持续高眼压状态下白内障青光眼联合手术

Phacoemulsification combined with trabeculectomy in patients with persistent high intraocular pressure

目的探讨持续性高眼压状态下晶状体超声乳化联合小梁切除术的效果。方法本研究采用前瞻性病例对照研究。随机选取郴州市第一人民医院2015年10月至2017年10月原发性闭角型青光眼伴发白内障经各种方法治疗后仍不能降低眼压者30例(30眼)为临床试验组,经治疗后眼压降至正常者60例(60眼)为对照组。两组均行晶状体超声乳化联合小梁切除术,术后随访6个月,对比两组的手术效果。结果术后3个月,两组的视力均较术前提高。术后两组眼压得到有效的控制。手术后前房炎症反应平均消退时间试验组及对照组分别为(12.5±4.5)d及(4.2±2.3)d。术后6个月,试验组手术成功率为90.0%(27/30);对照组为93.3%(56/60),两组差异无统计学意义(χ^(2)=0.019,P=0.889)。两组均未发生爆发性脉络膜上腔出血、大泡性角膜病变、视网膜脱离或眼内炎等严重并发症。结论持续性高眼压状态下晶状体超声乳化联合小梁切除术安全有效,但术后反应持续时间较久。

Objective To investigate the efficacy of phacoemulsification combined with trabeculectomy in patients with persistent high intraocular pressure(IOP).Methods This was a prospective case-control study.A total of 30 eyes of 30 of primary angle closure glaucoma with cataract cases with persistent high IOP after every treatment from Oct.2015 to Oct.2017 in the First People’s Hospital of Chenzhou were collected as the clinical trial group.The control group included 60 eyes of 60 primary angle-closure glaucoma with cataract cases with normal IOP after treatment.All cases received phacoemulsification combined with trabeculectomy.The efficacy between two groups was compared after 6 months of follow-up.Results After 3 months follow-up,the visual acuity of both groups improved.The IOP was effectively controlled after operation.The mean time of regression of anterior chamber inflammation after operation in the trial group and the control group was(12.5±4.5)days and(4.2±2.3)days respectively.After 6 months of follow-up,the success rate of operation was 90.0%(27/30)in the trial group and 93.3%(56/60)in the control group(χ^(2)=0.019,P=0.889).No severe complication such as fulminant suprachoroidal hemorrhage,bullous keratopathy,retinal detachment or endophthalmitis occurred.Conclusion Phacoemulsification combined with trabeculectomy in patients with persistent high IOP is safe and effective,but the reaction lasts for a longer time.