超声乳化加人工晶体植入联合内镜下睫状体光凝术治疗青光眼合并白内障的观察

Effect of phacoemulsification,intraocular lens implantation and endoscopic cyclophotocoagulation in treatment of glaucoma with cataracts

目的探讨白内障超声乳化加人工晶体植入联合内镜下睫状体光凝术治疗青光眼合并白内障的效果,为临床治疗提供支持。方法将2011年1月—2013年6月间泰安市中医医院收治的62例(73眼)原发性青光眼合并白内障患者随机分为2组。其中,观察组31例(38眼)给予白内障超声乳化加人工晶体植入联合内镜下睫状体光凝手术治疗,对照组31例(35眼)给予白内障超声乳化加人工晶体植入联合小梁切除术。手术前、后,检测2组患者视力、眼压、内皮细胞计数,并进行比较;术后统计2组人工晶体位置、前房炎症反应、并发症,并进行比较。进而对白内障超声乳化加人工晶体植入联合内镜下睫状体光凝术治疗青光眼合并白内障的效果进行探讨。结果术后,2组患者眼压均显著降低,差异有统计学意义(P<0.05),但2组眼压比较差异无统计学意义(P>0.05)。观察组术后视力提高率为78.9%(30/38),高于对照组的68.6%(24/35),但差异无统计学意义(P>0.05)。术后,2组患者角膜内皮细胞计数均显著降低,差异有统计学意义(P<0.05),但2组角膜内皮细胞计数比较差异无统计学意义(P>0.05)。观察组并发症率为21.1%(8/38),低于对照组的28.6%(10/35),但差异无统计学意义(P>0.05)。结论白内障超声乳化加人工晶体植入联合内镜下睫状体光凝术可有效治疗青光眼合并白内障,提高患者视力、降低患者眼压,效果与白内障超声乳化加人工晶体植入联合小梁切除术相当。

Objective To investigate the efficacy of phacoemulsification and intraocular lens implantation combined endo- scopic cyclophotocoagulation inthe treatment of glaucoma and cataracts, and provide date support for the clinical treatment. Methods A total of 62 cases（73 eyes） primary glaucoma and cataract patients from January 2011 to June 2013 in our hospital were randomly divided into two groups. Thirty-one cases （38 eyes） of the observation group were given phacoemulsification and intraocular lens implantation combined endoscopic cyclophotocoagulation, and 31 cases （35 eyes） in the control group were given phacoemulsification and intraocular lens implantation combined trabeculectomy. Before and after surgery, the visual acuity, intraocular pressure and endothelial cell counts of both groups were detected and compared; And after surgery, IOL position, anterior chamber inflammation and complications of both groups were counted and com- pared. And then, the efficacy of phacoemulsification and intraocular lens implantation combined endoscopic cyclophoto- coagulation for glaucoma and cataracts were evalnted. Results After the surgery,the intraocnlar pressure in both groups were significantly reduced, the difference was statistically significant（ P 〈 0. 05）, but there was no significant difference in intraocular pressure between two groups （ P 〉 0.05 ）. The postoperative visual acuity increasingrate of the observation group was 78.9% （30/38）, which was higher than [ 68. 6% （24/35） ] in the control group, but the difference was not significant（ P 〉 O. 05 ）. After the surgery, the corneal endothelial cell counts of both groups were significantly reduced, the difference was statistically significant（ P 〈0. 05 ） ,but there was no significant difference between two groups（ P 〉 0.05 ） ~ The incidence of complication of the observation group was 21.1% （8/38） ,which was lower than [28. 6% （10/35） ] in the control group,but there was no significant difference between two groups （P 〉 0.05）. Conclusion The phacoemulsi- fication and intraocular lens implantation combined endoscopic cyclophotocoagulation can effectively treat glaucoma and cataracts,improve visual acuity and reduce intraocular pressure, and has same efficacy with phacoemulsification and in- traocular lens implantation combined trabeculectomy surgery.