超声乳化联合小梁切除术治疗青光眼伴白内障

Phacoemulsification combined with trabeculectomy for angle-closure glaucoma with cataract

目的评价超声乳化联合小梁切除术治疗闭角型青光眼伴白内障的临床效果。方法回顾性分析超声乳化联合小梁切除术治疗闭角型青光眼伴白内障32例（38眼），观察手术前后眼压、视力、前房深度及并发症情况。结果术后随访3～12个月。术前平均眼压（25．8±3．9）mm．Hg（1mmHg=0．133kPa），术后平均眼压（14．2±4．1）mmHg，二者差异有统计学意义（t=12．637，P=0．000）。术后高眼压2眼，1眼给予局部降眼压药物治疗，2d后眼压下降至正常范围；另1眼经降眼压药物治疗效果不佳，再次行小梁切除术后，眼压正常。术前视力／〉0．3者11眼（28．9％），术后视力I〉0．3者36眼（94．7％），差异有统计学意义（X^2=34．850，P=0．000）。术前前房深度（2．0±0．3）mm，术后为（3．7±0．4）mm，术后前房深度均明显增加（t=-20．959，P=0．000）。术中发生前房积血3眼（7．9％），术后发生角膜水肿5眼（13．2％），前房炎症反应5眼（13．2％），对症处理后均好转。未见晶状体后囊破裂或后发性白内障等并发症。结论超声乳化联合小梁切除术治疗闭角型青光眼伴白内障可有效改善视力、降低眼压及加深前房。

Objective To evaluate the clinical efficacy of phacoemulsification combined with trabeculectomy for the treatment of angle-closure glaucoma with cataract. Methods Thirty-eight eyes of 32 cases with angle-closure glaucoma with cataract were selected and retrospectively analyzed. All cases underwent phacoemulsification combined with trabeculectomy. The visual acuity, intraocular pressure, anterior chamber depth and complications in pre- and post-operation were observed. Results The follow-up time was 3-12 months. The average intraocular pressure were （25.8±3.9 ）mmHg （1 mmHg = 0. 133 kPa） and （14.2±4. 1 ）mmHg in pre- and post-operation respectively, and the difference was statistically significant （ t = 12. 637, P = 0.000）. The high intraocular pressure after operation occurred in 2 eyes, 1 eye intraocular pressure decreased to normal range after topical anti glaucoma drugs treatment for 2 days, and the other eye received trabeculectomy again. The visual acuity ≥0.3 was in 11 eyes preoperatively and 36 eyes postoperatively . The difference was statistically significant （X^2 = 34. 8500, P = 0. 0000 ）. The anterior chamber depth in pre-and post-operation were （ 2.0±0.3 ） mm and （ 3.7±0.4 ） mm respectively, the difference was statistically significant between before and after treatment. （ t = -20. 959, P = 0. 000 ）. Hyphema occurred in 3 eyes （ 7. 9% ）, corneal edema in 5 eyes （ 13. 2% ）, and anterior chamber inflammation in 5 eyes （ 13.2% ）, they were corrected after symptomatic treatment. No posterior capsular rupture and after-cataract happened. Conclusion Phacoemulsification combined with trabeculectomy for angle-closure glaucoma with cataract can effectively improve vision, reduce intraocular pressure and deepen the anterior chamber depth.