超声乳化联合房角分离术对急性闭角型青光眼合效果及术后预后研究

The Clinical Effect and Outcome of Phacoemulsification Combined with Trabeculectomy for Acute Primary Angle Closure Glaucoma

目的观察超声乳化吸除联合房角分离术治疗急性闭角型青光眼的临床疗效。方法诊断为原发性闭角型青光眼(APAGG)患者86例(122眼),根据接受手术术式不同,随机分为房角组(A组)和小梁组(B组),比较二组手术前后患者眼压、中央前房深度、手术效果和术后并发症差异。结果患者术后眼压均恢复正常,其中B组术后术后3天、2周和3、6个月、1年眼压显著低于A组(P<0.05);A组患者术后中央前房深度及下降幅度均显著高于B组(P<0.05);总体上看A组手术成功率95.3%,B组90.7%,两组间无显著性差异(P>0.05);术后A组患者在前房炎症、浅前房、脉络膜脱落等并发症发生率均显著少于B组(P<0.05)。结论超声乳化吸除联合小梁切除或房角分离术均可有效治疗APAGG,其中小梁切除在眼压控制方面优于房角分离,房角分离在中央前房深度效果及并发症控制方面优于小梁切除。

Objective To evaluate and compare the clinical effect and safety of phacoemulsification combined with trabeculectomy for acute primary angle-closure glaucoma.Methods A total 67 patients(112 eyes)were divided into trabecular group(group A)and goniosynechialysis group(group B)randomly.Intraocular pressure and central anterior chamber depth before and after surgery,the total treatment effect and postoperative complications was compared.Results Intraocular pressure of all patients recovered after surgery and group B was significantly lower than that of group A at 3 days,2 weeks,3,6 months and 1year after operation(P<0.05).The depth and extent of central anterior chamber in group A were significantly higher than those in group B(P<0.05).Overall,the success rate of operation in group A was 95.3%and group B 90.7%,there was no significant difference between the two groups(P>0.05).Postoperative complications in A group with anterior chamber inflammation,shallow anterior chamber and choroidal detachment were significantly lower than group B(P<0.05).Conclusion phacoemulsification combined with trabeculectomy and phacoemulsification combined with goniosynechialysis to treatment acute primary angle-closure glaucoma with cataract are all safe and effective methods.Among them,trabeculectomy was superior to room angle control in intraocular pressure control.Angle separation was superior to trabeculectomy in central anterior chamber depth and complications control.