白内障超声乳化吸除联合小梁切开治疗青光眼合并白内障的疗效及对胰岛素抵抗的影响

Effect of phacoemulsification combined with trabeculectomy on glaucoma complicated with cataract and its effect on insulin resistance

目的:探讨白内障超声乳化吸除联合小梁切开术治疗青光眼合并白内障的疗效及对胰岛素抵抗的影响。方法:选取82例(82眼)青光眼合并白内障患者为研究对象,按照手术方式不同分为观察组与对照组,每组各41例(41眼)。观察组予以白内障超声乳化吸除联合小梁切开术;对照组予以单纯小梁切开术。比较两组患者术后1周、1个月、3个月眼压和视力[最佳矫正视力(BCVA)]变化,术后并发症发生情况及术后1周、3个月胰岛素抵抗(HOMA-IR)和血清超敏C反应蛋白(hs-CRP)、白细胞介素-6(IL-6)水平。结果:术后1周、1个月及3个月,两组患者眼压均较术前降低(P<0.05),但组间比较,差异无统计学意义(P>0.05);观察组BCVA优于对照组(P<0.05)。观察组术后睫状体脱离发生率低于对照组(P<0.05)。术后1周及3个月,两组患者HOMA-IR、hs-CRP、IL-6均较术前均降低(P<0.05),且观察组低于对照组(P<0.05)。结论:白内障超声乳化吸除联合小梁切开术治疗青光眼合并白内障能够更有效改善患者视力,机制可能与改善IR,减轻炎症反应有关。

Objective:To investigate the effect of phacoemulsification combined with trabeculectomy in the treatment of glaucoma complicated with cataract and its effect on insulin resistance.Methods:82 patients(82 eyes)with glaucoma and cataract were divided into observation group(41 cases,41 eyes)and control group(41 cases,41 eyes)according to different surgical methods.The observation group was treated with phacoemulsification combined with trabeculectomy,and the control group was treated with simple trabeculectomy.The changes of intraocular pressure and visual acuity[best corrected visual acuity(BCVA)]at 1 week,1 month and 3 months after operation were compared between the two groups.The postoperative complications were recorded,and the levels of insulin resistance(HOMA-IR),serum high-sensitivity C-reactive protein(hs-CRP)and interleukin-6(IL-6)at 1 week and 3 months after operation were compared between the two groups.Results:The intraocular pressure of the two groups at 1 week,1 month and 3 months after operation was significantly lower than that before operation(P<0.05),there was no significant difference between groups(P>0.05).The BCVA of the observation group was significantly better than that of the control group(P<0.05).The incidence of postoperative cyclodialysis in the observation group was significantly lower than those in the control group(P<0.05).At 1 week and 3 months after operation,HOMA-IR,hs-CRP and IL-6 in the two groups were lower than those before operation(P<0.05),and those in the observation group were significantly lower than the control group(P<0.05).Conclusion:Phacoemulsification combined with trabeculectomy in the treatment of glaucoma complicated with cataract can improve visual acuity more effectively,which may be achieved by improving IR and reducing inflammatory response.