超声乳化联合前房角分离术治疗青光眼术后白内障的效果

Efficacy of phacoemulsification combined with goniosynechialysis for the treatment of cataract with glaucoma after trabeculectomy

目的评价超声乳化联合前房角分离术治疗青光眼滤过性手术后白内障的临床效果。方法回顾性病例对照研究。分析2016年7月至2020年6月青岛大学附属威海市立第二医院眼科青光眼术后白内障40例(40只眼)的临床资料。根据青光眼类型分为急性和慢性闭角型青光眼术后白内障各20例(20只眼)。患者均行超声乳化联合前房角分离术, 术后随访12个月, 观察视力、眼压、中央前房深度及前房角。结果急闭组和慢闭组两组术后3个月视力均较术前提高, 但两组间视力差异无统计学意义(t=0.60, P=0.550)。两组术前眼压近似, 术后3、6及12个月, 急闭组眼压低于慢闭组(均P<0.05)。两组术后3个月中央前房深度均较术前增加, 但两组间差异无统计学意义(t=2.02, P=0.051);两组术后3个月周边虹膜前粘连范围均较术前缩小, 但两组间范围差异无统计学意义(Z=-0.97, P=0.332)。结论急性及慢性闭角型青光眼术后的白内障行超声乳化联合前房角分离术可以提高视力及降低眼压, 而急性闭角型青光眼患者术后眼压降低更明显。

Objective To evaluate the efficacy of phacoemulsification combined with goniosynechialysis for the treatment of cataract with glaucoma after trabeculectomy.Methods A retrospective case control study was performed.The data of 40 eyes of 40 patients with cataract after trabeculectomy in the Second Affiliated Hospital in Weihai of Qingdao University from Jul.2016 to Jun.2020 were analyzed.Two groups were divided based on glaucoma types.There were 20 eyes of 20 patients with acute primary angle-closure glaucoma(APACG)in the APACC group and 20 eyes of 20 patients with chronic primary angle-closure glaucoma(CPACG)in the CPACG group.All cases received trabeculectomy firstly and then phacoemulsification combined with goniosynechialysis.All patients were followed up for 12 months.The visual acuity,intraocular pressure,depth of central anterior chamber and anterior chamber angle were observed.Results The visual acuity improved significantly at 3 months after surgery in both groups,but there was no significant difference between the two groups(t=0.60,P=0.550).The intraocular pressure(IOP)before surgery in the two groups was similar,but the IOP at 3,6 and 12 months after surgery in the APACG group were lower than those in the CPACG group(all P<0.05).The depth of anterior chamber was increased significantly at 3 months after surgery in both groups,but there was no significant difference between the two groups(t=2.02,P=0.051).The range of peripheral anterior synechiae(PAS)was significantly reduced at 3 months after surgery in both groups,but there was no significant difference between the two groups(Z=-0.97,P=0.332).Conclusion Phacoemulsification combined with goniosynechialysis can improve visual acuity and decrease IOP for both APACG and CPACG patients with cataract after trabeculectomy,but the IOP are decreased more for the APACG patients.