白内障超声乳化手术联合内镜下睫状体光凝治疗青光眼的效果研究

Effect of cataract phacoemulsification combined with endoscopic ciliary body photocoagulation for glaucoma

目的探究与分析白内障超声乳化手术联合内镜下睫状体光凝治疗青光眼的临床效果。方法选取2018年6月至2020年6月聊城市中医医院眼科收治的120例青光眼合并白内障患者,男66例,女54例,年龄(59.87±2.33)岁,年龄范围为49~72岁。按照手术方法不同将患者分为小梁切除组(n=56)与联合手术组(n=64),小梁切除组实施小梁切除术治疗,联合手术组给予内镜下睫状体光凝术+白内障超声乳化吸除术+人工晶状体手术治疗,比较两组患者术前及术后1个月的眼压变化、角膜内皮细胞水平、视力矫正情况,同时观察并记录治疗期间的并发症发生情况。结果两组患者术前眼压比较、术前角膜内皮细胞水平比较、术前视力情况比较,差异均无统计学意义(P>0.05)。术后1个月,小梁切除组眼压[(15.98±3.27)mmHg,1 mmHg=0.133 kPa]低于术前[(25.14±4.56)mmHg],联合手术组眼压[(13.55±4.37)mmHg]低于术前[(25.20±5.14)mmHg],且联合手术组眼压低于小梁切除组;联合手术组细胞面积变异系数[(37.25±5.40)%]、六角形细胞比例[(55.43±4.27)%]、平均细胞面积[(409.87±50.33)μm^(2)]均低于小梁切除组[(43.10±5.33)%、(62.66±5.69)%、(553.50±46.25)μm^(2)],角膜内皮细胞密度[(2310.93±320.96)个/mm^(2)]高于小梁切除组[(1750.58±226.34)个/mm^(2)];联合手术组视力矫正情况优于小梁切除组,差异均有统计学意义(P<0.05)。联合手术组并发症发生率[1.6%(1/64)]低于小梁切除组[17.9%(10/56)],差异有统计学意义(P<0.05)。结论白内障超声乳化手术联合内镜下睫状体光凝治疗青光眼可有效帮助降低眼压,改善视力,保障角膜内皮细胞结构的完整性,且治疗期间无明显并发症,安全性高。

Objective To explore and analyze the clinical effect of cataract phacoemulsification combined with endoscopic ciliary body photocoagulation in the treatment of glaucoma.Methods A total of 120 patients with glaucoma and cataract admitted to the department of Ophthalmology of Liaocheng Hospital of Traditional Chinese Medicine from June 2018 to June 2020 were selected.There were 66 males and 54 females,aged(59.87±2.33)years old,and the age range was 49 to 72 years.Patients were divided into trabeculectomy group(n=56)and combined surgery group(n=64)by different surgical methods.The trabeculectomy group was treated with trabeculectomy,and the combined surgery group was treated with endoscopic ciliary body photocoagulation and phacoemulsification of cataract and intraocular lens surgery,compare the changes in intraocular pressure,corneal endothelial cell levels,and vision correction of the two groups before and 1 month after surgery.At the same time,observe and record the occurrence of complications during the treatment.Results There were no statistically significant differences in the comparison of intraocular pressure,corneal endothelial cell level,and visual acuity before operation between the two groups of patients(P>0.05).One month after the operation,the intraocular pressure of the trabeculectomy group[(15.98±3.27)mmHg,1 mmHg=0.133 kPa]was lower than the preoperative[(25.14±4.56)mmHg],and the intraocular pressure of the combined operation group[(13.55±4.37)mmHg]is lower than preoperative[(25.20±5.14)mmHg],and the intraocular pressure of the combined surgery group was lower than that of trabeculectomy group;the cell area variation coefficient of the combined operation group[(37.25±5.40)%],the proportion of hexagonal cells[(55.43±4.27)%],the average cell area[(409.87±50.33)μm^(2)]were lower than the trabeculectomy group[(43.10±5.33)%,(62.66±5.69)%,(553.50±46.25)μm^(2)],corneal endothelial cell density[(2310.93±320.96)cells/mm^(2)]It was higher than that of the trabeculectomy group[(1750.58±226.34)cells/mm^(2)];the vision correction of the combined surgery group was better than that of the trabeculectomy group,and the differences were statistically significant(P<0.05).The incidence of complications in the combined surgery group[1.6%(1/64)]was lower than that in the trabeculectomy group[17.9%(10/56)],and the difference was statistically significant(P<0.05).Conclusion Cataract phacoemulsification combined with endoscopic ciliary body photocoagulation for glaucoma can effectively help reduce intraocular pressure,improve vision,and ensure the structural integrity of corneal endothelial cells.There are no obvious complications during the treatment,and the safety is high.