超声乳化联合抗青光眼手术治疗白内障合并闭角型青光眼

Combined phacoemulsification and anti-glaucoma surgery for cataract patients with angle-closure glaucoma

目的 :评价超声乳化吸除术联合虹膜周边切除术和联合小梁切除术对白内障合并闭角型青光眼的手术效果。方法 :回顾性分析 2 0 0 1年 4月至 12月白内障合并原发性闭角型青光眼患者行青光眼白内障联合手术 34例 4 0只眼。其中 15例 17只眼行超声乳化吸除术联合虹膜周边切除术 ,19例 2 3只眼行超声乳化吸除术联合小梁切除术。术后随访 3个月。结果 :虹膜周边切除术组术后眼压 (15 78± 4 5 2 )mmHg ,小梁切除术组术后眼压 (17 71± 3 1)mmHg ,均较术前有显著性差异(P <0 0 1)。两组间术后 1周 ,1、3个月均无显著性差异 (P >0 0 5 )。虹膜周边切除术组术后视力≥ 0 5者 13只眼 (占76 4 7% ) ,小梁切除术组 14只眼 (占 6 0 87% )。术后各种并发症、虹膜周边切除术组为 4只眼 (2 3 5 % ) ,小梁切除术组 15只眼 (6 5 2 2 % )。结论 :超声乳化联合虹膜周边切除术或小梁切除术均可以明显降低闭角型青光眼的眼压 ,提高视力。但虹膜周边切除术手术操作简单 ,术后并发症少 。

Objective:To evaluate the effect of the combined phacoemulsification and trabeculectomy or peripheral iridectomy for cataract patients with angle closure glaucoma.Methods:34 patients (40 eyes) with cataract and angle closure glaucoma were treated with combined phacoemulsification and anti glaucoma surgery.Combined phacoemulsification and peripheral iridectomy were performed in 15 patients (17 eyes) and combined phacoemulsification and trabeculectomy in 19 patients (23 eyes).Results:After follow up for 3 months,the mean intraocular pressure(IOP) in the group with peripheral iridectomy was 15 78±4 52mmHg and 17 71±3 1 mmHg in the group with trabeculectomy.The intraocular pressures were significantly lowered in both groups(P<0 01).There was no difference in the postoperative outcomes of IOP at the 1st week,1st month and 3rd month (P>0 05).The visual acuities were≥0 5 in 13 eyes(76 47%)in the group with peripheral iridectomy and 14 eyes(60 87%) in the group with trabeculectomy.Four eyes(23 5%) in the group with peripheral iridectomy have postoperative complications and 15 eyes(65 22%) in the group with trabeculectomy have postoperative complications.Conclusion:Though in cataract patients with angle closure glaucoma,combined phacoemulsification and trabeculectomy or peripheral iridectomy may both significantly lowered the IOP and increasd the visual acuities,but peripheral iridectomy was more simple,recovered more quickly and had less complications.