for acute angle-closure glaucoma with age-related cataract[J].Recent Advances in Ophthalmology,2014,34(9):1184.[doi:10.13389/j.cnki.rao.2014.0329]
[6]彭红娟,赵桂玲,黎思毅,等. 急性闭角型青光眼临床前期房角的3D-OCT研究[J].眼科新进展,2015,35(7):656.[doi:10.13389/j.cnki.rao.2015.0179]
 PENG Hong-Juan,ZHAO Gui-Ling,LI Si-Yi,et al. Study on chamber angle in acute primary angle-closure glaucoma at preclinical phase by three dimensional optical coherence tomography[J].Recent Advances in Ophthalmology,2015,35(9):656.[doi:10.13389/j.cnki.rao.2015.0179]
[7]王志亮,陈志敏,张武林,等.多联手术治疗晶状体悬韧带松弛继发急性闭角型青光眼[J].眼科新进展,2016,36(5):453.[doi:10.13389/j.cnki.rao.2016.0121]
 WANG Zhi-Liang,CHEN Zhi-Min,ZHANG Wu-Lin,et al.Multi-surgery treatment for secondary acute angle-closure glaucoma due to zonular laxity of lens[J].Recent Advances in Ophthalmology,2016,36(9):453.[doi:10.13389/j.cnki.rao.2016.0121]
[8]李睿,李倩,崔红平,等.急性闭角型青光眼对侧眼易发作的解剖因素[J].眼科新进展,2016,36(8):728.[doi:10.13389/j.cnki.rao.2016.0193]
 LI Rui,LI Qian,CUI Hong-Ping,et al.Anatomical factors for susceptibility of fellow eyes of primary acute angle closure glaucoma[J].Recent Advances in Ophthalmology,2016,36(9):728.[doi:10.13389/j.cnki.rao.2016.0193]
[9]贺新征,陶黎明,李岩,等.急性闭角型青光眼急性发作早期的视网膜神经纤维层厚度变化特征分析[J].眼科新进展,2016,36(12):1150.[doi:10.13389/j.cnki.rao.2016.0306]
 HE Xin-Zheng,TAO Li-Ming,LI Yan,et al.Characteristics analysis of retinal nerve fiber layer thickness change of acute angle closure glaucoma in early acute episodes[J].Recent Advances in Ophthalmology,2016,36(9):1150.[doi:10.13389/j.cnki.rao.2016.0306]
[10]高郁玮,张舒心,孙丽,等.23G套管针在急性闭角型青光眼中的应用[J].眼科新进展,2017,37(4):369.[doi:10.13389/j.cnki.rao.2017.0094]
 GAO Yu-Wei,ZHANG Shu-Xin,SUN Li,et al.Application of 23G minimally vitrectomy trocar in acute angle closure glaucoma[J].Recent Advances in Ophthalmology,2017,37(9):369.[doi:10.13389/j.cnki.rao.2017.0094]

备注/Memo

备注/Memo:
N/A
更新日期/Last Update: 2020-09-05