伴白内障的青光眼手术与激光治疗的效果比较

Comparison of the efficacy between surgery and laser therapy for glaucoma with cataract

目的比较超声乳化术与激光周边虹膜切开术(LPI)两者治疗伴白内障的原发性闭角型青光眼(PACG)手术效果。方法回顾性分析郑州大学第一附属医院2018年5月至2019年6月伴白内障的PACG 51例(59眼)的临床资料,患者分为两组:超乳组,28眼,行超声乳化术;激光组,31眼行LPI。术后观察眼压、视力及前房参数等。结果术前超乳组与激光组眼压为(23.32±3.31)mmHg和(22.79±2.89)mmHg(1 mmHg=0.133 kPa),差异无统计学意义(t=0.658,P=0.513)。两组术后各时间点眼压均较术前下降,术后1个月和3个月超乳组眼压均低于激光组,差异有统计学意义(t=3.648,6.542;P=0.001,0.000)。术前超乳组最佳矫正视力(logMAR)为0.35±0.10,与激光组的视力0.33±0.09相比,差异无统计学意义(t=0.855,P=0.396)。术后3个月超乳组视力较术前明显提高(t=11.829,P=0.000),激光组无明显变化(t=-1.710,P=0.098)。术后3个月,超乳组中央前房深度(t=-30.553,P=0.000)、周边前房深度(上、下、鼻及颞侧)(t=-18.911,-21.389,-15.638,-20.983;均P=0.000)、前房容积(t=-19.205,P=0.000)及前房角(t=-16.693,P=0.000)均较术前增加,且前房角全周开放。而激光组前房各指标改善均不如超乳组,术后仍有8眼(25.8%)前房角关闭超过180°。结论与LPI相比,超声乳化术治疗伴白内障的PACG可降低眼压、提高视力,明显改善前房参数。

Objective To compare the efficacy between phacoemulsification and laser peripheral iridotomy(LPI)for primary angle-closure glaucoma(PACG)with cataract.Methods The clinical data of 59 eyes of 51 cases of PACG with cataract from May 2018 to Jun.2019 in First Affiliated Hospital of Zhengzhou University were retrospectively analyzed.The patients were divided into two groups.Phacoemulsification was performed in 28 eyes of the phacoemulsification group,and LPI was performed in 31 eyes of laser group.Intraocular pressure,visual acuity and the parameters of anterior chamber were observed after surgery.Results The preoperative intraocular pressure in phacoemulsification group and laser group were(23.32±3.31)mmHg and(22.79±2.89)mmHg(1 mmHg=0.133 kPa)respectively.The difference was not statistically significant(t=0.658,P=0.513).The intraocular pressure of the two groups were decreased at each time points after surgery.Intraocular pressure in the phacoemulsification group was lower than that in the laser group at 1 and 3 months after surgery,and the difference was statistically significant(t=3.648,6.542;P=0.001,0.000).The difference was not statistically significant in the best corrected visual acuity(logMAR)of the phacoemulsification group 0.35±0.10 and laser group 0.33±0.09 before surgery(t=0.855,P=0.396).At 3 months after surgery,the visual acuity of the phacoemulsification group was significantly improved(t=11.829,P=0.000),while that of the laser group was not significantly changed(t=-1.710,P=0.098).At 3 months after surgery,the central anterior chamber depth(t=-30.533,P=0.000),the peripheral anterior chamber depth(superior,inferior,nasal and temporal)(t=-18.911,-21.389;-15.638;-20.983,all P=0.000),the anterior chamber volume(t=-19.205,P=0.000)and the anterior chamber angle(t=-16.693,P=0.000)in the phacoemulsification group were all increased.And the anterior chamber angle was open completely.However,the improvement of anterior chamber indexes in the laser group was worse than that in the phacoemulsification group.The anterior angle closure after surgery of 8 eyes(25.8%)were still more than 180°.Conclusion Compared with LPI,phacoemulsification for the treatment of PACG with cataract can reduce intraocular pressure,improve vision,and significantly improve anterior chamber parameters.