同轴微切口超声乳化术联合小梁切除术治疗青光眼合并白内障的疗效

Efficacy of coaxial micro-incision phacoemulsification combined with trabeculectomy in the treatment of glaucoma combined with cataract

目的观察同轴微切口与小切口超声乳化术联合小梁切除术治疗青光眼合并白内障的疗效。方法选择2010年1月~2016年12月在我院青光眼合并白内障的患者90例(90眼),随机将患者分为观察组和对照组,每组均为45例。对照组采用传统的3 mm切口超声乳化联合小梁切除术,观察组采用1.8 mm的切口超声乳化联合小梁切除术。观察两组治疗后的手术成功率和并发症发生率及治疗前后两组的裸眼视力、散光、眼压、角膜内皮细胞密度、六角细胞比例、角膜内皮细胞变异系数和中央角膜厚度的变化。结果观察组的手术成功率为97.78%,对照组的成功率为91.11%,两组的手术成功率差异无统计学意义(χ2=0.847,P>0.05)。治疗前的裸眼视力、散光、眼压、角膜内皮细胞密度、六角细胞比例、角膜内皮细胞变异系数和中央角膜厚度差异无统计学意义(P>0.05)。治疗后两组的裸眼视力、角膜内皮细胞变异系数和中央角膜厚度较治疗前明显升高(P<0.01),裸眼视力和中央角膜厚度观察组升高更为明显(P<0.01),对照组的角膜内皮细胞变异系数升高水平更为明显(P<0.01)。治疗后对照组的散光水平较治疗前和观察组明显升高(P<0.01)。治疗后两组的眼压,角膜内皮细胞密度和六角细胞比例较治疗前明显降低(P<0.01),而对照的角膜内皮细胞密度和六角细胞比例降低水平更为明显(P<0.01),两组的眼压差异无统计学意义(P>0.05)。对照组的术后并发症发生率为31.11%,明显高于观察组的8.89%(χ~2=5.625,P<0.05)。结论同轴微切口超声乳化术联合小梁切除术治疗青光眼合并白内障的疗效优于传统手术方式,在减少术后散光和角膜内皮细胞的损伤和降低并发症方面具有明显的优势。

Objective To observe the curative effect of coaxial micro-incision and small incision phacoemulsification Combined with trabeculectomy in the treatment of glaucoma combined with cataract. Methods 90 patients（90 eyes） with glaucoma complicated with cataract in our hospital from January 2010 to December 2016 were selected and randomly divided into observation group and control group,with 45 cases in each group.The control group was treated with tradi- tional 3 mm incision phacoemulsification combined with trabeculeetomy, the observation group was treated with 1.8 mm incision phacoemulsification combined with trabeculectomy. The success rate and complications,the uncorrected visual acuity, astigmatism, intraocular pressure, corneal endothelial cell density, hexagonal cell ratio, corneal endothelial cell variation coefficient and the change of central corneal thickness before and after treatment between the two groups were observed. Results The operation success rate of the observation group was 97.78%, while the success rate of the control group was 91.11%. There was no significant difference in the operation success rate between the two groups （x2=0.847, P〉0.05）. There were no significant differences in uncorrected visual acuity, astigmatism, intraocular pressure, corneal endothelial cell density, hexagonal cell ratio, corneal endothelial cell variation coefficient and central corneal thick- ness before treatment （P〉0.05）. The uncorrected visual acuity, corneal endothelial cell variation coefficient and central corneal thickness of the two groups were significantly higher than those before treatment（P〈0.01）, and the uncorrected visual acuity and the central corneal thickness in the observation group were significantly higher（P〈0.01）. The corneal endothelial cell variation coefficient in the control group is more obvious （P〈0.01）. After treatment, the astigmatism level of the control group was significantly higher than that before treatment and observation group（P〈0.01）. The intraoc- ular pressure（IOP）, corneal endothelial cell density and hexagonal cell ratio in the two groups were significantly lower than those before treatment（P〈0.01）, while the corneal endothelial cell density and hexagonal cell ratio decreased more significantly in the control group（P〈0.01） There was no significant difference in intraocular pressure between thetwo groups（P〉0.05）. The incidence of postoperative complications was 31.11% in the control group, significantly higher than that in the observation group （x2=5.625, P〈0.05）. Conclusion The curative effect of coaxial micro-incision pha- coemulsification combined with trabeculectomy is higher than that of traditional surgical method in the treatment of glaucoma with cataract. The former surgical approach has obvious advantages in reducing postoperative astigmatism and corneal endothelial cell damage and reducing complications.