改良式“L型”巩膜瓣下超声乳化联合小梁切除术治疗青光眼合并白内障的临床观察

Clinical observation of modified“L-shaped”subscleral phacoemulsification combined with trabeculectomy for glaucoma complicated with cataract

目的探讨改良式“L型”巩膜瓣下超声乳化联合小梁切除术治疗青光眼合并白内障的的临床效果。方法回顾性病例研究。选取我院2018年2月至2020年8月原发性青光眼合并白内障患者共65例(70只眼),其中原发性闭角型青光眼合并白内障患者33例(35只眼),原发性开角型青光眼合并白内障患者32例(35只眼)。两组均采用改良式“L型”巩膜瓣下超声乳化联合小梁切除术治疗,术后随访6个月,观察两组患者视力、眼压、滤过泡、中央前房深度及并发症等情况。结果A、B两组术前视力差异无统计学意义(P>0.05),A组术后视力提高要优于B组(P<0.05);与术前视力相比,A组在术后1个月和6个月视力均有提高(P<0.05),而B组在术后1 d、1周、1个月和6个月视力提高,差异均有统计学意义(P<0.05)。末次随访,A组术后功能性滤过泡为31只眼(88.57%),B组术后功能性滤过泡为30只眼(85.71%),两组差异无统计学意义(P>0.05)。两组术后眼压及前房深度均低于术前(P<0.05)。A组手术成功率要优于B组(P<0.05),A组的手术并发症发生率高于B组(P<0.05)。结论改良式“L型”巩膜瓣下超声乳化联合小梁切除术治疗青光眼合并白内障,手术操作简便,手术时间缩短,不仅能降低眼压,还可显著提高视力,术后效果稳定,并发症少。

Objective To investigate the clinical effect of modified“L-shaped”scleral flap phacoemulsification combined with trabeculectomy in the treatment of glaucoma combined with cataract.Methods A total of 65 patients(70 eyes)with primary glaucoma combined with cataract in our hospital from February 2018 to August 2020 were selected,including primary angle-closure glaucoma combined with cataract in 33 cases(35 eyes)(group A)and primary open-angle glaucoma combined with cataract in 32 cases(35 eyes)(group B).Both groups were treated with modified"L-shaped"subscleral phacoemulsification combined with trabeculectomy.The visual acuity,intraocular pressure,filter bubbles,central anterior chamber depth and complications were observed in the two groups after 6 months follow-up.Results There was no significant difference in preoperative visual acuity between group A and group B(P>0.05).The postoperative visual acuity of group A was better than that of group B(P<0.05).Compared with the preoperative visual acuity,the visual acuity of group A improved at 1 and 6 months after surgery(P<0.05),and the visual acuity of group B improved at 1 day,1 week,1 month and 6 months after surgery(P<0.05).At the last follow-up,there were 31 eyes(88.57%)of functional blebs in group A and 30 eyes(85.71%)in group B,there was no significant difference between the two groups(P>0.05).The postoperative IOP and the anterior chamber depth in both groups was lower than that before operation(P<0.05).The success rate of operation in group A was better than that in group B(P<0.05),and the incidence of surgical complications in group A was higher than that in group B(P<0.05).Conclusions Modified“L-shaped”subscleral phacoemulsification combined with trabeculectomy for glaucoma combined with cataract is a simple operation with shorter operation time.It can not only reduce IOP,but also significantly improve visual acuity,with stable postoperative effect and fewer complications.