超声乳化及IOL植入联合小梁切除术治疗年龄相关性白内障合并急性PACG

Phacoemulsification and IOL implantation combined with trabeculectomy in the treatment of age-related cataract complicated with acute PACG

目的:探讨微切口超声乳化术及超薄人工晶状体植入联合小梁切除术治疗年龄相关性白内障合并急性原发性闭角型青光眼(PACG)的疗效。方法:回顾性研究。选择2017-01/2020-07我院收治的年龄相关性白内障合并急性PACG患者85例85眼,根据患者手术方案分为对照组(39例39眼)行1.8mm微切口超声乳化术并植入超薄人工晶状体,研究组(46例46眼)行1.8mm微切口超声乳化术并植入超薄人工晶状体联合小梁切除术。比较两组患者术前,术后1、3、6mo最佳矫正视力(BCVA)、眼压、前房角宽度分级、角膜内皮细胞数目、手术并发症。结果:术后1、3、6mo,两组患者BCVA(LogMAR)和眼压均较术前降低(均P<0.05),且研究组患者(LogMAR)和眼压均低于对照组(均P<0.05);两组患者前房角宽度分级NⅠ级占比上升、NⅣ级占比下降(P<0.05),且研究组的NⅠ级占比高于对照组(P<0.05)。两组间患者角膜内皮细胞数目无差异(P>0.05)、并发症发生率比较无差异(28%vs 26%;P>0.05)。结论:行1.8 mm微切口超声乳化术并植入超薄人工晶状体联合小梁切除术治疗年龄相关性白内障合并急性PACG可以显著降低眼压,改善青光眼对视力损害,且对角膜内皮细胞损伤小。

AIM:To investigate the curative effect of microincision phacoemulsification and ultra-thin artificial lens implantation combined with trabeculectomy in the treatment of age-related cataract complicated with acute primary angle-closure glaucoma(PACG).METHODS:Totally 85 elderly cataract patients(85 eyes)with acute PACG admitted between January 2017 and July 2020 were enrolled.According to the operation method,they were divided into study group(46 cases,46 eyes)and control group(39 cases,39 eyes).The control group was treated with 1.8mm microincision phacoemulsification and ultra-thin artificial lens implantation,while the study group was treated with trabeculectomy on the basis of the treatment of control group.The best corrected visual acuity(BCVA),intraocular pressure,anterior chamber angle width classification,corneal endothelial cell count and surgical complications of the two groups were compared.RESULTS:Compared with the same group before operation,the BCVA(LogMAR)of the two groups was significantly reduced at 1,3 and 6mo after operation(all P<0.05),and the study group had lower LogMAR BCVA than the control group(all P<0.05).At 1,3 and 6mo after operation,intraocular pressure of the two groups was significantly reduced(P<0.05),and the study group had lower intraocular pressure than the control group(P<0.05).Meanwhile,the proportion of anterior chamber angle width grade NⅠwas increased,and the proportion of grade NⅣwas reduced in the two groups(P<0.05).The proportion of grade NⅠwas higher in the study group than in the control group(P<0.05).No significant differences were found between the two groups in terms of corneal endothelial cell count(P>0.05)and the incidence of complications(28%vs 26%;P>0.05).CONCLUSION:For patients with senile cataract complicated with acute PACG,trabeculectomy based on microincision phacoemulsification and ultra-thin artificial lens implantation can significantly lower intraocular pressure,relieve glaucoma,and reduce visual impairment,with little damage to corneal endothelial cells and few complications.Besides,the clinical effect is marked.