白内障人工晶体植入联合小梁切除术治疗老年白内障合并急性闭角型青光眼的临床研究

Clinical study of treatment of phacoemulsification and intraocular lens implantation combined with trabeculectomy in elderly cataract patients with acute angle-closure glaucoma

目的探讨白内障人工晶体植入联合小梁切除术对老年白内障合并急性闭角型青光眼患者围术期并发症及术后康复的影响,为治疗该病症提供方法。方法回顾性分析2017年1月-2019年12月于本院住院治疗的老年白内障合并急性闭角型青光眼患者85例(102眼)的临床资料。根据患者手术类型分为观察组(n=40,49眼)和对照组(n=45,53眼)。观察组接受超声乳化吸除术人工晶体植入联合小梁切除术,对照组接受超声乳化吸除术人工晶体植入。观察并比较2组术眼的围术期并发症情况、治疗3个月时的裸眼视力和眼压。结果观察组患者的手术眼角膜水肿、前房炎症、前房出血、囊膜撕裂和黄斑水肿的发生率分别为14.29%、10.20%、6.12%、4.08%和4.08%,对照组分别为18.87%、11.32%、1.89%、5.66%和3.77%,组间比较差异均无统计学意义(P>0.05)。治疗3个月时,2组术眼的裸眼视力均较同组治疗前明显改善(P<0.05),而观察组视力明显优于对照组(P<0.05)。2组术眼的眼压均均较同组治疗前明显下降(P<0.05),而观察组的下降幅度明显大于对照组[(21.49±2.55)mmHg vs(20.41±2.36)mmHg,P<0.05]。结论白内障人工晶体植入联合小梁切除术治疗老年白内障合并急性闭角型青光眼患者的疗效显著,能有效提高裸眼视力,降低眼压,且不会增加围术期并发症发生,安全性较好,具有一定的临床应用价值。

Objective To explore the effect of intraocular lens implantation combinedwith trabeculectomy on perioperative complications and postoperative rehabilitation of elderly cataract patients with acute angle-closure glaucoma,and provide methods for the treatment of this disease.Methods The clinical data of 85 elderly cataract patients(102 eyes)complicated with acute angle-closure glaucoma who were hospitalized in our hospital from January 2017 to December 2019 were retrospectively analyzed.They were divided into observation group(n=40,49 eyes)and control group(n=45,53 eyes)according to the type of operation.The observation group received phacoemulsification and intraocular lens implantation combined with trabeculectomy,while the control group received phacoemulsification and intraocular lens implantation.The perioperative complications of the operating eyes,the naked vision and intraocular pressure at 3 months of treatment were observed and compared between the two groups.Results The incidence of corneal edema,anterior chamber inflammation,anterior chamber hemorrhage,capsular tear andmacular edema in the observation groupwere 14.29%,10.20%,6.12%,4.08%and 4.08%,respectively,while those in the control group were 18.87%,11.32%,1.89%,5.66%and 3.77%,respectively.There was no significant difference between the two groups(P>0.05).At 3 months of treatment,the naked vision of the two groups were significantly improved compared with the same group before treatment(P<0.05),while the vision of the observation group was significantly better than that of the control group(P<0.05).The intraocular pressure of the operating eyes of the two groups was significantly lower than that of the same group before treatment(P<0.05),while the reduction range in the observation group was significantly greater than that of the control group[(21.49±2.55)mmHg vs(20.41±2.36)mmHg,P<0.05].Conclusion Intraocular lens implantation combined with trabeculectomy is effective in the treatment of elderly cataract patients with acute angle-closure glaucoma.It can effectively improve naked vision and reduce intraocular pressurewithout increasing perioperative complications.It has good safety and certain clinical application value.