微创光凝术联合超声乳化人工晶状体植入术治疗青光眼合并白内障的疗效观察

Minimally invasive photocoagulation combined with phacoemulsification and intraocular lens implantation in treatment of glaucoma complicated with cataract

目的研究微创光凝术联合超声乳化人工晶状体植入术治疗青光眼合并白内障的临床价值。方法回顾性收集2018年5月至2019年12月本院收治的青光眼合并白内障患者97例(106眼)。按手术方式分为光凝组(n=51例,57眼)与传统组(n=46例,49眼),光凝组予微创光凝术联合超声乳化人工晶状体植入术,传统组予小梁切除术联合超声乳化人工晶状体植入术,评估手术效果,比较两组患者术前与术后1 d、1周、1个月眼压变化,记录术前与术后1周、1个月、6个月最佳矫正视力(BCVA)、前房深度、平均视野损失,比较两组患者术前与术后6个月角膜内皮细胞丢失情况(角膜内皮细胞密度、内皮细胞变异系数、六角细胞比例),统计两组患者手术并发症。结果光凝组、传统组的手术效果对比差异无统计学意义(P>0.05);光凝组、传统组术后不同时间眼压均较术前降低(P<0.05),传统组术后1 d眼压为(14.12±3.95)mmHg(1 mmHg=0.133 kPa),高于光凝组的(12.35±4.17)mmHg(P<0.05),其余时间点对比差异无统计学意义(P>0.05);光凝组、传统组术后不同时间BCVA均较术前上升(P<0.05),光凝组术后1周、1个月及6个月BCVA(LogMAR)分别为(0.67±0.14)、(0.70±0.13)、(0.68±0.15),均高于传统组的(0.59±0.11)、(0.63±0.09)、(0.60±0.11)(均P<0.05);光凝组、传统组术后不同时间前房深度均较术前上升(均P<0.05),组间不同时间对比差异均无统计学意义(均P>0.05);光凝组、传统组手术前后不同时间视野缺损情况比较差异无统计学意义(P>0.05);光凝组术后6个月角膜内皮细胞密度为(2367.45±268.89)个/mm^(2),高于传统组的(2198.52±200.16)个/mm^(2)(P<0.05);光凝组手术并发症发生率低于传统组[15.79%(9/57)比28.57%(14/49)],但差异无统计学意义(P>0.05)。结论微创光凝术联合超声乳化人工晶状体植入术治疗青光眼合并白内障手术效果与常规小梁切除术联合超声乳化人工晶状体植入术相似,但前者微创,更能促进术后视力恢复,对角膜内皮细胞功能影响小,眼内炎发生风险较低。

Objective To study the clinical value of minimally invasive photocoagulation combined with phacoemulsification and intraocular lens implantation in the treatment of glaucoma complicated with cataract.Methods A retrospective study was conducted in 97 patients(106 eyes)with glaucoma and cataract who were admitted and treated in our hospital from May,2018 to December,2019.According to the surgical methods,they were divided into a photocoagulation group(n=51,57 eyes)and a traditional group(n=46,49 eyes).The photocoagulation group were treated with minimally invasive photocoagulation,phacoemulsification,and intraocular lens implantation,and the traditional group with trabeculectomy,phacoemulsification,and intraocular lens implantation.The surgical results were evaluated.The intraocular pressures before and 1 d,1 week,and 1 month after operation were compared between the two groups.The best corrected visual acuities(BCVA),anterior chamber depths,and average visual field losses before and 1 week,1 month,and 6 months after operation were recorded.The corneal endothelial cell losses,including corneal endothelial cell densities,endothelial cell variation coefficients,and hexagonal cell ratios,were compared between the two groups before and 6 months after surgery.The incidences of complications were statistically analyzed.Results There was no statistical difference in surgical effect between the two groups(P>0.05).The intraocular pressures 1 d,1 week,and 1 month after operation were lower than those before operation in both groups(all P<0.05).The intraocular pressure of the traditional group 1 d after surgery was higher than that of the photocoagulation group[(14.12±3.95)mmHg vs.(12.35±4.17)mmHg;P<0.05].There were no statistical differences in intraocular pressure 1 week and 1 month after operation between these two groups(both P>0.05).The BCVA's 1 week,1 month,and 6 months after surgery were higher than those before surgery in both groups(all P<0.05).The BCVA's(LogMAR)1 week,1 month,and 6 months after operation were higher in the photocoagulation group than in the traditional group[(0.67±0.14)vs.(0.59±0.11),(0.70±0.13)vs.(0.63±0.09),and(0.68±0.15)vs.(0.60±0.11);all P<0.05].The anterior chamber depths 1week,1month,and 6months after surgerywere bigger than those before surgery(all P<0.05).There were no statistical differences in anterior chamber depth and visual field defect between groups at different times(all P>0.05).The corneal endothelial cell density 6 months after surgery was higher in the photocoagulation group than in the traditional group[(2367.45±268.89)/mm^(2) vs.(2198.52±200.16)/mm^(2);P<0.05].There was no statistical difference in the incidence of surgical complications between the two groups[15.79%(9/57)vs.28.57%(14/49);P>0.05].Conclusion Minimally invasive photocoagulation combined with phacoemulsification and intraocular lens implantation can achieve similar effect to trabeculectomy combined with phacoemulsification and intraocular lens implantation in treatment of glaucoma complicated with cataract.However,the former can promote postoperative vision recovery due to its minimally invasive characteristic,and has less influence on corneal endothelial cell function and lower risk of endophthalmitis.