两种联合手术方式治疗急性闭角型青光眼合并白内障的疗效比较

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术治疗原发性急性闭角型青光眼(acute primary angle-closure glaucoma，APACG)合并白内障的临床疗效。

方法：前瞻性随机对照研究。选择符合入组条件的急性闭角型青光眼合并白内障患者60例60眼，随机分为对照组和研究组； 对照组行白内障超声乳化吸除、人工晶状体植入联合小梁切除术(30眼)，研究组行白内障超声乳化吸除、人工晶状体植入联合房角分离术(30眼)，比较两种术式的临床疗效。

结果：术前两组视力、眼压、中央前房深度、房角开放程度差异无统计学意义(P>0.05)； 术后2mo两组视力、眼压、中央前房深度、房角开放程度均明显比术前改善，差异有统计学意义(P<0.001)； 研究组术后视力、中央前房深度、房角开放程度，均优于对照组，差异有统计学意义(P<0.05)； 两组术后眼压及并发症相比，研究组优于对照组，但差异无统计学意义(P>0.05)。

结论：白内障超声乳化人工晶状体植入联合房角分离术，对APACG合并白内障患者视力的提高、眼压的控制有着积极的临床效果。

Two different methods for acute angle-closure glaucoma with cataract

AIM:To investigate the clinical efficacy of phacoemulsification(Phaco)and intraocular lens(IOL)implantation combined with goniosychialysis in the treatment of acute primary angle-closure glaucoma(APACG)with cataract.

METHODS: In this prospective randomized clinical trial, 60 eyes of 60 patients with APACG and coexisting cataract were randomized to the control group(30 patients, 30 eyes)or the study group(30 patients, 30 eyes)and completed the trial. All the two groups were treated with phacoemulsification and intraocular lens implantation, and the control group(30 patients, 30 eyes)was combined with trabeculectomy, while the study group(30 patients,30 eyes)was treated with the goniosychialysis. All patients were followed up for 2mo. The preoperative and postoperative best corrected visual acuity(BCVA), intraocular pressure(IOP), anterior chamber depth(ACD), anterior chamber angle(ACA)and complications were compared.

RESULTS: There were no statistically significant differences between the 2 groups in BCVA, IOP, ACD, ACA before surgery(P>0.05). The postoperative BCVA, IOP, ACD and re-opening anterior chamber angle(ACA)in two groups were all improved, and the differences had statistical significance(P<0.001). BCVA, ACD, re-opening ACA of research group were significantly better than those of the control group(P<0.05). The decreased IOP of the study group were more than the control group and the complications of the control group were more than the study group, but there was no statistical difference in the postoperative IOP and complications between two groups(P>0.05).

CONCLUSION: The phacoemulsification and IOL implantation combined with goniosychialysis can improve the vision of patients, decrease IOP, increase ACD, and re-opening anterior chamber angle(ACA)in patients with APACG combined with cataract. It has a positive clinical effect.