PACG患者青白联合手术后的屈光状态及影响因素

doi:10.3760/cma.j.cn115909-20200531-00233

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Abstract Objective: To study the refractive outcome and related factors in primary angle closure glaucoma (PACG) patients 3 months after phacotrabeculectomy. Methods: This was a prospective clinical study. Fifty-one eyes of 51 patients with PACG and co-existing cataract who underwent phacotrabeculectomy at the Eye Center of the Second Hospital of Jilin University from December 2018 to September 2019 were enrolled. Patients with intraocular pressure (IOP) ≤21 mmHg (1 mmHg=0.133 kPa) were classified as the normal IOP group and patients with IOP >21 mmHg were classified as the high IOP group. Anterior chamber depth (ACD), axial length (AL) and keratometry were measured by AL-scan, and the SRK-T formula of AL-scan software was used to calculate the intraocular lense power and predict the refractive outcome. Subjective refraction was performed at 3 months. According to postoperative refractive error (RE), the patients were divided into a myopia group (RE <-0.5 D), hyperopia group (RE >0.5 D) and no refractive error group (-0.5 D≤RE≤0.5 D). A Chi-square test was used to compare the distribution of refractive errors between the normal and high IOP groups. The preoperative biological parameters of the myopia group and hyperopia group were compared by an independent t-test, and a paired sample t-test was used to compare the biological parameters before and after surgery. Results: In the normal IOP group, there were 4 patients with myopia (17%), 3 patients with hyperopia (12%), and 17 patients without refractive error (71%); in the high IOP group, there were 7 patients with myopia (26%), 16 patients with hyperopia (59%), and 4 patients without refractive error (15%). The reduction of AL in patients with high IOP was greater than that in patients with normal IOP, and the difference was statistically significant (t=-4.308, P<0.001). The preoperative ACD of the hyperopia group was shallower than that of the myopia group, and the preoperative AL was shorter than that of myopia group. The difference was statistically significant (t=3.226, P=0.03; t=4.993, P<0.001). With keratometry, there was no significant difference between the two groups (t=-1.143, P=0.263). There was a negative correlation between postoperative RE and preoperative ACD and AL (r=-0.32, P=0.023; r=-0.52, P<0.001); there was no significant correlation between postoperative RE and keratometry (r=0.15, P=0.101). Conclusions: Compared with normal IOP, PACG patients with high IOP have more RE, and most of them are hyperopic RE. In addition, the shallower the ACD and the shorter the AL were, the refractive outcome of PACG patients after phacotrabeculectomy more likely tends to be hyperopia.

Key words： primary angle closure glaucoma phacotrabeculectomy refractive error biological parameters

Received: 31 May 2020

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Corresponding Authors: Yajuan Zheng, Department of Glaucoma, the Eye Center of the Second Hospital of Jilin University, Changchun 130000, China (Email: zhengyajuan124@126.com)

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https://www.cjoovs.com/EN/10.3760/cma.j.cn115909-20200531-00233 OR https://www.cjoovs.com/EN/Y2020/V22/I12/908

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