晶状体摘除术在原发性闭角型青光眼合并白内障治疗中的应用价值

Application value of cataract extraction surgery in the treatment of primary angle-closure glaucoma and cataract

目的：探讨晶状体摘除术在原发性闭角型青光眼合并白内障治疗中的应用价值。方法选取原发性闭角型青光眼合并白内障患者132例，依据治疗方法不同分为晶状体摘除术治疗组（A组，n＝66）和激光周边虹膜切开术治疗组（ B组，n＝66）。对两组患者的视力、眼压、前房深度及并发症发生情况进行统计分析。结果 A组中术后视力＜0．1的患者0例、0．1～0．3的患者12例，＞0．3～0．4的患者20例、＞0．4的患者34例，分别占总数的0．00％、18．18％、30．30％、51．52％；B组患者中术后视力＜0．1患者的5例，0．1～0．3的患者14例，＞0．3～0．4的患者19例、＞0．4的患者28例，分别占总数的7．58％、21．21％、28．79％、42．42％。 A组中术后视力＜0．1的患者比例显著低于B组（χ2＝5．02，P＜0．05），＞0．4的患者比例显著高于B组（χ2＝7．38，P＜0．05），但两组中视力为0．1～0．3、＞0．3～0．4的患者比例之间的差异均无统计学意义（χ2＝2．71、4．61，均P＞0．05）；手术前两组患者的眼压、前房深度之间的差异均无统计学意义（t＝1．532、1．447，均P＞0．05），手术后A组患者的前房深度显著长于B组（t＝2．571，P＜0．05），但两组患者的眼压之间的差异无统计学意义（ t＝1．032，P＞0．05）；A组角膜水肿1例，一过性高眼压4例，前房积血2例，术后并发症发生率为10．61％，B组角膜水肿1例，一过性高眼压4例，前房积血2例，术后并发症发生率为10．61％，A组术后并发症发生率显著低于B组（χ2＝9．35，P＜0．05）。结论晶状体摘除术较激光周边虹膜切开术在原发性闭角型青光眼合并白内障患者临床治疗中具有较高的应用价值，其更能有效提高患者视力，延长患者前房深度，降低患者的并发症发生率，因此更为安全有效，值得推广。

Objective To investigate the application value of cataract extraction surgery in the treatment of primary angle-closure glaucoma and cataract.Methods 132 patients of primary angle-closure glaucoma and cata-ract were randomly selected,these patients were divided into lensectomy treatment group（A group,n=66） and laser peripheral iridotomy treatment group（B group,n=66） according to the treatment method.The visual acuity,intraocu-lar pressure,anterior chamber depth,and complications of the two groups were analyzed statistically.Results In A group,the visual acuity ＆lt;0.1 was in 0 case,0.1-0.3 in 12 cases,＆gt;0.3-0.4 in 20 cases,＆gt;0.4 in 34 cases, accounting for 0.00%,18.18%,30.30%,51.52%.In B group,the visual acuity ＆lt;0.1 was in 5 cases,0.1-0.3 in 14 cases,＆gt;0.3-0.4 in 19 cases,＆gt;0.4 in 28 cases,accounting for 7.58%,21.21%,28.79%,42.42%.A group of visual acuity ＆lt;0.1 proportion of patients was significantly lower than B group（χ2 =5.02,P〈0.05） ,the propor-tion of patients ＆gt;0.4 was significantly higher than B group（χ2 =7.38,P〈0.05）,but the differences of the propor-tion for 0.1-0.3,＆gt;0.3-0.4 vision between the two groups were not significant（χ2 =2.71,4.61,all P〉0.05）. The differences of the intraocular pressure and anterior chamber depth before surgery between the two groups were not significant（t=1.532,1.447,all P〉0.05）,the anterior chamber depth after surgery in group A was significantly lon-ger than B group（t=2.571,P〈0.05）,but the difference of IOP between the two groups was not significant（t=1.032,P〉0.05）.A group had corneal edema in 1 case,a transient high IOP in 4 cases,2 cases in hyphema,the postoperative complication rate was 10.61%.B group had corneal edema in 1 case,a transient high IOP in 4 cases, 2 cases in hyphema,the postoperative complication rate was 10.61%,the incidence rate of postoperative complica-tions in A group was significantly lower than B group（χ2 =9.35,P〈0.05）.Conclusion The application value of＆amp;nbsp;cataract extraction surgery in the treatment of primary angle -closure glaucoma and cataract is higher than laser peripheral iridotomy,which can more effectively improve visual acuity, prolong anterior chamber depth, reduce inci-dence of complications of patients,so it is more safe and effective,and worthy of promotion.