青光眼合并白内障患者联合手术的临床疗效及影响术后屈光误差的因素

Clinical Efficacy of Combined Surgery in Patients with Glaucoma Complicated with Cataract and Factors Affecting Postoperative Refractive Error

目的探究青光眼合并白内障患者联合手术的临床疗效并分析术后屈光误差的影响因素。方法选取河南省人民医院2021年1月至2023年1月收治的78例青光眼合并白内障患者(78眼),所有患者接受超声乳化联合小梁切除术治疗,检测患者平均眼压、视力水平、最佳矫正视力(BCVA)、屈光误差、眼轴长度(AL)、前房深度(ACD)、晶状体厚度、晶体拱高(LV)、角膜曲率(K)值、中央角膜厚度及白到白距离等。收集患者资料,单因素及多因素logistic回归分析影响患者术后屈光误差的因素。结果青光眼合并白内障患者术后平均眼压低于术前(P<0.05),平均视力及BCVA高于术前(P<0.05);术后3个月,青光眼合并白内障患者远视屈光误差41眼(52.56%),近视屈光误差12眼(15.38%),无屈光误差25眼(32.05%),绝对屈光误差为(0.52±0.06)D。屈光误差组AL、ACD低于无屈光误差组(P<0.05),晶状体厚度、平均视力高于无屈光误差组(P<0.05);将差异有统计学意义的因素行多因素logistic回归分析,结果显示AL、ACD及晶状体厚度为影响屈光误差发生的因素(P<0.05)。结论青光眼合并白内障患者联合手术治疗后可有效提高视力,但是发生屈光误差的比例较高,AL、ACD及晶状体厚度为影响其发生的重要因素。

Objective To investigate the clinical efficacy of combined surgery in patients with glaucoma complicated with cataract and to analyze the influencing factors of postoperative refractive error.Methods A total of 78 patients with glaucoma and cataract(78 eyes)admitted to People’s Hospital of Henan Province from January 2021 to January 2023 were enrolled,and all patients were treated with phacoemulsification combined with trabeculectomy,and the average intraocular pressure,visual acuity level,best-corrected visual acuity(BCVA),refractive error,axial length(AL),anterior chamber depth(ACD),lens thickness,lens arch height(LV),corneal curvature(K)value,central corneal thickness and white-to-white distance were detected.Clinical data of patients were collected,and the factors affecting postoperative refractive error were analyzed by univariate and multivariate logistic regression.Results The mean intraocular pressure of patients with glaucoma and cataract was lower than that before surgery(P<0.05),and the average visual acuity and BCVA were higher than that before surgery(P<0.05).Three months after surgery,the refractive error of 41 eyes(52.56%),12 eyes(15.38%)of myopia and no refractive error of 25 eyes(32.05%)and absolute refractive error of(0.52±0.06)D in patients with glaucoma and cataract were present.The refractive error group AL and ACD were lower than those in the non-refractive error group(P<0.05),and the lens thickness and average visual acuity were significantly higher than those in the non-refractive error group(P<0.05).Multivariate logistic regression analysis showed that AL,ACD and lens thickness were factors affecting the occurrence of refractive error(P<0.05).Conclusion Patients with glaucoma complicated with cataract can effectively improve visual acuity after combined surgery,but the proportion of refractive error is high,and AL,ACD and lens thickness are important factors affecting their occurrence.