激光虹膜成形术与超声乳化白内障吸除联合人工晶状体植入术治疗白内障合并闭角型青光眼的临床观察

Efficacy and safety of laser iridoplasty and ultrasonic phacoemulsification combined with intraocular lens implantation in the treatment of acute angle closure glaucoma

目的比较激光虹膜成形术与超声乳化白内障吸除联合人工晶状体植入术治疗白内障合并闭角型青光眼的临床效果。方法收集2013年2月至2014年2月山东省乐陵市中医院眼科收治的60例(64只眼)白内障合并闭角型青光眼患者的临床资料。按照数字表法随机将患者分为对照组和观察组,每组各30例(32只眼)。对照组患者给予激光虹膜成形术进行治疗,观察组患者给予术前或术中辅助减压后行超声乳化白内障吸除联合人工晶状体植入术进行治疗。手术前、后两组患者的眼压和视力以均数±标准差(x珋±s)的形式表示,并采用两因素重复测量方差分析的方法进行组间比较,采用配对t检验的方法进行组内比较。两组患者并发症的发生情况以例数和百分比的形式表示,并采用卡方检验的方法进行组间比较。结果术前、术后7 d及术后8个月观察组患者的平均眼压分别为(26.4±12.3)、(10.1±4.1)、(14.7±2.8)mm Hg。术前、术后7 d及术后8个月对照组患者的平均眼压分别为(40.9±9.4)、(10.2±4.4)、(15.3±3.1)mm Hg。两组患者的眼压比较,差异无统计学意义(F=1.02,P>0.05)。观察组患者术后7 d、8个月的眼压与术前比较,差异有统计学意义(t1=6.98,5.25;P1<0.05)。对照组患者术后7 d、8个月的眼压与术前比较,差异有统计学意义(t2=16.73,14.63;P2<0.05)。术前、术后7 d及术后8个月观察组患者的视力分别为(0.24±0.06),(0.67±0.28),(0.71±0.22);对照组患者的视力分别为(0.25±0.05),(0.41±0.17),(0.49±0.35)。观察组患者的视力优于对照组,差异有统计学意义(F=5.67,P<0.05)。对照组患者术后7 d、8个月的视力与术前比较,差异有统计学意义(t1=-8.49,-11.66;P1<0.05);观察组患者术后7 d、8个月的视力与术前比较,差异有统计学意义(t1=-5.11,-3.84;P2<0.05)。观察组出现眼内压升高者1例(1只眼),给予卡替洛尔滴眼液后恢复正常。对照组出现前房出血者8例(8只眼),出现白内障加速发展者10例(10只眼)。观察组患者并发症的发生率低于对照组,差异有统计学意义(χ2=21.63,P<0.05)。结论在白内障合并闭角型青光眼治疗中,采用超声乳化白内障吸除联合人工晶状体植入术临床效果更具优势,有利于从根本上解除患者的瞳孔阻滞,且有效降低眼压,提高患者视力,并发症少,疗效确切,值得临床推广应用。

Objective To evaluate the efficacy and safety of laser peripheral iridoplasty and ultrasonic phacoemulsification combined with intraocular lens（ IOL） implantation in the treatment of acute closed angle glaucoma. Methods This study enrolled 60 patients（ 64 eyes） who presented with acute closed angle glaucoma to our hospital between February,2013 and February,2014. They were randomly divided into a control group（ 30 patients,32 eyes） and an experimental group（ 30 patients,32 eyes）. Laser iridoplasty was performed in the control group whereas ultrasonic phacoemulsification combined with IOL implantation. Data on intraocular pressure（ IOP） and visual acuity were analyzed by ANOVA and t test whereas data on complications were analyzed by chi-square test. Results IOP was（ 26. 4 ± 12. 3） mm Hg before treatment,（ 10.1 ± 4. 1） mm Hg on postoperative day 7 and（ 4. 7 ± 2. 8） mm Hg at 8 months after treatment in the experimental group,and was（ 40. 9 ± 9. 4） mm Hg,（ 10. 2 ± 4. 4） mm Hg and（ 15. 3 ± 3. 1） mm Hg,respectively,at the corresponding time points in the control group; the differences between the two groups were not significance at all the time points assessed（ F = 5. 67,P〉0. 05）. Visual acuity was（ 0. 24 ± 0. 06）,（ 0. 67± 0. 28） and（ 0. 71 ± 0. 22）,respectively,before treatment and at 7 days and 8 months after treatment in the experimental group,and was（ 0. 25 ± 0. 05）,（ 0. 41 ± 0. 17） and（ 0. 49 ± 0. 35）,respectively,at the corresponding time points in the control group; while preoperative visual acuity was different between the two groups（ F = 5. 67,P〈0. 05）,postoperative visual acuity was significantly higher the experimental group than in the control group than that of the control group. The postoperative complication rate was higher in the control group than in the experimental group（ x2= 21. 63,P〈0. 05）; while increased IOP was observed in 1case in the experimental group,hyphema occurred in 8 cases and cataract developed in 10 cases.Conclusion Compared with laser iridoplasty,phacoemulsification in combination with IOL implantation appears superior in the treatment of acute angle closure glaucoma; it can more effectively relieve pupillary block,reduce intraocular pressure,improve visual acuity and reduce the risk of complications.