开角型青光眼合并白内障患者不同手术方式治疗效果比较

Comparison of clinical outcomes of different surgical methods in treatment of open-angle glaucoma complicated with cataract

目的比较原发性开角型青光眼合并白内障患者两种不同手术方式治疗的临床效果。方法选择2014年1月-2015年5月在哈尔滨医科大学附属第一医院眼科医院就诊的原发性开角型青光眼合并白内障患者78例,根据分段随机化法分为A组(39例,40只眼)和B组(39例,40只眼)。A组行白内障超声乳化+人工晶状体植入术+小梁切除术;B组行白内障小切口摘除+人工晶状体植入术+小梁切除术。比较术后1周、1个月两组患者视力、眼压和手术并发症发生率。结果 A组术后前房炎性反应发生率明显低于B组(10.0%vs 22.5%,P<0.05)。两组其他手术并发症发生率相似(P>0.05)。两组患者术后1周、1个月视力、眼压均较术前明显改善(P<0.05)。而两组术后1周、1个月视力、眼压差异无统计学意义(P>0.05)。结论原发性开角型青光眼合并白内障患者经白内障小切口摘除+人工晶状体植入术+小梁切除术或白内障超声乳化+人工晶状体植入术+小梁切除术治疗均有确切的效果,可显著改善视力和眼压,但后者前房炎性反应的发生率明显更低,值得推广。

Objective To study the clinical outcomes of different surgical methods in treatment of open-angle glaucoma complicated with cataract. Methods Seventy-eight cases with open-angle glaucoma complicated with cataract were enrolled in this study in the first Affiliated Hospital of Harbin Medical University from January 2014 to May 2015. The patients were randomly divided into two groups： group A （39 cases, 40 eyes） and group B （39 cases, 40 eyes）. Patients in group A underwent phacoemulsification with intraocular lens implantation and trabeculectomy, while group B underwent small incision cataract extraction with intraocular lens implantation and trabeculectomy. The visual acuity, intraocular pressure at 1 week and 1 month after surgery, and the incidence of operative complications within 1 month after surgery were compared between the two groups. Results The incidence of postoperative anterior chamber inflammation was significantly lower in group A than that of group B （10.0% vs 22.5%, P 〈 0.05）, while the incidence of other complications was similar in the two groups （P 〉 0.05）. The postoperative visual acuity and intraocular pressure at 1 week and 1 month after surgery improved significantly after surgery in both two groups. But there was no significant difference in postoperative visual acuity and intraocular pressure levels between two groups （P 〉 0.05）. Conclusion Both the two surgery methods can effectively improve postoperative visual acuity and ocular pressure in patients with open-angle glaucoma and cataract. But, there are less complications in patients undergoing phacoemulsification with intraocular lens implantation and trabeculectomy.