微型引流器联合超声乳化治疗闭角型青光眼合并白内障的效果

The clinical effect of miniature glaucoma drainage device implantation combined with phacoemnisification for angle-closure glaucoma with cataract

目的观察青光眼Ex—PRESS微型青光眼引流器联合晶状体超声乳化吸出及人工晶状体植入术治疗原发性闭角型青光眼合并白内障的临床效果。方法原发性闭角型青光眼合并白内障54例（55只眼）随机分为试验组30例（30只眼），采取微型引流器植入术联合白内障超声乳化人工晶状体植入术；对照组24例（25只眼）行复合式小梁切除术联合晶状体超声乳化人工晶状体植人术。两组患者术前及术后视力、眼压、角膜内皮和中央前房深度等进行比较。结果试验组术后末次复查时视力（视力数值按logMAR计算）为0．47±0．31，优于术前的0．75±0．63（P=0．002）。试验组术后各时期平均眼压较术前降低，差异均有统计学意义（P〈0．05）。试验组和对照组术后中央前房深度较术前均有明显增加，术后中央前房深度两组间差异无统计学意义（P=0．451）。试验组术前和术后的角膜内皮细胞密度差异无统计学意义（P=0．162）。试验组和对照组术后6个月的手术成功率分别为96．67％和92．00％，差异无统计学意义（P=0．585）。试验组术后总并发症发生率为3．33％，少于对照组的24．00％（P=0．022）。结论微型引流器植入术联合晶状体超声乳化人工晶状体植入术具有明显的降低眼压及提高视力的作用，并发症较少，是安全有效的青光眼白内障联合手术。

Objective To observe the treatment effect of Ex-PRESS miniature glaucoma drainage device implantation combined with phacoemulsification and intraocular lens implantation for the primary angle-closure glaucoma （PACG） with cataract. Methods Fifty-five eyes of 54 cases of PACG with cataract were selected, and they were randomly devided into clinical trail group （30 eyes of 30 cases） and control group （25 eyes of 24 cases）. The clinical trail group was treated with Ex-PRESS miniature glaucoma drainage device implantation combined with phacoemulsification and intraocular lens implantation. The control group was treated with trabeculectomy combined with phacoemulsification and intraocular lens implantation. The visual acuity, intraocular pressure （IOP）, corneal endothelium and central anterior chamber depth （ACD） were recorded and compared. Results At the last review of trail group after operation, the visual acuity （log MAR） was （0.47 ± 0.31 ）, which was better than the preoperative visual acuity （0.75 ± 0.63 ） （ P = 0. 002）. The postoperative IOP in the clinical trail group decreased compared with the preoperative one （P 〈 0.05）. The ACD of the clinical trail group and the control group obviously increased after operation, and the difference in ACD between the two groups after operation was not statistically significant （ P = 0.451 ）. The difference in corneal endothelial density between preoperation and postoperation in the clinical trail group was not statistically significant （P = 0. 162）. The success rates of the clinical trail group and the control group were 96.67% and 92.00% respectively 6 months after surgery, andthe difference was not statistically significant （ P = 0. 585 ）. The complication rate after operation of the clinical trail group （3.33%） was lower than that of the control group （24.00%） （ P = 0. 022）. Conclusion The operation of Ex-PRESS miniature glaucoma drainage device implantation combined with phacoemulsification and intraocular lens implantation, which can reduce IOP and improve visual acuity evidently with less complications, is a safe and effective combined operation for glaucoma with cataract.