白内障摘出联合人工晶状体植入术治疗闭角型青光眼合并白内障临床疗效分析

目的探讨白内障摘出联合人工晶状体植入术治疗闭角型青光眼合并白内障的临床效果。方法选取138例(138眼)闭角型青光眼合并白内障的患者,其中70例患者行白内障摘出联合人工晶状体植入术,68例患者行小梁切除术,术后随访3～24个月,每3个月做一次记录,比较各组术前术后及两组之间术后眼压、矫正视力、中央前房深度、房角的变化。结果两组患者术后的眼压较术前明显下降,白内障摘出联合人工晶状体植入术后的患者眼压为(10.81±0.31)mmHg(1kPa=7.5mm-Hg),小梁切除术后的患者眼压为(10.49±0.44)mmHg,两组患者术后眼压相比差异无统计学意义(Z=-1.08,P=0.28);白内障摘出联合人工晶状体植入术后患者的矫正视力明显优于小梁切除术后的患者,两组患者术后视力比较差异有统计学意义(Z=-5.74,P=0.01);白内障摘出联合人工晶状体植入术后患者的中央前房深度较小梁切除术后加深[前者为(3.37±0.02)mm,后者为(1.76±0.02)mm],两组患者术后的中央前房深度差异有统计学意义(P=0.01);白内障摘出联合人工晶状体植入术后患者的房角开放程度比小梁切除术后开放程度大,两组患者术后的房角开放程度相比差异有统计学意义(Z=-4.50,P=0.01);白内障摘出联合人工晶状体植入术后早期并发症主要有角膜水肿、前房反应,小梁切除术后早期并发症有浅前房、前房积血、睫状体脱离、术后早期高眼压。随访3～24个月,白内障摘出联合人工晶状体植入术后有5例患者需再次行小梁切除术控制眼压,小梁切除术后也有2例患者需再次行小梁切除术控制眼压。结论白内障摘出联合人工晶状体植入术治疗闭角型青光眼合并白内障疗效显著,相比小梁切除术手术操作简单,术后视力改善明显,并发症少,患者易于接受,值得推广应用。

Cataract extraction and intraocular lens implantation for angle-closure glaucoma with cataract

Objective To investigate the clinical effects of cataract extraction and intraocular lens implantation for angle-closure glaucoma with cataract. Methods A total of 138 patients (138 eyes) with angle-closure glaucoma and cataract were chosen,in which 70 cases treated by cataract extraction and intraocular lens implantation (group A) and another 68 patients underwent trabeculectomy (group B),the follow-up time was from 3 months to 24 months,every 3 months for a record,the preoperative and postoperative intraocular pressure,corrected visual acuity,central anterior chamber depth and angle change of two groups were observed and compared. Results The postoperative intraocular pressure in group A and B were (10.81±0.31)mmHg(1 kPa=7.5 mmHg) and (10.49±0.44)mmHg,respectively,which were all lower than pre-operation,but there was no statistical difference between two groups(Z=-1.08,P=0.28).The postoperative corrected visual acuity in group A were better than that in group B,there was statistical difference(Z=-5.74,P=0.01).The postoperative central anterior chamber depth in group A and B were (3.37±0.02)mm and (1.76±0.02)mm,respectively,there was statistical difference(P=0.01).There was statistical difference in open degree of anterior chamber angle between two groups(Z=-4.50,P=0.01).The early postoperative complications in group A were corneal edema and anterior chamber reaction,which in group B were shallow anterior chamber,hyphema,ciliary body detachment,early postoperative high intraocular pressure elevation.In group A and B,re-trabeculectomy were performed in 5 cases and 2 cases to control intraocular pressure,respectively. Conclusion Cataract extraction and intraocular lens implantation for angle-closure glaucoma with cataract have better effects than trabeculectomy,its producers are simple with postoperative visual acuity improved significantly and fewer complications,the patients are easy to accept,worthy of popularization and application.