不同手术方式治疗急性闭角型青光眼合并白内障的疗效及安全性  

Efficacy and safety of different surgical procedures for acute angle closure glaucoma with cataract

作　　者：古爱平[1] 吴艺[1] 刘燕芳[1] 龙佩仪[1] GU Ai-ping;WU Yi;LIU Yan-fang;LONG Pei-yi(Department of Ophtalmology , the Second People＇s Hospital of Guangdong Province, Guangzhou , Guangdong 510317, China)

机构地区：[1]广东省第二人民医院眼科,广东广州510317

出　　处：《热带医学杂志》2018年第5期658-661,F0002,共5页Journal of Tropical Medicine

摘　　要：目的分析小梁切除联合白内障超声乳化手术治疗急性闭角型青光眼合并白内障的临床疗效及安全性。方法回顾性分析2014年1月至2016年1月间在本院接受治疗急性原发性闭角型青光眼(APACG)合并白内障患者101例(107眼),其中48例(51眼)进行白内障和青光眼的联合手术,称为联合组;53例(56眼)分期进行青光眼和白内障的超声乳化手术,称为分期组;记录患者术前和手术后的眼压、视力变化、手术后患者并发症和中央角膜的内皮细胞计数等情况。结果治疗后两组患者眼压均下降显著,手术后1周、1个月、3个月与手术前比较差异均有统计学意义(P<0.05),两组间比较差异无统计学意义(P>0.05);两组患者视力情况得到改善明显,手术后两组比较差异无统计学意义(P>0.05);两组患者膜内皮的受损率、内皮细胞的数量和内皮细胞所占的比例均明显下降,与治疗前比较差异有统计学意义(P<0.05),但两组间比较差异无统计学意义(P>0.05)。截止术后3月,联合组并发症发生率为31.3%(16眼),高于分期组的17.9%(10眼),差异有统计学意义(χ2=7.23,P<0.05);不同并发症患者均对症治疗。结论小梁切除联合白内障超声乳化手术与分期进行两种手术方式均可有效提升患者视力,降低眼压,但分期手术术后患者出现并发症几率更低,安全性更高。Objective To analyze the clinical efficacy and safety of trabeculectomy combined with phacoemulsification and staging for two cases of acute angle closure glaucoma complicated with cataract. Methods 101 cases（107 eyes）of acute primary angle-closure glaucoma（APACG）complicated with cataract in our hospital between January 2014 and January2016 were retrospectively analyzed. 48 cases（51 eyes）were treated with cataract and glaucoma combined surgery,known as the combined group;53 cases（56 eyes）performed emulsification surgery for glaucoma and cataracts,known as a staging group;the preoperative and postoperative intraocular pressure,visual acuity changes,postoperative complications and central corneal endothelial cell counts were recorded. Results After treatment,IOP decreased significantly in both groups,and there was a significant difference between 1 week,1 month,and 3 months after surgery and before surgery（P〈0.05）. There was no significant difference between the two groups（P〈0.05）. The visual acuity of the two groups improved significantly,and there was no significant difference between the two groups after surgery（P〈0.05）. The damage rate of endothelium,the number of endothelial cells and the proportion of endothelial cells in both groups were significantly decreased,and there was a statistically significant difference between the two groups before treatment（P〈0.05）,but the difference between the two groups was not statistically significant（P〈0.05）. By the end of March,the incidence of complications in the combined group was 31.3%（16 eyes）,higher than the 17.9%（10 eyes）in the staging group,the difference was statistically significant（χ^2=7.23,P〈0.05）;different complications patients received symptomatic treatment.Conclusion Both trabeculectomy combined with cataract phacoemulsification and two stages of surgery can effectively improve the patient′s visual acuity and reduce the intraocular pressure. After surgery,the complication rate was low.

关 键 词：分期手术 联合手术 急性闭角型青光眼 白内障 

分 类 号：R775.2[医药卫生—眼科] R776.1[医药卫生—临床医学]