超声乳化白内障吸除联合房角分离术治疗原发性闭角型青光眼的临床研究

目的 探讨超声乳化白内障吸除、人工晶状体植入联合房角分离对原发性闭角型青光眼治疗的临床效果和安全性.方法 连续性选取收治的原发性闭角型青光眼合并有白内障的患者133例145只眼,随机分为超声乳化组(Phaco组)和小梁切除手术组(Trab组).观察手术前后视力、前房深度、角膜内皮细胞密度、房水流畅系数(C值)、房角及眼压的变化情况并进行统计学处理.平均随访时间(13.2±5.6)个月.结果 Phaco组术后视力明显提高而Trab组提高不明显;眼压在6个月时Phaco组由术前(46.47±9.12)mmHg降低为(16.55±4.36)mmHg,Trab组由术前(48.25±7.52)mmHg降低为(16.87±5.01)mmHg,两组手术前后比较差异均有统计学意义;Phaco组前房深度由术前(1.55±0.26)mm加深为(3.38±0.35)mm,房角关闭度数由术前(290±25)度减少到(60±35)度,手术前后比较差异有非常显著性,而Trab组则无明显变化;房水流畅系数(C值)检测两组手术前后比较差异均有显著性改善;角膜内皮细胞密度检测两组手术前后差异则无显著性.结论 超声乳化白内障吸除、人工晶体植入联合房角分离术能够显著地加深前房,开放房角,有效地降低眼压,提高患者视功能,并具有手术安全性高、术后并发症少等优势,是治疗PACG合并自内障患者的一种安全有效的手术方法.

Clinical research on the efficacy of treatment for patients with primary angle-closure glaucoma with the combined surgeries of phacoemulsification, intraocular lens implantation and goniosynechialysis

Objective To observe and assess the efficacy of treatment for patients with primary angle-closure glaucoma with the combined surgeries of phacoemulsification,intraocular lens implantation and goniosyoechialysis.Methods 145eyes of 133 consecutive patients with primary angle-closure glaucoma and cataract were randomized into Phaco group and Trab group; The changes of visual acuity,anterior chamber depth (ACD),extent of PAS,corneal endothelial cell density,coefficient of outflow facility,anterior chamber angle and IOP before and after operation were measured.The average follow-up period was (13.2±5.6) months.Results The visual acutity was improved significiantly after phacoemulsication and no significant difference in Trab group; The IOP significiantly decreased from (46.47±9.12)mmHg to (16.55±4.36)mmHg at 6 months after surgery in phaco group.While in Trab group,the IOP decreased from (48.25±7.52) mmHg to (16.87± 5.01) mmHg.There were significant differences in two groups before and after surgery;The anterior chamber depth (ACD) was increased from(1.55±0.26)mm before surgery to(3.38±0.35)mm at 3 months after surgery in the phaco group,but there were no significant differences in the trab group; The angle closure decreased from (290 ± 25) before surgery to(60±35) at three months after surgery in Phaco group,but no signifant difference in Trab group; The C value were increased more significiantly than preoperation in the two groups but there were no signifant difference in two groups before and after surgery with the change of the density of corneal endothelial cells .Conclusion Combined phacoemulsication and IOL implantation and Goniosynechialysis can deepen the anterior chamber depth significiantly,make the anterior chamber angle open ,reduce IOP effectively,improve the patients' visual acuity.It is a safe and effective approach to those patients with PACG and coexisting cataract.