白内障超声乳化术联合非穿透性深层巩膜切除术与联合小梁切除术的疗效比较(英文)

Comparison of combined phacoemulsification-non-penetrating deep sclerectomy and phacoemulsification-trabeculectomy

目的:比较白内障超声乳化术联合非穿透性深层巩膜切除术(P-DS)和白内障超声乳化术联合小梁切除术(P-T)在白内障合并中度至重度原发性开角型青光眼(POAG)或假性剥脱性青光眼(PXG)患者中的疗效。方法:前瞻随机性研究。选取40例(40眼)白内障合并POAG或PXG患者,所有患者均接受全面眼部检查和青光眼测试。每组20眼,分别在局部麻醉下行P-DS或P-T。术前,术后10d,1、3、6、12mo记录视力、眼压及青光眼用药量。并对P-DS组行激光前房角穿刺、P-T组行普通穿刺的术后并发症记录。结果:两组患者年龄(P-DS组:66.3±11.0;P-T组:70.2±9.3岁)和性别(P-DS组:女7,男13;P-T组:女9,男11)分布相似(P>0.05)。POAG和PXG患者在两组(P-DS组,P-T组)中分别为12例和8例,13和7例(P>0.05)。两组在术前视力(P-DS组:0.69±0.22 log MAR;P-T组:0.76±0.22 log MAR)、眼压(P-DS组:17.9±1.6 mm Hg;P-T组:18.1±1.9 mm Hg)及用药量(P-DS组:2.7±0.7;P-T组:2.9±0.8)差异均无统计学意义(P>0.05)。与术前相比,两组术后均出现视力提高,眼压和用药量减少的现象(P<0.01)。术后两组(P-DS组,P-T组)眼压分别为15.0±1.7 mm Hg和14.5±1.6 mm Hg(P=0.472)。术后P-T组(0.5±0.7)的用药量略少于P-DS组(0.8±0.9)(P=0.307)。两组中均无并发症。P-DS组中7眼(5眼一次;2眼两次)行激光前房角穿刺;P-T组中1眼行普通穿刺。结论:同时患有白内障和青光眼的患者行联合P-DS与PT具有一定安全性。两组的可靠性与疗效相当。对P-DS组应进行密切随访,如果有必要应行激光前房角穿刺。

AIM：To compare the outcomes of combined phacoemulsification and non- penetrating deep sclerectomy（P-DS） with combined phacoemulsification and trabeculectomy（P-T） in patients who have cataract and moderate-to-severe primary open angle glaucoma（POAG） or pseudoexfoliative glaucoma（PXG）.METHODS：In this prospective randomized study 40 eyes of 40 patients with cataract and POAG or PXG were evaluated.Complete eye examination and glaucoma tests were performed in all patients.Combined P-DS and P-T were performed under local anesthesia in 20 eyes in each group.Visual acuity（VA）,intraocular pressure（IOP）and number of glaucoma medications were all recorded preoperatively and postoperative on 10 d,1,3,6 and12 mo.Complications,laser goniopuncture in P-DS group and needling in P-T group were also recorded.RESULTS：The age（P-DS,66.3±11.0 and P-T,70.2±9.3y） and sex distribution（P-DS,7 female and 13 male,P-T,9 female and 11 male） were similar in both groups（P〈0.05）.Number of POAG and PXG patients were 12 and 8,and 13 and 7 in P-DS and P-T groups,respectively（P〈0.05）.There was no difference between groups in terms of preoperative VA（P-DS,0.69±0.22 and P-T,0.76±0.22 logMAR）,IOP（P-DS,17.9±1.6 and P-T,18.1±1.9mm Hg） and number of medications（P-DS：2.7±0.7 and P-T：2.9±0.8）,（P〈0.05）.VA increased,IOP and number of medications decreased in both groups postoperatively（P〈0.01）.Postoperative lOPs were 15.0±1.7 and 14.5±1.6 mm Hg in P-DS and P-T groups respectively（P=0.472）.Postoperative number of medications were slightly better in P-T group（0.5±0.7） than in P-DS group（0.8±0.9）（P=0.307）.There were no complications in both groups.Laser goniopuncture was applied in 7 eyes（once in 5 eyes and twice in 2 eyes） in P-DS group.Needling was performed in 1 eye in P-T group.CONCLUSION：In patients with coexisting cataract and glaucoma,both combined P-DS and P-T may be performed safely.Reliability and efficacy were similar in both groups.Follow- up of P-DS should be done cautiously and when necessary laser goniopuncture should be performed.