超声乳化白内障吸除联合房角分离术治疗闭角型青光眼合并白内障疗效及对房角宽度的影响

Efficacy of Phacoemulsification Combined with Goniosynechialysis on Angle-Closure Glaucoma with Cataract and Its Effects on the Angle of Anterior Chamber

摘要: 目的：探讨超声乳化白内障吸除联合房角分离术(Phaco-GSL)治疗闭角型青光眼(ACG)合并白内障疗效及对房角宽度的影响。方法：将我院眼科收治的90例ACG合并白内障患者随机分为Phaco-GSL组和Phaco组，各45例，Phaco组接受Phaco + 人工晶状体植入(IOL)术，Phaco-GSL组接受Phaco + IOL + GSL，比较两组手术前后眼压、降眼压药种类、房角宽度、最佳矫正视力及并发症。结果：两组术后1 d和术后1、3个月眼压均低于术前(P < 0.05)，术后1个月眼压低于术后1 d (P < 0.05)；Phaco-GSL组术后1 d眼压低于Phaco组(P < 0.05)，两组术前及术后1、3个月眼压比较，无显著差异(P > 0.05)；两组术前、术后降眼压药种类无显著差异(P > 0.05)；Phaco-GSL组手术前后眼压差值及降眼压药种类差值均高于Phaco组(P < 0.05)；两组术后1个月房角均较术前明显增宽(P < 0.05)，Phaco-GSL组房角开放情况优于Phaco组(P < 0.05)；两组术后3个月最佳矫正视力均明显提高(P < 0.05)，两组术前、术后3个月最佳矫正视力比较，无显著差异(P > 0.05)；Phaco-GSL组术后出现角膜水肿11例(24.44%)，前房微出血2例(4.44%)；Phaco组术后出现角膜水肿10例(22.22%)；两组均未出现视网膜脱落、后囊破裂等并发症。结论：Phaco-GSL治疗ACG合并白内障疗效确切，能有效降低眼压、开放房角，并改善患者是功能。

Abstract: Objective: To explore the efficacy of phacoemulsification combined with goniosynechialysis (Pha-co-GSL) on angle-closure glaucoma (ACG) with cataract and its effects on angle of anterior chamber. Methods: 90 patients with ACG and cataract admitted to ophthalmology department of our hospital were randomly divided into Phaco-GSL group and Phaco group, with 45 cases in each group. Phaco group was given Phaco + intraocular lens implantation (IOL), and Phaco-GSL group was given Phaco + IOL + GSL. The intraocular pressure, types of ocular hypotensive agents, angle of anterior chamber, best corrected visual acuity and complications were compared between the two groups before and after surgery. Results: The intraocular pressure in the two groups at 1 d, a month and 3 months after surgery was lower than that before surgery (P < 0.05), and the intraocular pressure at 1 month after surgery was lower than that at 1 d after surgery (P < 0.05). The intraocular pressure in Phaco-GSL group at 1 d after surgery was lower than that in Phaco group (P < 0.05), and there was no significant difference in intraocular pressure between the two groups before surgery and at 1 month and 3 months after surgery (P > 0.05). There were no significant differences in the types of ocular hypotensive agents before and after surgery (P > 0.05). The intraocular pressure difference and difference of types of ocular hypotensive agents before and after surgery in Phaco-GSL group were higher than those in Phaco group (P < 0.05). The angle of anterior chamber in the two groups was significantly wider than that before surgery (P < 0.05), and the angle opening in Phaco-GSL group was better than that in Phaco group (P < 0.05). The visual acuity in the two groups was significantly improved at 3 months after surgery (P < 0.05), and there was no significant difference in the best corrected visual acuity between the two groups before surgery and at 3 months after surgery (P > 0.05). There were 11 cases (24.44%) of corneal edema and 2 cases (4.44%) of anterior chamber microbleeds in Phaco-GSL group. There were 10 cases (22.22%) of corneal edema after surgery in Phaco group. There were no complications such as retinal detachment and posterior capsule rupture in the two groups. Conclusions: Phaco-GSL has exact efficacy in the treatment of ACG with cataract, and it can effectively reduce intraocular pressure, open angle, and improve the function of patients.