两种术式对白内障合并青光眼患者的眼压、视力以及浅前房影响的比较

Comparison of Effects of Two Surgical Procedures for Cataract joint Glaucoma on Intraocular Pressure,Vision and Shallow Anterior Chamber

目的探讨并比较超声乳化白内障吸出+人工晶状体植入联合小梁切除与小切口白内障摘除+人工晶状体植入联合小梁切除两种术式对白内障合并青光眼治疗后患者的眼压、视力以及浅前房的影响。方法选取2009年1月至2015年5月宜宾市第一人民医院眼科收治的白内障合并青光眼患者50例,按抽签法随机分为观察组和对照组,各25例。为观察组行超声乳化白内障吸出术+人工晶状体植入术联合小梁切除术,对照组行小切口白内障摘除术+人工晶状体植入术联合小梁切除术。比较两种术式对白内障合并青光眼治疗后患者的眼压、视力以及浅前房形成率,同时观察并记录患者术后90 d并发症的发生情况。结果两组患者术后3、30、90 d眼压均较治疗前降低并呈上升趋势,观察组上升趋势更慢,两组在组间、不同时点间、组间·不同时点间交互作用比较差异有统计学意义[对照组:(14.2±3.7)、(18.6±4.9)、(21.5±5.3)mm Hg比(46.2±8.4)mm Hg;观察组:(13.9±3.4)、(15.9±3.8)、(17.4±4.8)mm Hg比44.2±9.8)mm Hg](P<0.05)。观察组患者的视力显著高于对照组(0.88±0.09比0.50±0.11)(P<0.01)。观察组浅前房形成率及术后并发症发生率均显著低于对照组[12.0%(3/25)比36.0%(9/25),4.0%(1/25)比28.0%(7/25),P<0.05]。结论采用超声乳化白内障吸出+人工晶状体植入联合小梁切除方法对白内障合并青光眼进行治疗可以有效降低患者眼压、提高患者的视力状况、手术后浅前房可以达到深度稳定,且并发症少、安全性高,患者的顺应性较高,值得进行临床推广。

Objective To explore and compare the effects of ultrasound emulsification cataract suction ＋ intraucular lens implantation and trabeculectomy and small incision cataract extraction ＋ intraccular lens implantation and trabeoulectomy on the intraccular pressure, sight, and shallow anterior chamber in the treatment of cataract complicated with glaucoma. Methods Total of 50 patients with cataract complicated with glaucoma in Yibin First People＇s Hospital from Jan. 2009 to May 2015 were included in the study and divided into an observation group and a control group according to the draw method ,25 eases each. The observation group was treated with the ultrasound emulsification cataract suction combined with intraccular lens implantation and trabeculectomy; the control group was treated with the small incision cataract extraction combined with intraocular lens implantation and trabeculectomy. The effects of the two operations on the intraucular pressure, sight, and shallow anterior chambers of the two groups were compared, and the incidence of postoperative complications in 90 d were observed and recorded. Results The intraccular pressures of the observation group during postoperative 3,30,90 d were all lower than before treatment, but in a gradual increase trend, and the observation group increased slower, there were statistically significant differences between the groups,different time points and the interaction of groups · different time points[ control group： （14.2±3.7） ,（18.6±4.9） ,（21.5 ±5.3） mmHg vs （46.2±8.4） mmHg;observation group： （13.9 ± 3.4）, （ 15.9 ±3.8 ）, （ 17.4 ±4. 8 ） mmHg vs （44.2 ± 9.8 ） mmHg] （ P 〈 0. 05 ）. The postoperative sight value of the observation group was significantly higher than the control group （0. 88 ± 0. 09 vs 0. 50 ±0. 11 ） （ P 〈 0. 01 ）. The anterior chambers formation rate and postoperative complications rate of the observation group were significantly lower than the control group[ 12. 0% （3/25） vs 36. 0% （9/25） ,4. 0% （1/25） vs 28.0% （7/25） ,P 〈 0. 05 ]. Conclusion The application of the ultrasound emulsification cataract suction combined with intraocular lens implantation and trabeculectomy in the treatment of cataract complicated with glaucomatous has less complications and high safety, which can effectively reduce the intraocular pressure, improve the patient＇s sight,with deep stability of anterior chamber after operation,and has high patient compliance, thus is worthy of the clinical promotion.