小梁切除联合超声乳化白内障吸除及人工晶状体植入术治疗青光眼合并白内障的临床疗效观察

Effectiveness of trabeculectomy combined with phacoemulsification and intraocular lens implantationfor primary angle-closure or open-angle glaucoma with cataract

目的探讨小梁切除联合超声乳化白内障吸除及人工晶状体植入术治疗原发性闭角型青光眼及开角型青光眼合并白内障的临床效果。方法收集2012年2月至2013年12月山东省东营市第二人民医院眼科收治的64例(64只眼)原发性青光眼合并白内障患者的临床资料。按照疾病类型将患者分为闭角型青光眼组和开角型青光眼组,每组各32例(32只眼)。两组患者均采用小梁切除术联合超声乳化白内障吸除及人工晶状体植入术进行治疗。手术前、后闭角型青光眼组和开角型青光眼组患者的眼压、视力及前房深度以均数±标准差(x珋±s)的形式表示,并采用独立样本t检验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。两组患者的手术成功率及并发症的发生率以例数和百分率的形式表示,并采用卡方检验的方法进行比较。结果术前闭角型青光眼组患者的眼压为(42.09±10.24)mm Hg,开角型青光眼组患者的眼压为(42.12±10.27)mm Hg,术前两组患者的眼压比较,差异无统计学意义(t1=0.32,P1>0.05)。术后闭角型青光眼组患者的眼压为(10.32±3.60)mm Hg,开角型青光眼组患者的眼压为(16.70±4.80)mm Hg,术后两组患者的眼压比较,差异有统计学意义(t1=6.01,P1<0.05)。术后闭角型青光眼组患者的眼压低于术前,差异有统计学意义(t2=16.55,P2<0.05);术后开角型青光眼组患者的眼压低于术前,差异有统计学意义(t3=12.68,P3<0.05)。术前闭角型青光眼组患者的视力为(0.24±0.06),开角型青光眼组患者的视力为(0.25±0.05),术前两组患者的视力比较,差异无统计学意义(t1=0.38,P1>0.05)。术后闭角型青光眼组患者的视力为(0.72±0.21),开角型青光眼组患者的视力为(0.50±0.36),术后两组患者的视力比较,差异有统计学意义(t1=2.98,P1<0.05)。术后闭角型青光眼组患者的视力优于术前,差异有统计学意义(t2=12.43,P2<0.05);术后开角型青光眼组患者的视力优于术前,差异有统计学意义(t3=3.89,P3<0.05)。术前闭角型青光眼组患者的前房深度为(1.79±0.21)mm,开角型青光眼组患者的前房深度为(1.81±0.22)mm,术前两组患者的前房深度比较,差异无统计学意义(t1=0.32,P1>0.05)。术后闭角型青光眼组患者的前房深度为(3.82±0.53)mm,开角型青光眼组患者的前房深度为(2.71±0.29)mm,术后两组患者的前房深度比较,差异有统计学意义(t1=10.39,P1<0.05)。术后闭角型青光眼组患者的前房深度优于术前,差异有统计学意义(t2=20.27,P2<0.05);术后开角型青光眼组患者的前房深度优于术前,差异有统计学意义(t3=13.98,P3<0.05)。闭角型青光眼组手术成功者32例(32只眼),占100%;开角型青光眼组手术成功者27例(27只眼),占84.38%,闭角型青光眼组的手术成功率高于开角型青光眼组,差异有统计学意义(χ2=-1.50,P>0.05)。闭角型青光眼组发生并发症19例(19只眼),占59.38%。其中角膜水肿4例(4只眼),占12.50%;前房出血4例(4只眼),占12.50%;浅前房3例(3只眼),占9.38%;前房纤维素渗出8例(8只眼),占25.00%。开角型青光眼组发生并发症14例(14只眼),占43.75%。其中,角膜水肿3例(3只眼),占9.38%;前房出血2例(2只眼),占6.25%;浅前房2例(2只眼),占6.25%;前房纤维素渗出7例(7只眼),占21.88%,闭角型青光眼组的并发症发生率高于开角型青光眼组,差异有统计学意义(χ2=7.92,P<0.05)。结论采用小梁切除术联合超声乳化白内障吸除及人工晶状体植入术治疗原发性闭角型及开角型青光眼合并白内障,能明显降低患者的眼压,改善患者视力,并发症的发生率较低,安全系数较高,是临床治疗原发性青光眼合并白内障的有效方法,且原发性闭角型青光眼合并白内障患者的眼压控制情况优于开角型青光眼合并白内障患者。

Objective To evaluate the effectiveness of trabeculectomy combined with phacoemulsification and intraocular lens implantationfor primary angle closure or open-angle glaucoma with cataract. Method A total of 64 patients（ 64 eyes） who presented with primary angle-closure（ n = 32） or open-angle（ n = 32） glaucoma with cataract to the Department of Ophthalmology,Second People＇s Hospital of Dongying consecutively between February,2012 and February,2013 were recruited. All patients underwent trabecular resection surgery combined with ultrasonic phacoemulsification and intraocular lens implantation.Intraocular pressure（ IOP）,visual acuity andanterior chamber depth were recorded before and at the end of treatment and analyzed statistically. Results Before treatment,the average IOP was not significantly different between patients with angle-closure glaucoma（ 42. 09 ± 10. 24 mm Hg） and patients with open-angle glaucoma（ 42. 12 ± 10. 27 mm Hg）（ P 0. 05）. The combined treatment significantly decreased IOP in both groups of patients（ P 0. 05）,but the decrease was more pronounced in patients with angle-closure glaucoma（ 10. 32 ± 3. 60 mm Hg） than in patients with open-angle glaucoma（ 16. 70 ± 4. 80 mm Hg）（ P 0. 05）.Before treatment,the average visual acuity was not significantly different between patients with angle-closure glaucoma（ 0. 24 ± 0. 06） and patients with open-angle glaucoma（ 0. 25 ± 0. 05）（ P 0. 05）. The treatment significantly improved the average visual acuity in both groups（ P 0. 05）,but the improvement was more significant in patients with angel-closure glaucoma（ 0. 72 ± 0. 21） than in patients with open-angle glaucoma（ 0. 50 ± 0. 36）（ P 0. 05）. Before treatment,the average anterior chamber depth was not significantly different between patients with angle-closure glaucoma（ 1. 79 ± 0. 21mm） and patients with open-angle glaucoma（ 1. 81 ± 0. 22 mm）（ P 0. 05）. The treatment significantly increased the average anterior chamber depth in both groups（ P 0. 05）,but the improvement was more significant in patients with angel-closure glaucoma（ 3. 82 ± 0. 53mm） than in patients with open-angle glaucoma（ 2. 71 ± 0. 29）（ P 0. 05）. The overall success rate was significantly higher in patients with closed-angle glaucoma（ 100%） than in patients with open-angle glaucoma（ 84. 38%）（ P 0. 05）. The post-operative complication rate was also significantly higher in patients with closed-angle glaucoma（ 59. 38%） than in patients with open-angle glaucoma（ 43. 75%）（ P 0. 05）. Conclusion Trabecular resection combined with ultrasonic phacoemulsification and intraocular lens implantation is effective and safe in reducing IOP,improvingvisual acuity and increasing anterior chamber depth in both angle-closure and open-angle glaucoma patients with concomitant cataract,butit is more beneficial to closed-angle glaucoma patients.