超声乳化白内障吸除术联合不同手术治疗合并白内障的原发性闭角型青光眼的效果比较

Comparison of the efficacy between trabeculectomy and goniosynechialysis in the treatment of primary angle-closure glaucoma with cataract

目的比较超声乳化白内障吸除术联合小梁切除术与房角分离术治疗合并白内障的原发性闭角型青光眼(PACG)的效果。方法回顾性病例对照研究。纳入郑州普瑞眼科医院2020年6月至2022年6月治疗的合并白内障的PACG 80例(89只眼)作为研究对象,按照手术方式分为A组40例(46只眼)和B组40例(43只眼)。两组患者均行超声乳化白内障吸除人工晶状体植入术,A组联合小梁切除术;B组联合房角分离术。术后随访12周,观察最佳矫正视力(BCVA)、眼压(IOP)、中央前房深度(ACD)、前房角开放距离500(AOD500)、小梁虹膜角(TIA)、小梁睫状体距离(TCPD)及术后并发症发生率。结果A组患者在术后1周、4周、12周的眼压分别为(15.30±2.00)、(14.72±1.96)、(15.00±2.30)mmHg(1 mmHg=0.133 kPa),均明显低于B组的(17.14±2.32)、(15.90±2.21)、(16.72±2.31)mmHg(t=-4.02,P<0.001;t=-2.67,P=0.009;t=-3.52,P<0.001)。两组术后BCVA及眼压与术前相比均明显改善,差异具有统计学意义(均P<0.05)。两组术后的ACD、AOD500、TIA、TCPD测定值与术前相比,均明显增大,其中A组患者在术后1周、4周、12周的AOD500测定值依次为(0.295±0.045)、(0.291±0.048)及(0.293±0.053)mm,均明显低于B组的(0.321±0.049)、(0.317±0.051)、及(0.320±0.056)mm(t=-2.61、-2.48、-2.34,P=0.011、0.015、0.022)。术后并发症发生率,A组21.74%(10/46)高于B组6.98%(3/43)(χ^(2)=3.88,P=0.049)。结论超声乳化白内障吸除联合小梁切除术与房角分离术治疗合并白内障的PACG患者均能有效控制眼压并改善视力,但联合房角分离术更有利于恢复前房结构,降低手术并发症。

ObjectiveTo compare the clinical efficacy of phacoemulsification combined with trabeculectomy and goniosynechialysis in the treatment of primary angle closure glaucoma(PACG)with cataract.MethodsThis was a retrospective case-control study.A total of 80 patients(89 eyes)of PACG with cataract treated from Jun.2020 to Jun.2022 in Zhengzhou Purui Eye Hospital were collected as the study subjects,and were divided into group A with 40 cases(46 eyes)and group B with 40 cases(43 eyes)based on surgical method.The two groups of patients were both treated with phacoemulsification and intraocular lens implantation.However,patients in group A were treated in combination with trabeculectomy,while patients in group B were treated in combination with goniosynechialysis.Postoperative follow-up time was 12 weeks,and the best corrected visual acuity(BCVA),intraocular pressure(IOP),central anterior chamber depth(ACD),angle open distance 500(AOD500),trabecular iris angle(TIA),trabecular ciliary body distance(TCPD),and incidence of postoperative complications were observed.ResultsThe IOP of group A at 1 week,4 weeks,and 12 weeks after surgery were(15.30±2.00),(14.72±1.96)and(15.00±2.30)mmHg(1 mmHg=0.133 kPa),respectively,which were significantly lower than those of group B[(17.14±2.32),(15.90±2.21)and(16.72±2.31)mmHg],respectively(t=-4.02,P<0.001;t=-2.67,P=0.009;t=-3.52,P<0.001).Postoperative BCVA and IOP in the two groups both improved,and the differences were statistically significant(all P<0.05).The postoperative ACD,AOD500,TIA,and TCPD measurements of the two groups all significantly increased when compared to the corresponding preoperative values.Wherein,the AOD500 measurement values of group A at 1 week,4 weeks,and 12 weeks after surgery were(0.295±0.045),(0.291±0.048)and(0.293±0.053)mm,respectively,which were significantly lower than those of group B at(0.321±0.049),(0.317±0.051),and(0.320±0.056)mm,respectively(t=-2.61,-2.48,-2.34;P=0.011,0.015,0.022).The incidence of postoperative complications was 21.74%(10/46)in group A,which was significantly higher than the 6.98%(3/43)in group B(χ^(2)=3.88,P=0.049).ConclusionPhacoemulsification with trabeculectomy and goniosynechialysis can both effectively control intraocular pressure and benefit for visual acuity improvement in patients of PACG with cataract.However,gonisosynechialysis has more advantages in restoring anterior chamber structure and reducing postoperative complications.