三种手术方式治疗青光眼合并白内障疗效的比较

Comparison of three methods for glaucoma with a cataract

目的探讨治疗青光眼合并白内障3种手术方式的适应证和临床疗效。方法对青光眼合并白内障患者135例152只眼进行手术分组：其中30例36只眼先行抗青光眼手术，待白内障发展到一定程度再行白内障手术，即所谓的两阶段手术（A组）；87例98只眼行一白联合手术一复合式小梁切除联合小切口白内障晶体吸除＋人工晶状体植入术（B组）；18例18只眼行单纯白内障手术＋人工晶状体植入术（C组）。比较不同适应证下3种手术方式的临床疗效，包括眼压控制情况、角膜内皮细胞、视力以及术后并发症等。随访时间（12＋1）月。结果均经统计学处理。结果手术前后视力≥0．2的眼数3组比较，差异有统计学意义（x^2=16．00，P〈0．01）。A组与B组手术前后眼压有显著性差异（t1=1．89，P1=0．01：t2=2．87，P2=O．03），C组手术前后无显著性差异（t=0．43，P=0．78）。术前术后角膜内皮细胞数量无显著性差异（p〉0．05），3组均未见严重术中并发症，其个A组滤泡形成良好，眼压控制满意，B组术后角膜水肿17例，未特殊处理，1周后全部消退；有2只眼出现瞳孔区纤维膜，滤泡形成欠理想。c组术后视力均显著提高，有2只眼轻度角膜水肿，有2只眼需加用药物控制眼压，其中1只眼最后接受抗青光眼手术。结论青光眼合并白内障患者应根据具体情况选择适当的手术方式，以获得较好的视力和眼压控制。

Objective To compare three types of microsurgery on management of glaucoma com- bined with a cataract.Methods The indications of three types of microsurgery were set up for a non-random- ized comparison study on 152 eyes （ 135 cases ） with acute or chronic glaucoma and coexisting cataracts which were performed trabeculectomy only, NF trabeculectomy plus intraocular lens implantation, NF with IOL.The eyes were categorized into three groups according to whether staged procedure, one procedure or combined procedure.Group A： 36 eyes with staged procedure, after successful trabeculectomy, underwent cataract surgery by NF techniques and intraocular lens implantation.The average time from initial trabeculectomy to cataract surgery was 24.2 mo.Group B： 98 eyes with triple procedure, cataract surgery by NF techniques and intraocular lens implantation combined with trabeculectomy with peripheral iridectomy.Mean follow-up was 12＋ 1 mo.Group C： 18 eyes with one procedure, cataract surgery by NF techniques and intraocular lens implantation only.The postoperative visual acuity, intraocular pressure （lOP） and corneal endothelial cell among the three groups were analyzed and compared.Results Of the three groups, the patients with VA better than 0.2 improved statistically after operation （x^2=16.00, P〈0.01 ）.Mean intraocular pressure was lowered significantly in Group A and Group B （h=1.89, P1=0.01; t2=2.87, P2=0.03）.In Group C, there was no significantly difference with post-operation and pre-operation （ t=0.43, P=0.78 ）.As to corneal endothelial cell, there was no statistically significant difference among the three groups （P〉0.05）.No severe intra-operative complications happened in three groups.Two eyes with mildest postoperative inflammatory response were seen in Group B. There were 17 eyes happened low-grade to moderate corneal edema in Group B and 5 eyes in Group C.Couclusions Various surgery techniques for glaucoma with a cataract should be chosen depending on the different conditions.Only if we recognize correctly the type of glaucoma and know accurately the stage and cause of cataract, can we select the most effective therapy with lowest complications and optimal surgery outcome.