超声乳化联合房角分离术治疗闭角型青光眼合并白内障的临床效果分析

Clinical analysis of phacoemulsification combined with goniosynechialysis for the treatment of angle-closure glaucoma with cataract

目的观察白内障超声乳化吸除人工晶状体植入联合房角分离术治疗原发性闭角型青光眼（PACG）合并白内障的临床效果.方法回顾性分析天津市黄河医院接受白内障超声乳化吸除人工晶状体植入联合房角分离术的PACG 合并白内障患者71 例,共98 眼;男21 例（30 眼）,女50 例（68 眼）,年龄53～94 岁,平均（73.94±6.43）岁.包括：急性闭角型青光眼缓解期47 例,64 眼,为急闭组;慢性闭角型青光眼进展期24 例,34 眼,为慢闭组.观察并比较2 组患者手术前后矫正视力、眼压（IOP）、房角、中央前房深度（CCT）、降眼压药物使用次数以及术后并发症发生情况,随访6 个月.结果随访期末,2 组术后矫正视力均较术前明显提高,眼压较术前明显下降,CCT 较术前明显加深,房角较术前均明显增宽,降眼压药物（点及口服）应用数量减少（P 〈 0.01）,2 组间术前和术后视力、IOP、房角差异无统计学意义（P 〉 0.05）;2 组间术前和术后CCT 均是慢闭组高于急闭组（P 〈 0.05）;慢闭组术后无药物眼压控制率为76.5%（26/34）,8 只眼需点眼药（0.50±0.12）次,而急闭组为100%（64/64）,术后均未用药.2 组共有14 眼发生角膜水肿,8 眼出现虹膜纤维性渗出,无其他严重并发症.结论白内障超声乳化吸除人工晶状体植入联合房角分离术可以有效降低眼压、提高视力,术后并发症少,是治疗PACG 合并白内障安全有效的术式.

Objective To investigate the clinical effects of phacoemulsification combined with goniosynechialysis on the treatment of primary angle-closure glaucoma (PACG) with cataract. Methods The retrospective review included 71 patients (98 eyes) with PACG and cataract treated in Tianjin Huanghe Hospital. Patients were underwent phacoemulsification and intraocular lens implantation combined goniosynechialysis. Among these patients, there were 21 males (30 eyes) and 50 females (68 eyes). Patients ranged in age from 53 to 94 years old, everage (73.94 ± 6.43) years old. They were divided into acute angle-closure glaucoma with cataract group (47 patients, 64 eyes) and chronic angle-closure glaucoma with cataract group (24 patients, 34 eyes). The visual acuity, intraocular pressure (IOP), anterior chamber angle, anterior chamber depth (CCT), topical and oral medications and surgical complications were observed before and after surgery in two groups. All the patients were followed up for 6 months. Results At the end of follow-up, postoperative visual acuity, IOP, CCT, anterior chamber angle and IOP-lowing medicine (topical and oral medications) were all improved in the two groups compared with those of preoperative levels (all P < 0.01). There were no statistical differences in preoperative or postoperative average visual acuity, IOP and anterior chamber angle between two groups (all P > 0.05). Values of CCT were significantly higher before and after operation in chronic angle-closure glaucoma with cataract group than those of acute angle-closure glaucoma with cataract group (P < 0.05). No drug-control rate of intraocular pressure was 76.5% (26/34) for chronic angle-closure glaucoma with cataract group than that of acute angle-closure glaucoma with cataract group (100%, 64/64). There was no need on topical medication in acute angle-closure glaucoma with cataract group. There were 14 eyes had corneal edema and 8 eyes appeared iris fibrous exudation in two groups, while no other serious complications. Conclusion For patients with PACG and cataract, the combined surgery of phacoemulsification and goniosynechialysis is a safe and effective therapy that can improve visual acuity and reduce IOP with fewer complications.