不同手术方法治疗闭角型青光眼合并短眼轴的对比观察

Comparative study of different surgical treatments for angle-closure glaucoma with short axial length

目的:比较单纯小梁切除术和小梁切除术联合白内障超声乳化联合人工晶状体植入术(以下简称三联术)治疗闭角型青光眼合并短眼轴的疗效。方法:回顾分析2005-07/2009-01收住我院的闭角型青光眼合并短眼轴患者31例39眼。行单纯小梁切除术者25眼,行三联术者14眼。术后随访1～25(平均9.51±6.11)mo。结果:术后眼压:三联术者术后眼压平均(11.31±0.69)mmHg,手术前后有显著统计学差异(P<0.01);小梁切除术者术后平均(18.47±3.54)mmHg,手术前后差异有统计学意义(P<0.05);最佳矫正视力:三联术者术后均提高,≥0.3者占78%,小梁切除术者术后5眼视力不增反降,≥0.3者占32%,两者差异有显著性;UBM(超生生物显微镜)检查:小梁虹膜角(TIA)三联术者手术前后差异有显著性,小梁切除术者手术前后无显著性差异;中央前房深度(ACD):三联术术后平均为(3.22±0.53)mm,手术前后有显著性差异(P<0.01),小梁切除术后平均为(2.21±0.41)mm,比较差异无显著性;术后并发症:三联术术后并发症少,且均无需再手术纠正,小梁切除术者术后并发症较多,部分严重且持久,需再次手术。结论:小梁切除术联合白内障超声乳化联合人工晶状体植入术治疗闭角型青光眼合并短眼轴较单纯小梁切除术设计更合理,手术成功率高,疗效好,并发症少。

AIM： To compare effect of simple trabeculectomy and trabeculectomy combined with cataract phacoemulsification and intraocular lens implantation （hereinafter referred to as triple surgery） in the treatment of angle-closure glaucoma with short axial length. METHODS, Thirty-nine eyes from 31 patients who suffered from angle-closure glaucoma with short axial length from July 2005 to January 2009 were retrospectively analyzed, in which 25 eyes had undergone simple trabeculectomy,14 triple surgeon. The patients were followed up for 1-25 months with an average of （9.51±6.11） months. RESULTS：Postoperative intraocular pressure（lOP） ： the average lOP after triple surgery was（11.31±0. 69） mmHg, before and after surgery there was a statistically significant difference （ P 〈 0.01 ）, the average lOP after trabeculectomy was（18.47±3. 54） mmHg, before and after surgery the difference was statistically significant （ P 〈 0.05） ; Bestcorrected visual acuity（BCVA） ： all BCVA were increased after triple surgery,of which 78% ≥0.3, BCVA of 5 eyes dropped instead of rising after trabeculectomy, of which 32% ≥0.3,the two methods had a significant difference; ultrasound biomicroscope（UBM） ：before and after triple surgery there was a statistically significant difference in trabecubr iris angle（TIA）, but no difference before and after simple trabeculectomy; anterior chamber depth （ACD） ： the average ACD after triple surgery was（3.22±0. 53 ） mm, before and after surgery there was a statistically significant difference （ P 〈 0.01 ）, the average ACD after trabeculectomy was （2.21±0.41 ） mm, before and after surgery the difference was not statistically significant; Postoperative complications： triple surgery had fewer postoperative complications, which needed no surgical correction, trabeculectomy had more postoperative complications, some of which were serious and lasting, and needed reoperation. ~ CONCLUSION ~ Compared with simple trabeculectomy, trabeculectomy combined with cataract phacoemulsification and intraocular lens implantation for angle-closure glaucoma with short axial length has a higher success rate, and better efficacy and fewer complications.