超声乳化白内障吸出联合房角分离术治疗原发性闭角型青光眼并发白内障的疗效观察

Observation on the Clinical Effect of Phacoemulsification Combined with Goniosynechialysis in the Treatment of Primary Angle Closure Glaucoma with Cataract

目的:观察超声乳化白内障吸出联合房角分离术治疗原发性闭角型青光眼(PACG)并发白内障的临床疗效和安全性。方法:将60例(63眼)PACG并发白内障患者随机分为观察组和对照组,观察组采用超声乳化白内障吸出、后房人工晶体植入联合房角分离术治疗,对照组采用超声乳化白内障吸出、后房人工晶状体植入联合小梁切除术治疗,治疗后观察和比较两组患者治疗前后眼压、视力、房角粘连度的变化及并发症的发生情况等。结果:观察组和对照组术后3天、7天和术后1、3、6月时眼压均较术前显著下降,差异有统计学意义(P<0.01),且术后观察组眼压显著低于同期对照组患者,差异均有统计学意义(P<0.01)。观察组和对照组术后6月视力与术前比较均显著上升(P<0.01),且观察组视力显著高于同期对照组(P<0.01)。而观察组和对照组术后6月房角粘连度均下降,与术前比较有显著性差异(P<0.01),且观察组显著低于同期对照组(P<0.05)。对照组术后并发症的发生率为71.0%,观察组为18.8%,较对照组显著降低(P<0.01)。结论:超声乳化白内障吸出联合房角分离术治疗PACG并发白内障比超声乳化白内障吸出联合后房人工晶状体植入以及小梁切除术更加安全有效。

Objective： To investigate the clinical efficacy and safety of phacoemulsification combined with goniosynechialysis for primary angle closure glaucoma（PACG） with cataract.Methods： 60 patients（63 eyes） of PACG with cataract were randomly divided into observation group and control group.The observation group was treated with phacoemulsification with intraocular lens implantation combined with goniosynechialysis,and the control group was treated with phacoemulsification with intraocular lens implantation combined with trabeculectomy.The intraocular pressure,visual acuity,goniosynechia degrees and complications of the two groups were observed and compared after treatment.Results： 3 days,7 days,3 and 6 months after surgery,the intraocular pressure of observation group and control group both decreased significantly in comparison with preoperative intraocular pressure（P0.01）,and post-operative intraocular pressures of observation group were all significantly lower than those in contemporary control group（P0.01）.The visual acuities of observation group and control group at sixth month post-operation were both significantly higher than those pre-operation（P0.01）,and the visual acuity of observation group was significantly higher than that in contemporary control group（P0.01）.However,the goniosynechia degrees of observation group and control group both evidently decreased in comparison with those pre-operation（P0.01）,and the goniosynechia degree of observation group was significantly lower than that in contemporary control group（P0.01）.The incidence rate of complications in observation group was 18.8%,and 71.0% in control group,it was lower in observation group than than in the control group（P0.01）.Conclusion： Phacoemulsification combined with goniosynechialysis for PACG with cataract is safe and effective.