超声乳化联合房角分离治疗白内障合并急性闭角型青光眼

Phacoemulsification combined with goniosynechialysis treating cataract with acute angle-closure glaucoma

目的:分析白内障超声乳化联合房角分离治疗白内障合并急性闭角型青光眼的临床疗效和安全性。方法:回顾性分析本院收治的45例48眼白内障合并急性闭角型青光眼患者,根据治疗方式分为两组,28例30眼予以白内障超声乳化联合房角分离术者为研究组;17例18眼予以白内障超声乳化术联合小梁切除者为对照组。统计两组患者手术前后的视力、眼压、房角关闭程度、中央前房深度和并发症。结果:术前1d,两组患者的最佳矫正视力和房角关闭程度比较,差异无统计学意义(P>0.05);术后7d,1、3、6、12mo,两组患者最佳矫正视力均优于术前1d,且研究组优于对照组,两组房角关闭程度均小于术前,且研究组小于对照组(P<0.05)。组别与时间对患者眼压和前房深度均有影响(P<0.05),且两因素之间无交互作用(P>0.05)。组内对比:术后7d～12mo,两组患者眼压均低于术前1d,术后3、6、12mo研究组眼压低于术后7d(P<0.05),对照组眼压与术后7d差异无统计学意义(P>0.05);术后7d,1、3、6、12mo,两组患者中央前房深度均高于术前1d;术后3、6、12mo,研究组中央前房深度与术后7d相比差异无统计学意义(P>0.05),对照组中央前房深度术后12mo明显低于术后7d(P<0.05)。组间对比:术前1d和术后7d,1、3、6mo,两组患者眼压差异无统计学意义(P>0.05),术后12mo,研究组眼压低于对照组(P<0.05);术前1d,两组患者中央前房深度差异无统计学意义(P>0.05),术后3、6、12mo研究组中央前房深度高于对照组(P<0.05)。结论:白内障超声乳化联合房角分离治疗急性闭角型青光眼疗效确切,中远期疗效尤为突出,且不增加安全风险。

·AIM:To analyze the clinical effect and security of phacoemulsification combining goniosynechialysis to treat cataract accompanied with acute angle-closure glaucoma.·METHODS:The clinical data of totally 45 patients(48 eyes)with cataract and acute angle-closure glaucoma was retrospectively analyzed,including 28 patients(30 eyes)treated with phacoemulsification with goniosynechialysis(the study group)and 17 patients(18 eyes)treated with phacoemulsification with trabeculectomy(the control group).The visual acuity,intraocular pressure,iridocornealis,central anterior chamber depth and complications were compared between groups.·RESULTS:Before surgery,there was no significant difference in best corrected visual acuity and iridocornealis angle between groups(P>0.05).At 7d,1mo,3mo,6mo and 1a after surgery,the best corrected visual acuity of both groups increased,and the study group was higher than the control group;the iridocornealis angle close degree of both groups decreased,and the study group was lower than the control group(P<0.05).Both groups and time had an effect on intraocular pressure and chamber depth of patients(P<0.05),and there was no reciprocal action between the two factors(P>0.05).Compare in groups:7d,1mo,3mo,6mo and 1a after surgery,the intraocular pressure of both groups decreased,and at 3mo,6mo and 1a after surgery,the study group was lower than that at 7d after surgery(P<0.05),the control group was similar to that at 7d after surgery(P>0.05).At 7d,1,3,6mo and 1a after surgery,the chamber depth of both groups were higher than 1d before surgery,3,6mo and 1a after surgery,the study group was similar to that at 7d after surgery(P>0.05),the control group after 12mo was lower than that at 7d after surgery(P<0.05).Compare between groups:Before treatment,7d,1,3 and 6mo after treatment,there was no significant difference between groups in intraocular pressure(P>0.05);at 1a after surgery,IOP of the study group was lower than the control(P<0.05).Before treatment,there was no significant difference between groups in anterior chamber depth(P>0.05);at 3,6mo and 1a after surgery,the study group was higher than the control group(P<0.05).·CONCLUSION:Phacoemulsification combined with goniosynechialysis is effective to treat acute angle-closure glaucoma,with prominent long-term efficacy and the risk is not increased.