两种切口白内障合并闭角型青光眼三联手术的近期疗效对比

目的：观察比较单切口和双切口超声乳化白内障吸除、折叠式人工晶体植入联合青光眼小梁切除术治疗闭角型青光眼合并白内障的临床疗效。方法闭角型青光眼合并白内障患者86例（138眼），其中行单切口术式组44例（72眼），双切口术式组42例（66眼）。分析对比两组患者术前及术后1个月时视力、眼压、角膜内皮细胞密度和面积以及术后滤过泡和并发症情况。结果两组术后视力均较术前明显提高、眼压明显下降，差异均有统计学意义（P＜0.05），但两组术后视力、眼压、滤过泡功能比较差异无统计学意义（P＞0.05）。两组患者术后1个月双切口组角膜内皮细胞密度明显高于单切口组（P＜0.05），两组术后角膜内皮细胞面积均相应增大，但单切口组增大更为明显，两组比较差异有统计学意义（P＜0.05）。结论单切口和双切口两种术式的联合手术治疗白内障合并闭角型青光眼，术后患者恢复良好，并发症少；但双切口三联手术在角膜内皮细胞损失方面较单切口组更具优势。

[Abscract]ObjectiveTo compare the therapeutic effects of single incision surgery and double incision surgery phacoemulsification with foldable intraocularlens implantation combined with trabeculectomy in treating angle-closure glaucoma complicated with cataract.MethodsThis prospective,randomized study includes 86 patients（136 eyes）with glaucoma and cataract. One -site approach was performed in 44 patients（72 eyes）and two-site approach in 42 patients（38 eyes）.Visual acuity, intraocular pressure（IOP）,the density and preservation of corneal endothelium cell,filtration bleb and complications were observed at presurgery and 1mo after operation.ResultsVisual acuity was obviously improved,the intraocular pressure drop signifi cantly,function improved signifi cantly both in the two groups（P〈0.05）,but there was no statistical signifi cance between the two groups（P〉0.05）. The corneal endothelial cell density in double incision group was obviously higher than that of single incision group at 1mo after operation.（P〈0.05）,the corneal endothelial cell area was accordingly increasesed both the two groups,but single incision group increased more obviously,there was statistical signifi cance between the two groups（P〈0.05）.ConclusionBoth single incision and double incision approach phacotrabeculectomy are effective in treatment angle- closure glaucoma with cataract,but the double incision approach is superior in minimizing the corneal endothelial cells loss compared to the single incision approach.