超声乳化联合小梁切除术治疗闭角型青光眼合并白内障的临床研究

目的:探讨超声乳化白内障吸除术(Phaco)、人工晶状体植入术(IOL)联合小梁切除术(TBL)治疗原发性闭角型青光眼(PACG)伴厚晶状体白内障的临床疗效和安全性。方法:将82例(98眼)原发性闭角型青光眼伴厚晶状体白内障患者随机分为A组(41例52眼)和B组(41例46眼),A组行Phaco+IOL+TBL治疗,B组单纯行TBL治疗,比较两组的手术前后眼压、最佳矫正视力、中央前房深度(ACD)、小梁虹膜角(TIA)、房角开放距离500(AOD500)及小梁睫状体距离(TCPD)的变化、视力提高率及并发症的发生情况。结果:两组术后眼压均较术前显著降低,且A组的降低幅度显著高于B组(P0.05);两组术后最佳矫正视力均显著提高,且A组显著高于B组(P0.05);A组术后视力提高率为86.54%,显著高于B组的32.61%(P0.05);两组术后ACD、TIA、AOD500及TCPD均显著提高,且A组显著高于B组(P0.05);A组手术并发症发生率为5.77%,显著低于B组的17.39%(P0.05)。结论:超声乳化白内障摘除术、人工晶状体植入术联合小梁切除术治疗PACG伴厚晶状体白内障的疗效较单用小梁切除术更好,且安全性更高。

A Clinical Study on Phacoemulsification and Intraocular Lens Implantation Combined with Trabeculectomy in the Treatment of Primary Angle closure Glaucoma with Thick Lens Cataract

ABSTRACT Objective: To study the clinical effect and safety of ultrasonic emulsification cataract gettering technique (Phaco), in- traocular lens implantation (IOL) combined trabeculectomy (TBL) on the primary angle-closure glaucoma (PACG) with thick lens cataract. Methods: 82 cases (98 eyes) of primary angle-closure glaucoma with thick lens cataract patients were randomly divided into group A (41 cases (52 eyes) and group B(41 cases (46 eyes), group A was treated by Phaco + IOL + TBL, group B was treated by TBL alone, the best corrected visual acuity, intraocular pressure central anterior chamber depth (ACD), trabecular iris Angle (TIA), room 500 (AOD500) and trabecular Angle opening distance (TCPD) the changes of ciliary body distance, visual improved rate and incidence of complications were compared between two groups before and after surgery. Results: The postoperative intraocular pressures of both groups were significantly decreased compared with those preoperation, which was significantly lower in group A than that of group B (P<0.05). The best corrected vision were significantly improved in both groups after operation, which was significantly higher in the group A than that of group B (P<0.05). The increase rate of postoperative vision in group A was 86.54%, which was significantly higher than that of the group B (32.61%, P<0.05). The postoperative ACD, TIA, AOD500 and TCPD of both groups were significantly im- proved, and the group A was significantly higher than that of group B (P<0.05). The complication rate of surgery was 5.77% in group A,which was significantly lower than that of the group B (17.39%, P<0.05). Conclusion: Ultrasound emulsification cataract extraction, in- traocular lens implantation combined with trabeculectomy therapy was more effective and safer for PACG with thick lens than tra- beculectomy alone.