白内障超声乳化摘除联合小梁切除术以及单纯小梁切除术在原发性闭角型青光眼的治疗中的对比研究

白内障超声乳化摘除联合小梁切除术以及单纯小梁切除术在原发性闭角型青光眼的治疗中的对比研究背景：对于原发性闭角型青光眼的眼压控制来说，小梁切除术是主流手术方式，而对合并有白内障的原发性闭角型青光眼患者，小梁切除联合白内障超声乳化摘除+人工晶体植入术不仅可以控制眼压，还可以提高患者的视力。本文旨在对两种手术方式在合并白内障的原发性闭角型青光眼的安全性和有效性进行对比研究。方法：本文为病例对照系列研究。共纳入31例合并白内障的原发性闭角型青光眼患者，其中，17例患者行小梁切除术联合白内障超声乳化摘除+人工晶体植入术，14名患者单行小梁切除术。对于术后的眼压、滤过泡及并发症进行对比。手术完全成功定义为术后不用降眼压药物时眼压低于21mmHg.结果：术后共随访10个月，青白联合及单纯小梁切除组在降眼压方面没有显著差异(20.597.94 vs. 24.8514.39 mmHg, P=0.614)，完全成功率分别为88.2% 及 71.4%, （P=0.37），滤过泡形成比例分别为64.7% [11/17] vs. 92.9% [13/14]（P=0.094），并发症发生的比例分别为41.2% [7/17] vs. 57.1% [8/14],（P=0.38）。两组患者中绝大多数术后停用降眼压药物；单纯行小梁切除组部分患者需要进一步的手术干预，包括前房形成术、白内障超声乳化术等。结论：虽然单纯小梁切除术组术后有几例因白内障及并发症的存在需进一步手术，青光眼白内障联合术及小梁切除术在合并白内障的原发性闭角型青光眼的降眼压效果、手术成功率及术后并发症相当。关键词：原发性闭角型青光眼；小梁切除术；白内障超声乳化摘除联合梁切除术；白内障。

Comparison of Combined Phacotrabeculectomy and Trabeculectomy only in the Treatment of Primary Angle-Closure Glaucoma

BACKGROUND: Trabeculectomy has become a mainstream treatment in intraocular pressure (IOP) reduction for primary angle-closure glaucoma (PACG); combined trabeculectomy and cataract surgery was reported to reduce IOP and simultaneously improve vision for patients with PACG and coexisting cataract. This study was specialized to compare the efficacy and safety of combined phacotrabeculectomy and trabeculectomy only in the treatment of PACG with coexisting cataract.METHODS: This is a comparative case series study. Thirty-one patients (31 eyes) with PACG and coexisting cataract were enrolled. Of these, 17 underwent phacotrabeculectomy and 14 underwent trabeculectomy alone. IOP, filtering blebs, and complications were compared at the final follow-up. Complete success was defined as a final IOP less than 21 mmHg without IOP-lowering medication.RESULTS: After 10 months of postoperative follow up, the phacotrabeculectomy and trabeculectomy groups showed no significant differences regarding IOP reduction (20.597.94 vs. 24.8514.39 mmHg, P=0.614), complete success rate (88.2% vs. 71.4%, P=0.37), formation rate of functioning blebs(64.7% [11/17] vs. 92.9% [13/14], P=0.094), and complications (41.2% [7/17] vs. 57.1% [8/14], P=0.38). IOP-lowering medication was not required for most of the patients in both groups. Additional surgery interventions, including anterior chamber reformation and phacoemulsification, were needed in the trabeculectomy group, whereas no surgery was needed postoperatively in the phacotrabeculectomy group.CONCLUSIONS: Phacotrabeculectomy and trabeculectomy treatments exhibit similar IOP reduction, successful rates, and complications when it comes to treating PACG patients with coexisting cataract, although additional surgery intervention may be needed for a few cases with cataract and complications after trabeculectomy.Key words: Primary angle-closure glaucoma; trabeculectomy; phacotrabeculectomy; cataract