两种手术方式治疗原发性闭角型青光眼疗效比较

目的:探讨治疗原发性闭角型青光眼二种手术方式的适应症和初步临床疗效观察。方法:拟订手术适应症,对临床收治的42例48眼原发性闭角型青光眼进行手术处理:单纯抗青光眼手术--小梁切除术(Trabeculectomy,Trab)、青白联合手术--超声乳化白内障吸除联合小梁切除+人工晶体植入术(Phacotrabeculectomy+IOL,PhacoTrab+IOL)。比较不同适应症下二种手术方式初步的临床疗效。包括术前术后眼压情况、前房深度、眼轴长度的变化。随访时间平均1个月。结果均经统计学处理。结果:原发性闭角型青光眼患者术后眼压有显著改变,有统计学差异,Trab组手术后平均(10.92±1.74)mmHg,Phaco Trab+IOL组手术后平均(10.86±1.73)mmHg。术后眼压明显降低(t检验,P值<0.001),Trab组和Phaco Trab+IOL组两组间术后眼压无显著差异(t检验,P值>0.05)。Trab组手术前后前房深度无统计学差异(t检验,P值>0.05),Phaco Trab+IOL组手术前后前房深度有统计学差异(t检验,P值均<0.001)。术前分别为(1.74±0.16)mm、(1.72±0.16)mm,术后分别为(1.74±0.17)mm、(2.06±0.14)mm。Trab组及Phaco Trab+IOL组手术前后眼轴长度无统计学差异(t检验,P值>0.05)。结论:青-白联合手术可以改善前房深度,明显降低眼压,不同手术方式适合不同的病人情况,但要注意适应症的选择。利用A超检查可快速、有效、准确地观察眼前节结构,有助于早期进行手术。

A Preliminary Comparison Study of Two Types of Microsurgery on Management of Primary Angle-closure Glaucoma

Objective: Objective To investigate the indications and preliminary clinical results of two types of microsurgery on management of primary angle-closure glaucoma.Methods: The indications of two types of microsurgery were set up for a comparison study on 48 eyes(42 cases) with primary acute or chronic angle-closure glaucoma which were performed with trabeculectomy only(Trab group) and phacortrabeculectomy plus intraocular lens implantation(Phaco Trab + IOL group).The preliminary clinical results of two groups including the changes of the intraocular pressure(IOP),the anterior chamber depth and the ocular axial length were compared.The mean follow-up was one month.The results are all processed by the statistics.Results: The postoperative IOP were well changed(all P < 0.001).Before surgery the average IOP was respectively(17.68±3.09) mmHg and(18.07 ±2.92) mmHg in Trab group and in Phaco Trab + IOL group.After surgery the average IOP was respectively(10.92 ±1.74) mmHg and(10.86±1.73) mmHg.The postoperative IOP were reduced in two groups(P<0.001).There were no significant differences in postoperative IOP between the Trab group and the Phaco Trab + IOL group(P value > 0.05).The anterior chamber depth(ACD) wasn’t seen significantly changed in the Trab group(P value>0.05),while it was seen deeper in the Phaco Trab + IOL group(P value<0.001).Before surgery the average ACD was(1.74 ±0.16) mm and(1.72±0.16) mm respectively in trab group and in Phaco Trab + IOL group.After surgery the average ACD was(1.74±0.17) mm and(2.06±0.14) mm respectively.There were significant differences between the Trab group and the Phaco Trab + IOL group(P <0.001).There was no statistically difference in ocular axial length before and after surgery(t test,P value > 0.05).Conclusion: The phacortrabeculectomy plus intraocular lens implantation operation could improve the anterior chamber depth significantly,and reduce the IOP obviously.It is important to pay attention to the indications and choose different operation method for different conditions of patients.Anterior segment structures in glaucoma can be measured effectively with ultrasonic scanning machine at A-mode.