前房穿刺术联合两种不同手术方式治疗原发性急性闭角型青光眼合并白内障的临床效果

Clinical effect of anterior chamber puncture combined with two different methods in the treatment of primary acute angle closure glaucoma with cataract

目的观察前房穿刺术联合两种不同手术方式治疗原发性急性闭角型青光眼合并白内障的临床效果。方法选择2018年6月至2020年6月广东省东莞东华医院收治的原发性急性闭角型青光眼合并白内障68例患者为研究对象。依据随机数字表法将其分为A组和B组,每组34例。两组行前房穿刺术后,A组行白内障超声乳化+人工晶体植入+房角分离术,B组行小梁切除术。记录并比较两组术前、术后3个月视力(由国际标准视力转化成LogMAR视力)、眼压、角膜内皮计数、视盘神经纤维层(RNFL)厚度,房角开放范围及中央前房深度(ACD)等;观察两组并发症的发生情况。结果术前,两组视力(LogMAR)、ACD、房角开放范围比较,差异无统计学意义(P>0.05)。术后3个月,A组视力(LogMAR)、ACD、房角开放范围高于术前,且A组高于B组,差异有统计学意义(P<0.05);B组视力(LogMAR)、ACD、房角开放范围与术前比较,差异无统计学意义(P>0.05)。术前及术后3个月,两组眼压比较,差异无统计学意义(P>0.05);术后3个月,两组眼压低于术前,差异有统计学意义(P<0.05)。术前及术后3个月,两组RNFL厚度比较,差异无统计学意义(P>0.05)。术前,两组角膜内皮细胞计数比较,差异无统计学意义(P>0.05)。术后3个月,A组角膜内皮细胞计数低于术前,且A组低于B组,差异有统计学意义(P<0.05);B组角膜内皮细胞计数与术前比较,差异无统计学意义(P>0.05)。两组并发症发生率比较,差异无统计学意义(P>0.05)。结论前房穿刺术联合两种不同手术方式均可降低眼压,保护视功能,但联合白内障超声乳化+人工晶体植入+房角分离术可以有效增加前房深度、提高视力,值得在临床进一步推广应用。

Objective To observe the clinical effect of anterior chamber puncture combined with two different methods in the treatment of primary acute angle closure glaucoma with cataract.Methods A total of 68 patients with primary acute angle closure glaucoma with cataract in Dongguan Tungwah Hospital,Guangdong Province from June 2018 to June 2020 were selected as the research subjects.According to random number table method,they were divided into group A and group B,with 34 cases in each group.After anterior chamber puncture,group A was treated with phacoemulsification+intraocular lens implantation+goniosynechialysis,group B was treated with trabeculectomy.Visual acuity(converted from international standard visual acuity to LogMAR visual acuity),intraocular pressure,corneal endothelium count,retinal nerve fiber layer(RNFL)thickness,atrial angle open range and central anterior chamber depth(ACD)were recorded and compared between two groups before and three months after surgery.The incidence of complications in two groups was observed.Results Before surgery,there were no significant differences in visual acuity(LogMAR),ACD,atrial angle open range between two groups(P>0.05).At three months after surgery,the visual acuity(LogMAR),ACD,atrial angle open range of group A were higher those that before surgery,and group A was higher than group B,and the differences were statistically significant(P<0.05);while the visual acuity(LogMAR),ACD,atrial angle open range of group B were not significantly differences from those before surgery(P>0.05).Before and three months after surgery,there was no significant difference in intraocular pressure between two groups(P>0.05).Three months after surgery,intraocular pressure of two groups were lower than those before surgery,and the differences were statistically significant(P<0.05).There were no significant differences in RNFL thickness between two groups before and three months after surgery(P>0.05).Before surgery,there was no significant difference in corneal endothelium count between two groups(P>0.05).Three months after surgery,corneal endothelium count in group A was lower than that before surgery,and group A was lower than group B,and the differences were statistically significant(P<0.05);while corneal endothelium count of group B was not significantly difference from that before surgery(P>0.05).There was no significant difference in the incidence of complications between two groups(P>0.05).Conclusion Anterior chamber puncture combined with two different methods can reduce intraocular pressure and protect visual function,but combined with phacoemulsification+intraocular lens implantation+goniosynechialysis can effectively increase anterior chamber depth and improve visual acuity,which is worthy of further clinical application.