青光眼合并白内障给予白内障超声乳化吸出并小梁切开术的临床效果及胰岛素抵抗水平研究

Clinical Effect and Insulin Resistance Level of Phacoemulsification and Trabeculotomy in Glaucoma Complicated with Cataract

目的:研究青光眼合并白内障给予白内障超声乳化吸出并小梁切开术的临床效果及改善胰岛素抵抗水平的作用。方法:某院2019年6月-2021年8月确诊并收治的86例白内障合并青光眼患者以随机数字表法编入对照组和观察组各43例,观察组给予实施白内障超声乳化吸除合并人工晶体植入术,同期实施小梁切开术,对照组给予小梁切开术。对比两组术前,术后1周、4周、3月的眼压值及最小分辨角对数视力(logMAR),对比两组术后并发症发生率,对比两组术前及术后3个月胰岛素抵抗指数(HOMA-IR)、超敏C反应蛋白(hs-CRP)、白细胞介素-6(IL-6)。结果:两组术后各时段眼压均显著优于术前(P<0.05),两组术后各时段眼压组间对比无显著差异(P>0.05)。两组术前及术后1周的BCVA组间对比无显著差异(P>0.05);两组术后1周、4周、3个月BCVA均比治疗前显著改善(P<0.05),观察组术后4周及术后3个月的BVCA显著优于对照组(P<0.05)。观察组并发症发生率为6.98%,与对照组的4.65%无显著差异(P>0.05)。两组治疗前HOMA-IR、hs-CRP、IL-6相比无显著差异(P>0.05),治疗后各指标均比治疗前显著改善,观察组上述指标治疗后改善幅度显著优于对照组(P<0.05)。结论:青光眼合并白内障给予白内障超声乳化吸出并小梁切开术可尽快同时解决白内障和青光眼疾患,显著改善患者视力,且不会显著增加并发症发生风险,能更有效改善胰岛素抵抗及眼部的炎症状态。

Objective:To study the clinical effect of phacoemulsification combined with trabeculotomy for glaucoma complicated with cataract and the effect of improving insulin resistance level.Methods:A total of 86 patients with cataract complicated with glaucoma diagnosed and treated in a hospital from June 2019 to August 2021 were randomly assigned to the control group and the observation group,with 43 patients in the two groups.The observation group was given phacoemulsification combined with intraocular lens implantation and trabeculotomy at the same time.The control group was given trabeculotomy alone.The intraocular pressure values and logarithmic visual acuity of minimum resolution angle(logMAR)were compared between the two groups before operation,1 week,4 weeks,and 3 months after operation,and the incidence of postoperative complications between the two groups was compared.The insulin resistance index(HOMA-IR),high-sensitivity C-reactive protein(hs-CRP),and interleukin-6(IL-6)before and at 3 months after surgery were compared between the two groups.Results:The intraocular pressure of the two groups in each period after surgery was significantly better than that before the operation(P<0.05),and there was no significant difference in intraocular pressure in each period between the two groups before and after the operation(P>0.05).There was no significant difference in BCVA between the two groups before and 1w after operation(P>0.05).The BCVA of the two groups at 1 week,4w,and 3 months after operation was significantly improved than before treatment(P<0.05).The BVCA 4 weeks and 3 months after operation in the observation gorup was significantly better than that in the control group(P<0.05).The incidence of complications in the observation group was 6.98%,which was not significantly different from 4.65%in the control group(P>0.05).There was no significant difference in HOMA-IR,hs-CRP and IL-6 between the two groups before treatment(P>0.05),each index after treatment was significantly improved compared with before treatment,and the improvement of each index in the observation group was significantly better than that in the control group(P<0.05).Conclusion:Phacoemulsification combined with trabeculotomy for glaucoma complicated with cataract can solve both cataract and glaucoma diseases as soon as possible,significantly improve the patients'vision without significantly increasing the risk of complications,and more effectively improve insulin resistance and inflammatory condition of the eye.