原発閉塞隅角疾患に対する白内障および隅角癒着解離術後の毛様体ブロックの予測因子

To identify predictive factors for ciliary block (CB) following combined phacoemulsification, intraocular lens implantation, and goniosynechialysis (P+I+GSL) in patients with primary angle-closure (PAC) and primary angle-closure glaucoma (PACG).

Multicenter retrospective study PARTICIPANTS: This study analyzed 66 eyes from 66 patients who underwent P+I+GSL between February 2022 and December 2024. Patients were categorized into two groups: those who developed CB (n=33) and those who did not (n=33). All participants were Chinese.

Preoperative biometric parameters obtained from ultrasound biomicroscopy (UBM) and IOLMaster, along with intraoperative data, were analyzed. Univariable and multivariable logistic regression analyses were conducted to identify risk factors for CB.

Compared to the non-CB group, patients who developed CB had shorter axial length, narrower anterior chamber width (ACW), and thinner lenses (LT) (P<0.05) preoperatively. Multivariable analysis identified reduced ACW (odds ratio, OR=0.049, P<0.05), decreased LT (OR=0.007, P<0.05), and lack of preoperative mannitol administration (OR=0.025, P<0.05) as significant predictors of CB. The optimal cut-off values for predicting CB were 11.72 mm for ACW and 4.84 mm for LT, with area under the curve values of 0.861 and 0.863, respectively.

Shorter AL, narrow ACW, thin lenses, and lack of preoperative mannitol administration are significant risk factors for CB following P+I+GSL in PAC and PACG patients. These findings highlight the importance of preoperative assessment of ACW and LT, along with the use of mannitol, may help reduce the incidence of CB in high-risk patients.