闭角型青光眼伴白内障两种手术方式的选择

目的探讨闭角型青光眼伴发白内障的手术方式选择。方法观察闭角型青光眼伴发白内障116例（124眼），根据眼压控制和前房角粘连情况分为两组，A组：单用缩瞳剂使眼压控制在≤30mmHg（1mmHg=0．133kPa），前房角粘连≤180°者70例（76眼），行白内障超声乳化人工晶状体植入联合前房角分离术。B组：眼压〉30mmHg，前房角粘连〉180°者46例（48眼），行白内障超声乳化人工晶状体植入联合小梁切除术。术后随访6个月，观察视力、眼压、前房深度。结果A、B两组术后平均矫正视力均较术前有显著性提高（A组：Z=-6．584，P〈0．01，B组：Z=-4．516，P〈0．01）。术后平均眼压显著下降（A组：t=4．504，P〈0．01，B组t=10．802，P〈0．01）。术后平均前房深度显著增加（A组：t=-16．3693，P〈0．01，B组：t=-14．2475，P〈0．01）。结论闭角型青光眼伴发白内障单用缩瞳剂眼压控制在≤30mmHg，前房角粘连≤180。者行白内障超声乳化人工晶状体植入联合前房角分离术是安全有效的；眼压〉30mmHg，前房角粘连〉180。者联合小梁切除术则较好。

Clinical observation on two types of phacoemulsification for the treatment of angle-closure glaucoma combined with cataract

Objective To investigate the surgical approach for angle-closure glaucoma combined with cataract. Methods Totally 124 eyes of 116 patients with angle-closure glaucoma combined with cataract were divided into two groups according to their intraocular pressure（lOP） and the degrees of synechial angle closure（SAC）. Group A ：76 eyes with SAC ≤180° and IOP ≤30 mmHg （1 mmHg =0. 153 kPa） after control with pilocarpine were treated with phacoemulsification and intraocular lens （IOL） implantation combined with goniosynechialysis. Group B： 48 eyes with IOP 〉 30mmHg and SAC 〉 180° were treated with phacoemulsification and IOL implantation combined with trabeculectomy. The follow-up time was 6 months. The vision, IOP and chamber depth were observed. Results The corrected visual acuity of all patients were improved significantly compared with preoperative visual acuity （Group A： Z = -6. 584, P 〈 0. 01, Group B：Z = -4. 516,P 〈 0. 01 ）. The IOP was reduced significantly after operation （Group A： t=4. 504, P 〈0. 01, Group B ： t = 10. 802, P 〈 0.01 ）. The mean chamber depth after operation increased significantly （Group A：t= -16.3693, P〈0.01, Group B： t= -14.2475, P〈0.01）. Conclusion Phacoemulsifica- tion and IOL implantation combined with goniosynechialysis are safe and effective for the patients with angle- closure glaucoma and cataract whose IOP ≤30 mmHg after control with pilocarpine singly and whose SAC ≤ 180°. For the patients with IOP 〉 30 mmHg and SAC 〉 180°, phacoemulsification combined with trabecu- lectomy surgery should be the better choice.