不同房角关闭状态闭角型青光眼合并白内障的手术方式探讨

Research on surgical methods for angle-closure glaucoma with different closure conditions accompanied with cataract

目的：观察白内障超声乳化摘除联合房角分离术和白内障超声乳化摘除联合小梁切除术治疗不同房角关闭状态的闭角型青光眼合并白内障的疗效和安全性。方法：选择在本院治疗的原发性闭角型青光眼合并白内障65例70眼,根据房角关闭状态分别实施白内障超声乳化摘除联合房角分离术（A组）和白内障超声乳化摘除联合小梁切除术（B组）,其中A组30例33眼,B组35例37眼。观察两组手术前后眼压、视力、前房深度以及并发症情况。随访时间6~8（平均6.5）mo。结果：手术后1mo A组与B组各组的平均眼压与术前比较,差异有统计学意义（P〈0.05）。各组术前与术后1wk视力比较,差异有统计学意义（P〈0.05）。各组术后1mo与术前平均前房深度比较,差异有统计学意义（P〈0.05）。两组之间术后1mo平均前房深度比较,差异无统计不意义（P〉0.05）。两组之间术后并发症比较,差异无统计学意义（P〉0.05）。结论：临床上可根据原发性闭角型青光眼合并白内障患者的房角关闭状态选择适宜的治疗方式。

AIM ： To observe the efficacy and safety of the phacoemulsification combined with goniosynechialysis and the phacoemulsification combined with trabeculectomy for angle-closure glaucoma（ ACG） with different closure conditions accompanied with cataract.METHODS： A total of 65 patients（ 70 eyes） with primary ACG accompanied with cataract were selected fromthose admitted in our hospital and were given phacoemulsification with goniosynechialysis（ group A,30 patients with 33 eyes） and the phacoemulsification with trabeculectomy（ group B, 35 patients with 37 eyes）according to the conditions of the closed anterior angle,respectively. The two groups of patients were observed for preoperative and postoperative intraocular pressure（ IOP）, vision, anterior chamber depth, and complications,and were followed up for 6. 5mo（ 6-8mo）on average.RESULTS： Mean postoperative IOP in either group A or group B at 1mo after operation was of statistically significant difference,compared with mean preoperative IOP（ P0. 05）. Postoperative 1-week vision in each group was of statistically significant difference,compared with preoperative vision（ P 0. 05）. Postoperative 1-month mean anterior chamber depth in each group was of statistically significant difference, compared with preoperative anterior chamber depth（ P 0. 05）. There were no significant differences between the two groups on postoperative 1-month mean anterior chamber depth（ P0. 05） and postoperative complications（ P0. 05）.CONCLUSION： Clinical doctors can choose appropriate treatment according to different conditions of the closed anterior angle in patients with primary angle-closure glaucoma.