超声乳化白内障吸除联合人工晶状体植入及窦小梁切除术治疗青光眼合并白内障的临床观察

Retrospective analysis of phacoemulsification combined with trabeculectomy in the treatment of primary angle-closure glaucoma complicated by cataract

目的探讨超声乳化白内障吸除联合人工晶状体植入及窦小梁切除术治疗原发性闭角型青光眼合并白内障的临床疗效。方法收集2011年3月至2013年3月重庆市大足区人民医院眼科44例(48只眼)原发性闭角型青光眼合并白内障患者的临床资料。采用数字表法将患者随机分为观察组和对照组,其中观察组21例(24只眼)患者行超声乳化白内障吸除术联合人工晶状体植入及窦小梁切除术;对照组23例(24只眼)患者行超声乳化白内障吸除术联合人工晶状体植入术。对全部患者进行6个月的随访。手术前后观察组和对照组患者的眼压、前房深度及前房角变化情况以均数±标准差(x±s)的形式表示,采用独立样本t检验进行比较;两组患者手术成功率的比较采用χ2检验;手术前后两组患者视力变化情况的比较采用Kruskal-Wallis H秩和检验。结果对照组患者手术成功者16例(16只眼),占66.67%,有效者7例(7只眼),占29.16%;观察组患者手术成功者23例(23只眼),占95.83%,有效者1例(1只眼),占4.17%。两组患者手术成功率比较,差异有统计学意义(χ2=6.76,P【0.05)。对照组患者术前平均眼压为(37.5±4.35)mmHg(1 mmHg=0.133kPa),观察组患者术前平均眼压为(38.1±4.21)mmHg,两组患者术前眼压比较,差异无统计学意义(t=-0.49,P】0.05)。对照组患者术后3 d、7 d、1个月、3个月及6个月的平均眼压分别为(20.2±5.9)mmHg、(18.1±4.5)mmHg、(16.8±5.1)mmHg、(16.7±4.3)mmHg及(17.1±4.8)mmHg;观察组患者术后3 d、7 d、1个月、3个月及6个月的平均眼压分别为(13.4±3.9)mmHg、(14.5±3.1)mmHg、(14.3±2.9)mmHg、(13.8±2.7)mmHg及(13.2±2.9)mmHg,两组患者术后各时间段的眼压比较,差异有统计学意义(t=4.71,3.23,2.78,2.80,3.41;P【0.05)。术前对照组患者视力【0.1者15例(15只眼),视力为0.1~0.3者5例(5只眼),视力为0.4~0.6者4例(4只眼);观察组患者视力【0.1者17例(17只眼),视力为0.1~0.3者5例(5只眼),视力为0.4~0.6者2例(2只眼),术前两组患者视力比较,差异无统计学意义(Hc=-0.72,P】0.05);术后对照组患者视力【0.1者7例(7只眼),视力为0.1~0.3者12例(12只眼),视力为0.4~0.6者3例(3只眼),视力】0.6者2例(2只眼);观察组患者视力【0.1者5例(5只眼),视力为0.1~0.3者3例(3只眼),视力为0.4~0.6者15例(15只眼),视力】0.6者1例(1只眼),术后两组患者视力比较,差异有统计学意义(Hc=-4.18,P【0.05)。术前对照组患者前房角为(173.32±30.21)°,观察组患者为(169.21±28.65)°,术前两组患者前房角度数比较,差异无统计学意义(t=0.48,P】0.05);术后对照组患者前房角为(90.35±43.87)°,观察组患者为(60.65±40.26)°,术后两组患者前房角度数比较,差异有统计学意义(t=2.44,P【0.05)。术前对照组患者前房平均深度为(1.86±0.28)mm,观察组患者为(1.91±0.32)mm;术后对照组患者前房平均深度为(2.51±0.82)mm,观察组患者为(2.89±0.39)mm,术后两组患者前房深度比较,差异有统计学意义(t=2.05,P【0.05)。结论超声乳化白内障吸除联合人工晶状体植入及窦小梁切除术是治疗闭角型青光眼合并白内障的有效方法,其疗效优于超声乳化白内障吸除联合人工晶状体植入术。

Objective To evaluate the effect of phacoemulsification and intraocular lens implantation combined with trabeculectomy on the outcome of patients with primary angle-closure glaucoma complicated by cataract.Methods Clinical records of 44 patients (48 eyes) who were diagnosed with primary angle-closure glaucoma and concurrent cataract between March,2011 and March,2013 were accessed and reviewed.Of these patients,21 (24 eyes) were classified as experimental subjects who underwent small incision cataract extraction and intraocular lens implantation combined with trabeculectomy whereas the other 23 ( 24 eyes ) were considered as control subjects who underwent small incision cataract extraction and intraocular lens implantation.All patients were followed for 6 months.Data on the intraocular pressure ( IOP) ,central anterior chamber depth,and goniosynechia before and after operation were and analyzed by the independent samples t test.Data on the success rate of surgery were analyzed byχ2 test.Data on the visual acuity were analyzed by Kruskal-Wallis H Rank test.Results In the control subjects,16 (66.67%) eyes were completed cured and 7 (29.16%) eyes were partially cured.In the experimental subjects, 23 ( 95.83%) eyes achieved a complete cure and 1 (4.17%) eye achieved a partial cure.The difference in the success rate between the two groups was statistically significant (χ2=6.7564,P<0.05).The preoperative IOPwas 38.1±4.21 mmHg in the experimental group and 37.5±4.35 mmHg in the control group (t=-0.49,P <0.05).In the control group,the IOP was 20.2±5.9 mmHg,18.1±4.5 mmHg,16.8±5.1 mmHg,16.7±4.3 mmHg,and 17.1± 4.8 mmHg,respectively,3 days,7 days,1 month,3 month and 6 months after treatment.In the experimental group,the IOP was 13.4±3.9 mmHg,14.5±3.1 mmHg,14.3±2.9 mmHg,13.8±2.7 mmHg and 13.2± 2.9 mmHg at the corresponding postoperative time points,respectively.Postoperative IOP in the experimental group was significantly lower than that in the control group at each of the time points assessed (P<0.05).In the control group,the preoperative visual acuity was lower than 0.1 in 15 eyes,between 0.1 and 0.3 in 5 eyes,and between 0.4 and 0.6 in 4 eyes.In the experimental group,the preoperative visual acuity was lower than 0.1 in 17 eyes,between 0.1 and 0.3 in 5 eyes,and between 0.4 and 0.6 in 2 eyes.The difference in the preoperative visual acuity was not significant between the two groups (Hc=-0.72,P <0.05).In the control group,the postoperative visual acuity was lower than 0.1 in 7 eyes,between 0.1 and 0.3 in 12 eyes, between 0.4 and 0.6 in 3 eyes,and higher than 0.6 in 2 eyes.In the experimental group,the postoperative visual acuity was lower than 0.1 in 5 eyes,between 0.1 and 0.3 in 3 eyes,between 0.4 and 0.6 in 15 eyes, and higher than 0.6 in 1 eye.The difference in postoperative visual acuity was statistically significant between the two groups (Hc=-4.18,P <0.05).The range of preoperative goniosynechia was 173.32±30.21°in the control group and 169.21±28.65°in the experimental group (t=0.48,P<0.05).The range of postoperative goniosynechia was 60.65±40.26°in the experimental group and 90.35±43.87°in the control group (t=-2.443 6,P <0.05).The central anterior chamber depth was similar in the control (1.86±0.28 mm) and experimental (1.91±0.32 mm) groups before treatment (P >0.05) but was significantly different between the two groups after treatment (2.51±0.82 mm vs 2.89±0.39 mm,t=2.05,P <0.05).Conclusions Phacoemulsification and intraocular lens implantation combined with trabeculectomy is more effective than phacoemulsification and intraocular lens implantation for primary angle-closure glaucoma complicated by cataract.