房角分离或小梁切除联合超声乳化治疗PACG合并年龄相关性白内障

目的：分析房角分离或小梁切除术联合超声乳化(Phaco)治疗原发性闭角型青光眼(PACG)合并年龄相关性白内障的有效性和安全性。

方法：回顾性研究。收集我院2013-03/2018-02期间收治的PACG合并年龄相关性白内障患者96例108眼。根据治疗方式不同分为房角分离术联合Phaco组(A组，50例54眼)和小梁切除术联合Phaco(B组，46例54眼)。比较两组患者术前和末次随访时最佳矫正视力、眼压、中央前房深度、角膜内皮细胞计数，以及手术失败率、术后复发率、手术时间、平均住院日。

结果：两组患者术后至少随访12mo，最佳矫正视力明显提高，且眼压比术前明显下降(P<0.01)。术后B组眼压明显低于A组(P=0.004)，而最佳矫正视力低于A组(P=0.012)。两组患者中央前房深度比术前明显加深(P<0.01)，但两组间无差异(P=0.231)。末次随访时角膜内皮细胞计数、六角形细胞比例组间无差异(P>0.05)。A组手术时间较B组短(P=0.022)，且平均住院日明显低于B组(P<0.001)。两组手术失败率(P=0.243)和术后复发率(P=0.113)无差异。

结论：房角分离联合Phaco治疗PACG合并白内障和小梁切除联合Phaco手术具有相似疗效和安全性。前者更容易获得较好视力，手术时间短，可以缩短住院时间，而后者手术失败率和复发率较低，更适合慢性PACG患者。

Angle separation or trabeculectomy combined with phacoemulsification in the treatment of primary angle closure glaucoma with age-related cataract

AIM: To analyze the efficacy and safety of goniosynechialysis or trabeculectomy combined with phacoemulsification(Phaco)in the treatment of primary angle-closure glaucoma(PACG)and coexisting cataract.

METHODS: A retrospective study. A total of 108 eyes of 96 PACG patients with age-related cataract admitted to our hospital from March 2013 to February 2018 were collected. Goniosynechialysis combined with Phaco(group A)was performed in 50 cases(54 eyes), and trabeculectomy combined with Phaco(group B)in 46 cases(54 eyes). The best corrected visual acuity, intraocular pressure, central anterior chamber depth, corneal endothelial cell count, failure rate, recurrence rate, operation time and average hospitalization days were compared between the two groups.

RESULTS: After at least 12mo of follow-up(till February 2019), the best corrected visual acuity of the two groups was significantly improved, and the intraocular pressure was significantly lower than preoperation(P<0.01). Intraocular pressure in group B was significantly lower than that in group A postoperatively(P=0.004), while the best corrected visual acuity in group B was lower than that in group A(P=0.012). The central anterior chamber depth of the two groups was significantly deeper than pre-operation(P<0.01), but there was no significant difference between the two groups(P=0.231). At the last follow-up, there was no significant difference in the percentage of hexagonal cells(P>0.05). The operation time of group A was shorter(P=0.022), and the average hospitalization days were significantly lower than those of group B(P<0.001). There was no significant difference in the failure rate(P=0.243)and recurrence rate(P=0.113)between the two groups.

CONCLUSION: Goniosynechialysis combined with Phaco in the treatment of PACG and coexisting cataract has similar efficacy and safety to trabeculectomy combined with Phaco. The former may achieve better visual acuity, shorter operation time and shorter hospitalization time, while the latter has lower failure rate and recurrence rate, which is more suitable for patients with chronic PACG.