超声乳化联合房角分离治疗急性闭角型青光眼的临床观察

目的:观察和比较白内障超声乳化吸除人工晶状体植入术联合前房角分离术或小梁切除术治疗原发性急性闭角型青光眼合并白内障的临床疗效。方法:选择哈尔滨医科大学附属第一医院眼科医院2017年1月～2017年11月收治的原发性急性闭角型青光眼合并白内障患者62例,根据手术方式不同将其随机分为A、B两组,A组(31例,行Phaco+IOL联合前房角分离术);B组(31例,行Phaco+IOL联合小梁切除术)。分别观察两组患者术前术后最佳矫正视力(BCVA)、眼压(IOP)、前房深度(ACD)、角膜内皮细胞密度(ECD)的变化。结果:两组患者术后3天、3个月BCVA及IOP和术前比较均明显提高(P0.05),IOP控制至正常范围。且术后1周,A组视力恢复及眼压控制均优于B组(P0.05)。两组患者术后3月,ACD及ECD均较术前明显变化,ACD加深,ECD减少(P0.05),且A组ACD明显高于B组(P0.05)。结论:Phaco+IOL联合前房角分离术治疗急性闭角型青光眼合并白内障患者能有效降低眼压,在早期即可获得较好的临床效果。

A Clinical Study on Phacoemulsification Combined with Goniosynechialysis in the Treatment of Primary Acute Angle Closure Glaucoma

ABSTRACT Objective: To observe and compare the clinical efficacy of phacoemulsification and intraocular lens implantation combined with goniosynechialysis or trabeculectomy in the treatment of acute primary angle-closured glaucoma with cataract.Methods: 62 cases of patients diagnosed with acute angle-closure glaucoma combined with cataract in the Eye Hospital of the First Affiliated Hospital of Harbin Medical University from January 2017 to November 2017 were selected and randomly divided into group A and B according to different operation methods, group A(31 cases, Phaco+IOL combined goniosynechialysis); group B(31 cases, Phaco + IOL combined trabeculectomy). The best corrected visual acuity (BCVA), intraocular pressure (IOP), anterior chamber depth (ACD), the changes of corneal endothelial cell density (ECD) after operation were compared between two groups of patients. Results: The BCVA and IOP of both groups of patients at 3 days and 3 months after operation were significantly improved(P<0.05), the IOP returned to the normal range. Furthermore, at 1 week after operation, the visual acuity of group A was better than that of group B (P<0.05). At three months after operation, the ACD and ECD of both groups changed significantly compared with those preoperation(P<0.05), and the ACD of group A was significantly deeper than that of group B(P<0.05). Conclusion: Phaco+IOL combined goniosynechialysis can effectively reduce intraocular pressure, obtain good clinical effect at the early satge in the treatment of acute primary angle-closured glaucoma with cataract.