青光眼合并白内障三种手术方式的效果比较

Comparison of three kinds of surgery for glaucoma with cataract

目的比较3种手术方式治疗青光眼伴发白内障的临床效果。方法回顾性分析我科收治的72例（72眼）青光眼伴白内障，手术以前使用药物能将眼压控制在正常的范围之内并且视力在0．3以下患者的病历资料。患者分成A、B、C3组，每组24例（24眼）。A组采取晶状体超声乳化加人工晶状体植入术进行治疗，B组患者在A组的基础上联合周边虹膜切除术进行治疗，C组在A组的基础上联合小梁切除术进行治疗。在手术以后对3组患者均进行6个月的随访。比较眼压、裸眼视力、并发症的发生情况。结果术后6个月眼压A组、B组和C组分别为（14．73±3．06）mmHg、（15．12±2．78）mmHg和（13．97±2．24）mmHg（1mmHg=0．133kPa），均较术前降低（P〈0．05）。术后3组的裸眼视力均提高，但组间裸眼视力比较差异无统计学意义（P〉0．05）。在3组患者中，都出现一定程度存留房角关闭粘连。术后少数患眼出现角膜水肿，2例出现前房纤维素样渗出。术后3组的并发症比较差异无统计学意义。结论青光眼伴发白内障患者实施3种不同的手术方法治疗效果没有明显的差异，可根据患者临床表现选择合适的手术方式。

Objective To compare the clinical efficacy of three surgical treatments for glaucoma with cataract. Methods The data of 72 eyes of 72 patients of glaucoma with cataract in our department were reviewed. The patients whose intraocular pressure could be controlled within normal range by the use of drugs before surgery, and their visual acuities less than 0.3, were regarded as research subjects. Those patients were divided into group A, B and C with 24 eyes of 24 cases in each group . The patients in group A were treated by phacoemulsification combined with intraocular lens implantation, the patients in group B were treated with iris root resection on the basis of treatment in group A, and the patients in group C were treated with trabeculectomy combined with the treatment of group A. The patients were followed up for 6 months. The intraocular pressure, uncorrected visual acuity and complications before and after the surgery were compared. Results Six months after the surgery, the intraocular pressure of group A, group B and groupCwere （I 4. 73 ＋ 3. 06） mmHg, （15. 12 ＋ 2. 78）mmHg and （13. 97 ＋ 2. 24）mmHg respectively. The intraocular pressure of the three groups were decreased comparing with the preoperative ones（P 〈0. 05）. The uncorrected visual acuities of the three groups were all improved, but the differences were not statistically significant between the three groups （P 〉 0.05 ）. Angle closure and adhesions appeared in patients of all the three groups. A few patients had postoperative corneal edema. Fibrinoid exudation of anterior chamber occured in two cases. The differences in postoperative complications between the three groups showed no statistically significant. Conclusion The efficacy of three different surgical methods for the treatment of patients with glaucoma with cataract are similar, and appropriate surgical approach could be chosen according to the patients＇ clinical manifestations.