两种切口青光眼白内障三联手术近期疗效的对比研究

Comparison of the one-site vs two-site phacotrabeculectomy in glaucoma and cataract patients

目的:评价并比较单切口和双切口超声乳化白内障摘除、人工晶状体植入联合小梁切除术治疗青光眼合并白内障的近期疗效。方法:采用前瞻性随机对照临床试验研究,青光眼合并白内障的患者60例78眼。31例40眼行单切口超声乳化白内障摘除、人工晶状体植入联合小梁切除术,29例38眼行双切口手术。术后2wk;1mo观察视力、眼压、术后滤过泡、散光及术后并发症。结果:术后全部患者都感到视力较术前提高,不同切口组间视力在术后2wk;1mo比较无显著差异(P>0.05);术后2wk;1mo两组患者的眼压较术前均降低,有显著性差异(P<0.05),两组间比较无显著性差异(P>0.05);单切口组及双切口组功能滤过泡的眼数在术后2wk;1mo比较均无显著意义(P>0.05);术后2wk时,单切口组散光较术前增大,与同期的双切口组相比散光大,均有显著差异(P<0.05);术后1mo时,两组与术前相比、两组间比较均无显著差异(P>0.05);3眼术后出现少量前房积血,12眼术后早期出现角膜内皮水肿、后弹力层皱褶,6眼出现前房纤维素性渗出。结论:双切口超声乳化白内障摘除、人工晶状体植入联合小梁切除术治疗青光眼白内障,手术操作简便、疗效佳,是一种理想的手术方式。

AIM： To compare the effects of one-site vs two-site phacotrabeculectomy, intraocular lens implantation with trabeculectomy in the treatment of glaucoma with cataract. METHODS： This prospective, randomized study including 60 patients （78 eyes） with glaucoma and cataract. One- site approach was performed in 31 patients （40 eyes） and two-site approach in 29 patients （38 eyes）. Visual acuity, intraocular pressure （lOP）, filtration, astigmatism and complications were observed at 2wk and 1 mo after operation. RESULTS： Postoperative visual acuitywas improved in 78 eyes. There was no significant difference of visual acuity between two groups at 2wk and l mo after operation （P〉0.05）. The lOP at 2wk and lmo after operation were lower than that of preoperation in two groups （ P〈0.05）, and there was no significant difference between two groups （P〉0.05）. The number of eyes with functional filtration has no significant difference between two groups at 2wk and lmo after operation （ P〉 0.05） ; 2wk after operation, the astigmatism in one- site approach was bigger than preoperative astigmatism, also bigger than that of two- site approach （ P〈 0.05）, and there was no significant difference of astigmatism between two groups at lmo after operation （ P〉 0.05）. There were 3 cases with few hemorrhage in anterior chamber after operation, 12 cases with slight cornealepithelial edema, descemet membrane folds, 6 cases with cellulose exudation in anterior chamber. CONCLUSION. It is an ideal operation that two-site approachphacoemulsification and intraocular lens implantation combined with trabeculectomy in cataract and glaucoma patients, and has the advantages of simple operation, good treatment effect.