超声乳化白内障吸除联合后房型人工晶状体植入及房角分离术治疗闭角型青光眼合并白内障的临床疗效观察

Clinical effects of phacoemulsification combined with trabeculectomy on angle-closure glaucoma and cataract

目的探讨超声乳化白内障吸除联合后房型人工晶状体植入及房角分离术治疗闭角型青光眼（ACG）合并白内障的临床疗效。方法收集2009年1月至2012年12月期间山西省晋城煤业集团总医院眼科收治的80例（110只眼）ACG合并白内障患者的临床资料,进行回顾性分析。所有患者均行超声乳化白内障吸除联合房角分离术进行治疗,术后对患者进行1~3个月的随访。观察患者术后1 d及3个月的眼压和视力变化情况,同时观察随访末期时患者的中央前房深度、房角形态及术后并发症的发生情况。手术前后患者的眼压及视力变化情况以均数±标准差（x珋±s）的形式表示,并采用单因素重复测量方差分析的方法进行比较。以P〈0.05为差异有统计学意义,当比较结果有统计学意义时,进一步采用SNK法进行不同时间点的两两比较。结果术前患者平均眼压为（24.6±2.4）mm Hg（1 mm Hg=0.133 k Pa）,术后1 d平均眼压为（19.6±1.6）mm Hg,术后3个月的平均眼压为（13.2±1.4）mm Hg,差异有统计学意义（F=10.32,P〈0.05）;术前患者眼压与术后1 d与比较,差异有统计学意义（t=6.94,P〈0.05）,术前患者眼压与术后3个月比较,差异有统计学意义（t=38.4,P〈0.05）。术前患者平均视力为（0.14±0.08）,术后1 d患者平均视力为（0.27±0.08）,术后3个月患者的平均视力为（0.46±0.14）,差异有统计学意义（F=12.48,P〈0.05）;术前患者的视力与术后1 d比较,差异有统计学意义（t=13.4,P〈0.05）,术前患者的视力与术后3个月比较,差异有统计学意义（t=10.6,P〈0.05）。术后末期所有患者进行超声生物显微镜检查,显示所有患者中央前房深度均加深,膨隆的虹膜变平坦,周边房角开放,粘连的范围减小,未发现再次粘连。术后出现短期角膜水肿者30例（30只眼）,出现短期高眼压者20例（20只眼）,出现前房纤维素样渗出者12例（12只眼）,术中和术后出现前房不同程度出血者5例（5只眼）,经对症处理后均恢复,无严重并发症出现。结论采用超声乳化白内障吸除联合后房型人工晶状体植入及房角分离术治疗ACG合并白内障患者,术后患者眼压得到控制,视力得到改善,中央前房深度增加,前房角结构恢复正常,手术并发症少。

Objective To evaluate the efficacy of phacoemulsification combined with goniosynechialysis in the management of concomitant angle-closure glaucoma and cataract. Methods Medical records of 80 patients （110 eyes） with concomitant angle-closure glaucoma and cataract who underwent phacoemulsification combined with goniosynechialysis in our hospital between January, 2009 and December, 2012 were reviewed. The follow-up time was from 1 month to 6 months,averaged 3 months. Data on intraocular pressure （ IOP ） and visual acuity before treatment and at various postoperative time points and on the central chamber thickness and complications at the time of the final follow-up were extracted and analyzed. Results IOP was （24.6~2.4） mmHg （ 1 mmHg=0. 133 kPa） before treatment, which was significantly reduced at day 1 （ 19.6 ± 1.4 ） mmHg and 3 months （ 11.4 ± 1.4） mmHg after operation （P 〈0.05 ）. The preoperative visual acuity was 0. 14 ±0.08, which was significantly improved at postoperative day 1 （0.27±0.08） and 3 months （0.46±0.14） , （ P 〈0.05 ）. The central anterior chamber depth was increased and the extent of iridocorneal adhesions was decreased in all cases as revealed by ultrasound biomicroscopy. Conclusion Phacoemulsification combined with goniosynechialysis may achieve an effective eontrol of IOP, improve visual acuity, and increase the central chamber thickness without significant complications, thus offering an effective treatment for concomitant cataract and angle- closure Glaucoma