白内障超声乳化术联合小梁切除术治疗青光眼合并白内障的临床疗效

目的:观察白内障超声乳化吸除及人工晶状体植入术联合小梁切除术治疗原发性闭角型青光眼(primary angle-closure gloucoma,PACG)合并白内障的临床疗效和安全性。方法:对49例59眼PACG合并白内障患者进行回顾性调查研究,其中急性闭角型青光眼(急性ACG)35眼,慢性闭角型青光眼(慢性ACG)24眼。患者均行白内障超声乳化吸除及人工晶状体植入术联合小梁切除术。观察患者术前及术后视力、眼压、中央前房深度、晶状体厚度、眼轴、术后用药情况及并发症。随访6～12mo。结果:(1)急性ACG组术前(n=35眼)平均眼压23.9±6.6mmHg,术后12mo时(n=28眼)平均眼压11.7±2.6mmHg(P<0.01)。慢性ACG组(n=24眼)术前平均眼压20.9±6.5mmHg,术后12mo时(n=19眼)平均眼压14.5士1.4mmHg(P<0.01)。急性ACG组术后眼压降低幅度为11.3±5.9mmHg,慢性ACG组为7.4±7.1mmHg,差异有统计学意义(P<0.05)。(2)PACG59眼术后末次复查时44眼(74.6%)视力较术前提高。(3)急性ACG组术前、术后中央前房深度分别为1.79±0.15,3.32±0.17mm,差异有统计学意义(P<0.01)。慢性ACG组术前、术后中央前房深度分别为1.84±0.19,3.37±0.20mm,差异有统计学意义(P<0.01)。(4)两组晶状体厚度/眼轴长度系数分别为2.26±0.16,2.14±0.13,差异有统计学意义(P<0.01)。(5)急性ACG组、慢性ACG组手术完全成功率分别为94.3%,87.5%,条件成功率分别为5.7%,8.3%。(6)全部患者术后有15眼(25.4%)发生轻或中度角膜内皮水肿,15眼(25.4%)发生前房纤维素渗出。结论:白内障超声乳化吸除及人工晶状体植入术联合小梁切除术是治疗PACG合并白内障的有效而安全的方法。急性ACG的疗效优于慢性ACG。

The clinical effect of phacoemulsification combined with trabeculectomy for primary angle-closure glaucoma with cataract

AIM:To evaluate the effect and safety of phacoemulsification and intraocular lens implantation combined with trabeculectomy for primary angle-closured glaucoma with cataract.

METHODS: Retrospective study was performed in 49 cases(59 eyes)of primary angle-closure glaucoma with cataract patients treated with phacoemulsification and intraocular lens implantation combined with trabeculectomy. Among them, 35 eyes were acute primary angle-closure glaucoma(APACG), 24 eyes were chronic primary angle-closure glaucoma(CPACG).Visual acuity, intraocular pressure(IOP), thickness of lens, axial length of eyeball, central anterior chamber depth, complications and medications were detected in all patients followed up until 6-12 months.

RESULTS: 1)Preoperative and postoperative IOP were 23.9±6.6mmHg, 11.7±2.6mmHg respectively in APACG group(n=35, P<0.01), and 20.9±6.5mmHg, 14.5±1.4mmHg respectively in CPACG group(n=24, P<0.01). Postoperative IOP of APACG decreased in 11.3±5.9mmHg, while 7.4±7.1mmHg in CPACG group(P<0.05). 2)The visual acuity of 44 eyes in 59 eyes of PACG(74.6%)increased postoperatively compared with that preoperatively(P<0.05). 3)Preoperative, postoperative central depth of the anterior chamber were 1.79±0.15, 3.32±0.17mm respectively in APACG group(P<0.01), while 1.84±0.19, 3.37±0.20mm respectively in CPACG group(P<0.01). 4)The thickness of lens and the axial length of eyeballs ratio in APACG and CPACG group were 2.26±0.16, 2.14±0.13 respectively(P<0.01). 5)The total success rate, partial success rate were 94.3%, 5.7% in APACG group, compared to 87.5%, 8.3% in CPACG respectively. 6)Mild and moderate corneal endothelial edema and fibrinous exudate were occurred in 15 eyes(25.4%)in all patients respectively.

CONCLUSION:Phacoemulsification and intraocular lens implantation combined with trabeculectomy is effective and safe treatment for primary angle-closure glaucoma with cataract patients, especially for acute primary angle-closure glaucoma compared with chronic primary angle-closure glaucoma.