带深巩膜床切除的改良小梁切除术在晚期闭角型青光眼合并白内障联合手术中的应用分析

目的 探讨带深巩膜床切除的改良小梁切除术治疗晚期闭角型青光眼合并白内障的临床疗效及安全性.方法 选择晚期闭角型青光眼合并白内障患者145例（151眼）,其中85例（91眼）行带深巩膜床切除的改良小梁切除联合超声乳化人工晶状体植入术（观察组）,60例（60眼）行经典小梁切除联合超声乳化人工晶状体植入术（对照组）,比较两组术后视力变化、眼压、滤过泡情况及术后并发症.结果 两组术后1个月视力＜0.1、0.4～ 0.5、＞0.5眼数比例与术前比较差异有统计学意义（P＜0.05）,0.1～0.3眼数比例与术前比较差异无统计学意义（P＞0.05）.两组间术前、术后1个月视力比较差异无统计学意义（P＞0.05）.观察组术前眼压为（29.6±4.1） mmHg（1 mmHg=0.133kPa）,术后12个月眼压为（13.1±4.9） mmHg,降低幅度为（16.6±5.0） mmHg;对照组术前眼压为（30.4±6.3）mmHg,术后12个月眼压为（18.9±3.0） mmHg,降低幅度为（10.4±4.0） mmHg,两组术后眼压及眼压降低幅度比较差异均有统计学意义（P＜0.05）.观察组术后功能性滤过泡（Ⅰ型和Ⅱ型）77眼（84.6％,77/91）,对照组为51眼（85.0％,51/60）,两组比较差异无统计学意义（P＞0.05）.术后1个月内观察组8眼发生一过性低眼压,对照组5眼,两组比较差异无统计学意义（P＞0.05）.结论 带深巩膜床切除的改良小梁切除联合手术治疗晚期闭角型青光眼合并白内障较常规方法能更好地降低眼内压,未增加术中风险和术后并发症.

The utilized analysis of modified trabeculectomy in advanced stage angle-close glaucoma with cataract

Objective To compare the feasibility,effectivity and security of modified trabeculectomy in advanced stage angle-close glaucoma with cataract. Methods One hundred and forty-five patients （ 151 eyes） of advanced stage angle-close glaucoma with cataract were enrolled in this study. Among them, 85 patients （91 eyes, observation group） were treated with modified trabeculectomy with the resection of deep scleral resection and 60 patients （60 eyes, control group） were treated with routine trabeculectomy. The visual acuity, intraocular pressure （IOP）, type of filtering bleb and postoperative complication were compared. Results There was significant difference in the visual acuity 〈 0.1,0.4 - 0.5, 〉 0.5 between after operation for 1 month and before operation in two groups （P 〈 0.05）. but there was no significant difference in the visual acuity 0.1 - 0.3 （P 〉 0.05）. The lOP before operation in observation group was （29.6 ± 4.1 ） mmHg （ 1 mmHg = 0.133 kPa）, 12 months after operation was （13.1 ± 4.9） mmHg , the degree of decrease was （16.6 ± 5.0） mmHg. The IOP before operation in control group was （30.4 ± 6.3） mmHg, 12 months after operation was （ 18.9 ± 3.0） mmHg, the degree of decrease was （ 10.4 ± 4.0） mmHg. The IOP after operation and the degree of decrease between two groups had significant difference （P 〈 0.05 ）. The functional filtering bleb（I type and II type） in observation group was 77 eyes（84.6%, 77/91 ）,and 51 eyes（85.0% ,51/60） in control group, there was no significant difference （P 〉 0.05）. After operation for 1 month, there was 8 eyes appeared transient hypotony in observation group and 5 eyes in control group, there was no significant difference （P 〉 0.05）. Conclusion The modified trabeculectomy in advanced stage angle-close glaucoma with cataract can reduce IOP more effectively and not increase the intraoperative risk and postoperative complication.