闭角型青光眼合并白内障手术方案的选择

青光眼是全球仅次于白内障的致盲性眼病，严重损害人们的视力。青光眼合并白内障的诊疗一直是眼科临床研究的热点。随着眼科医师的临床实践，青光眼，尤其是闭角型青光眼合并白内障的手术方案经历了较大的变革。经典的小梁切除术、传统的三联手术（超声乳化白内障吸除+人工晶状体植入+小梁切除术），以及近年不断拓宽适应证的白内障联合房角分离术，这些术式如何选择是白内障及青光眼诊疗医师要面对的重要问题。尽管青光眼合并白内障的患者通常具有共同的特性，但是个体差异性同样突出，如发病后就诊时机、眼部解剖结构、就诊医疗机构的条件、主治医师技术特点的差异等均会对术式的选择有重要影响。本文结合临床研究报道以及临床实践经验，对不同手术方案进行分析，以期推动闭角型青光眼合并白内障诊疗的讨论和研究。

Selection of surgical procedures for angle closure glaucoma complicated with cataract

Glaucoma is a blinding eye disease which is second only to cataract in the world, which seriously damages human vision. The diagnosis and treatment of glaucoma complicated with cataract has always been a hot spot in ophthalmic clinical research. With the clinical practice of ophthalmologists, the surgical scheme of glaucoma, especially angle closure glaucoma with cataract, has undergone great changes. How to choose the classic trabeculectomy, the traditional triple surgery (ultrasonic phacoemulsification + intraocular lens implantation + trabeculectomy), and the phacoemulsification combined with goniosynechiasis, which has been expanding the indications in recent years, are the important problems that cataract and glaucoma doctors must face. Although the patients with glaucoma and cataract usually have common characteristics, the individual differences are also prominent, such as the opportunity of seeing a doctor after the onset of the disease, the anatomical structure of the eye, the conditions of the medical institutions, and the technical characteristics of the attending doctors will have an important impact on the choice of surgical methods. In this paper, combined with clinical research and our clinical practice experience, the different surgical schemes were analyzed in order to promote the treatment of angle closure glaucoma complicated with cataract.