分期手术治疗急性闭角型青光眼合并白内障的疗效评估

Comparison between combined surgery and sequential surgery in treating APACG with cataract

目的 探讨在急性原发性闭角型青光眼(acute primary angle closure glaucoma,APACG)合并白内障患者中,分期手术与青光眼白内障联合手术的疗效与安全性.方法 回顾性病例研究.选取就诊于福建医科大学附属第一医院的APACG合并白内障患者41例43只眼,按术式不同分为两组:分期手术组先行小梁切除术,择期行白内障手术;而联合手术组同期行青光眼白内障联合手术.对两种方案进行术前及术后观察并进行统计学分析.结果 两组患者的年龄具有可比性(P>0.05),两组术后眼压与组内术前相比差异有统计学意义(P<0.05),组间术后眼压、视力相比差异无统计学意义(P>0.05),组间的手术并发症相比,差异有统计学意义(P<0.05).两组间角膜内皮细胞数量在术前、术后1个月和3个月的差异有统计学意义(P<0.05).结论 术后3个月的临床观察表明,两种手术策略均能有效的降低眼压,疗效差异无统计学意义.与联合手术相比,分期手术无明显严重并发症.初步显示采用分期行青光眼和白内障手术安全可行,可作为解决APACG合并白内障的有效手段.

Objective To estimate the surgical management of acute primary angle-closure glaucoma (APACG)with cataract via clinical analysis of phacotrabeculectomy versus trabeculectomy followed by phacoemulsification and foldable intraocular lens implantation.Methods Clinical data of twenty-two patients underwent trabeculectomy followed by phacoemulsification and another twentyone patients received phacotrabeculectomy were collected.The therapeutic effects of two groups were compared.Results The ages of two groups were possessed comparability preoperatively,showed no statistical significance(P >0.05).The IOP were controlled after each surgeries with no statistical significance (P <0.05).The postoperative BCVA and IOP of two groups showed no statistical significance(P >0.05).The complications of sequentialsurgery groupwere more than combined surgeries(P <0.05).Furthermore,the corneal endothelial cellnumberin the combined operation group were significantly reduced compared with the staging operation group(P <0.05).Conclusions The combined and sequential surgeries can control IOP in APACG with cataract.However,the complications in phacotrabeculectomy were more frequent than sequential strategy.Trabeculectomy followed by phacoemulsification and foldable intraocular lens implantation is safe and effective in treating APACG with cataract.