老年性白内障合并原发性闭角型青光眼外科手术治疗的术式选择及其术后用药评价

Choice of surgical formula and evaluation of postoperative pharmacotherapy in elderly patients with cataract and primary angle closure glaucoma

目的:探讨超声乳化术和房角分离术治疗老年白内障合并闭角型青光眼的临床价值及术后使用迪非和典必殊的药理作用。方法:本院2013-01~2016-03行白内障手术的200例老年患者随机分为4组,每组50例,1、3组行超声乳化术和房角分离术,2、4组行超声乳化术和小梁切除术;1、2组术后使用迪非和典必殊,3、4组术后使用典必殊。比较各组视力、眼压、房角开放程度、眼部症状评分以及黄斑水肿发生情况。结果:各组术后视力均明显升高,眼压均明显下降(P<0.05);1、3组术后房角开放程度明显优于2、4组(P<0.05);1、2组术后7、14 d症状评分和黄斑水肿发生率均明显低于3、4组(P<0.05)。结论:超声乳化术和房角分离术应用于白内障合并闭角型青光眼能够提高视力、降低眼压和改善房角开放程度,术后使用迪非和典必殊能够缓解眼部症状,降低黄斑水肿发生率。

Objective:To investigate the clinical value of phacoemulsification combined with goniosynechialysis in the treatment of cataract and angle closure glaucoma and the effect of bromfenac sodium hydrate ophthalmic solution and tobramycin dexamethasone eye drops in elderly patients. Methods:A total of 200 elderly patients with cataract admitted to our hospital from Jan. 2013 to Mar. 2016 were included in the study and randomly divided into 4groups with 50 cases in each group. Patients in groupⅠand Ⅲ were treated by phacoemulsification combined with goniosynechialysis. Patients in groupⅡand Ⅳ were treated by phacoemulsification combined with trabeculectomy.Patients in groupⅠandⅡ were given bromfenac sodium hydrate ophthalmic solution and tobramycin dexamethasone eye drops after surgery. Patients in group Ⅲand Ⅳ were only given tobramycin dexamethasone eye drops after surgery. Visual acuity,intraocular pressure,opening degree of angle,score of the ocular symptoms and the occurrence of macular edema were observed and compared in 4 groups. Results:The postoperative visual acuity increased and intraocular pressure decreased significantly in 4 groups(P < 0. 05). Angle opening degrees were significantly better in groupⅠand Ⅲ than in groupⅡand Ⅳ(P < 0. 05). Score of the ocular symptoms and incidence of macular edema were significantly lower in groupⅠandⅡ than in groupⅢandⅣ 7 d and 14 d after surgery. Conclusion:Phacoemulsification combined with goniosynechialysis can improve visual acuity,reduce intraocular pressure and improve angle opening degree in patients with cataract and angle closure glaucoma Bromfenac sodium hydrate ophthalmic solution and tobramycin dexamethasone eye drops can relieve eye symptoms and reduce incidence of macular edema after surgery.