白内障超声乳化吸除联合房角粘连分离术治疗白内障合并闭角型青光眼的临床分析

Clinical analysis of combined phacoemulsification with goniosynechialysis in the therapy of cataract complica- ting angle closure glaucoma

目的探讨白内障超声乳化吸除联合或不联合房角粘连分离术治疗白内障合并闭角型青光眼的效果。方法31例（33只眼）随机分为2组：A组行白内障超声乳化吸除人工晶状体植入术；B组行白内障超声乳化吸除人工晶状体植入术联合房角粘连分离术。追踪观察眼压、降眼压药种类、最佳矫正视力、前房角粘连关闭情况。平均随访20个月。结果术后眼压平均降低：A组（1．92±1．65）mmHg，B组（3．64±2.64）mmHg；两组间比较，差异有统计学意义（t=2．206，P〈0．05）；术后降眼压药种类平均减少：A组1．50±1．03，B组1．63±1．02，两组间比较，差异无统计学意义（t=0．344，P〉0．05）；最佳矫正视力≥0．5，A组13只眼（81．2％），B组15只眼（93．8％），两组间比较差异无统计学意义（χ^2=0．286，P〉0．05）；前房角全部开放：A组0只眼（0％），B组10只眼（62．5％），差异有统计学意义（χ^2=11．782，P〈0．005）。结论白内障超声乳化吸除联合或不联合房角粘连分离术都是治疗白内障合并闭角型青光眼的有效方法，联合房角粘连分离术，降低眼压和开放房角的效果更明显。

Objective To discuss the effect of phacoemulsification combining/non-combining goniosynechialys in the therapy of cataract complicating angle closure glaucoma. Methods 31 patients （33 eyes） were randomly divided into two groups. Phacoemulsification with folding intraocular lens implantation was performed in group A and phacoemulsification with folding intraocular lens implantation combining goniosynechialys was performed in group B. The intraocular pressure, the types of drug to lower the intraocular pressure and the closure scope of goniosynechia were oberserved. The mean follow up was 20 months. Results The intraocular pressure was reduced （ 1.92 ± 1.65 ） mm Hg in group A and （ 3.64±2.64） mm Hg in group B. There was significantly difference between the two group（ t =2.206, P 〈0.05）. The types of drugs to reduce the intraocular pressure decreased 1.50 ± 1.03 in group and 1.63 ± 1.02 in group B, there was on difference between the two groups（ t = 0.344, P 〉0.05 ）. The best corrected visual acuity above 0.5 was 81.2% in group A and 93.8% in group B （χ^2 = 0.286, P 〉 0.05 ）. The anterior chamber were completed reopened in62.5% of the patients in group B, while 0 in group A. There was significantly difference between the two group （ χ^2 = 11. 782, P 〈 0. 005 ）. Conclusion Phaeoemulsification combining/ non-combining goniosynechialys are both the effective surgery in the therapy of cataract complicating angle closure, glaucoma. While, phacoemulsification combining goniosynechialys performs better than the other, with lower intraocular pressure and more anterior chamber reopened.