内路小梁切开联合白内障超声乳化吸除术治疗原发性开角型青光眼的短期疗效

目的对比内路小梁切开联合白内障超声乳化吸除术和单纯内路小梁切开术治疗合并白内障的原发性开角型青光眼(primary open angle glaucoma,POAG)的早期手术效果和并发症。设计病例对照研究。研究对象2018年3月至2019年3月在北京同仁眼科中心住院手术治疗的合并白内障的POAG患者36例(36眼)。方法根据患者选择的手术方式,将患者分为两组:行内路小梁切开联合白内障超声乳化吸除术的POAG患者12例(12眼)为观察组,行内路小梁切开术的POAG患者24例(24眼)为对照组。记录并比较两组患眼术前、术后1、2、3、5天、1周、1个月时眼压、视力、并发症和使用降眼压药的种类。主要指标眼压、视力、并发症和降眼压药物种类。结果观察组和对照组术前最高眼压分别为(34.08±8.21)mmHg和(37.75±8.61)mmHg(P=0.46),观察组术后第1天、1周、1个月的平均眼压分别为(20.75±11.89)mmHg、(21.23±8.72)mmHg、(15.00±2.22) mmHg,对照组术前、术后第1天、1周、1个月的平均眼压分别为(16.08±5.63)mm Hg、(22.08±11.48)mmHg、(16.05±5.25)mmHg,两组术后眼压整体变化趋势随时间降低(P<0.001),两组间术后眼压波动虽然存在差异,但是无统计学意义(P=0.77)。观察组和对照组术后1个月降眼压幅度分别为53.09%±15.19%和55.68%±15.63%(P=0.64)。观察组和对照组术前降眼压药物使用种类分别为(2.67±0.99)种和(3.08±0.72)种(P=0.16),术后1个月时分别下降至(0.17±0.58)种和(0.96±1.33)种(P=0.06)。观察组和对照组组术后眼压反跳发生率分别为16.67%和54.17%(P=0.03)。前房积血为术后最常见的并发症,观察组发生率为83.3%,对照组为62.5%(P=0.21)。观察组和对照组睫状体脱离发生率分别为25.0%和75.0%(P=0.004)。观察组中,8眼(66.7%)术后生活视力提高,4眼(33.3%)视力恢复至术前水平,0眼视力降低;对照组中,20眼(83.3%)术后生活视力恢复至术前水平,4眼(16.7%)视力降低(P<0.001)。结论对于合并白内障的开角型青光眼患者,内路小梁切开联合白内障超声乳化吸除术和单纯内路小梁切开术在术后1个月时降眼压作用相似。联合手术术后视力改善明显,眼压反跳发生率较单纯内路小梁切开术低,是一种安全有效的手术方式,远期效果有待进一步观察。

Short-term efficacy of trabeculotomy combined with phacoemulsification for primary open angle glaucoma

Objective To observe the safety and efficacy of trabeculotomy combined with phacoemulsification for primary open-angle glaucoma (POAG) with cataract. Design case-controlled study. Participants Thirty-six eyes of 36 POAG patients with cataract underwent surgery in Beijing Tongren Eye Centre from Mar. 2018 to Mar. 2019. Methods According to the surgical method selected by the patients, the patients were divided into two groups: 12 patients (12 eyes) receiving trabeculectomy combined with phacoemulsification were the observation group, and 24 patients (24 eyes) receiving trabeculectomy alone were the control group. The intraocular pressure (IOP), visual acuity, complications and the types of antiglaucoma drugs were recorded and compared between the two groups before surgery and at 1, 2, 3, 5 days, 1 week and 1 month after surgery. Main Outcome Measures IOP, the presenting visual acuity, short-term postoperative complications and antiglaucoma drops. Results The highest preoperative IOP for treatment group and control group were (34.08±8.21) mmHg and (37.75±8.61) mmHg respectively（P=0.46）. Mean IOP decreased postoperatively, being (20.75±11.89) mmHg at 1 day, (21.23±8.72) mmHg at 1 week, and (15.00±2.22) mmHg at 1 months in treatment group, and being (16.08±5.63) mmHg at 1 day, (22.08±11.48) mmHg at 1 week, and (16.05±5.25) mmHg at 1 months in control group. The intraocular pressure decreased with time in the two groups after surgery (all P<0.001). Although postoperative intraocular pressure fluctuations were different between the two groups, there was no statistical significance (P=0.77). The mean amplitude of IOP decrease in the two groups after 1 month were 53.09%±15.19% and 55.68%±15.63% respectively (P=0.64). Mean kind of antiglaucoma drops before surgery was 2.67±0.99 and 3.08±0.72（P=0.16）, and decreased to 0.17±0.58 and 0.96±1.33 in treatment group and control group at 1 months after the surgery (P=0.06). Transient IOP spikes were observed in 16.67% and 54.17% in the treatment group and control group (P=0.03). The most frequent postoperative complication was hyphema, 83.3% in treatment group and 62.5% in control group (P=0.21). Ciliary body detachment was observed in 25.0% in treatment group versus 75.0% in control group (P=0.004). In treatment group, the presenting visual acuity of operated eyes improved in 8 eyes（66.7%), and remained in 4 eyes (33.3%). In control group, the presenting visual acuity of operated eyes remained in 20 eyes (83.3%), and decreased in 4 eyes (16.7%)，the change of visual acuity was different in the two groups (P<0.001). Conclusion Both trabeculotomy combined with phacoemulsification and trabeculotomy alone could reduce IOP effectively for POAG. The incidence of transient IOP spike was lower in trabeculotomy combined with phacoemulsification than trabeculotomy alone. However the middle- and long-term efficacy between the two groups is yet to be determined.