超声乳化白内障吸除分别联合小梁切除术与房角分离术治疗白内障合并闭角型青光眼的疗效比较

Comparison of efficacy of phacoemulsification combined with trabeculectomy or goniosynechialysis on cataract with angle clo-sure glaucoma

中文关键词: 老年  白内障  闭角型青光眼  超声乳化白内障吸除  小梁切除术  房角分离术

英文关键词: elderly  cataract  angle closure glaucoma  phacoemulsification  trabeculectomy  goniosynechialysis

中文摘要:

      目的 探究超声乳化白内障吸除联合小梁切除术(Phaco-TM)与超声乳化白内障吸除联合房角分离术(Phaco-GSL)治疗白内障合并闭角型青光眼(ACG)的临床疗效和安全性差异.方法 回顾性分析2020年10月—2023年10月成都市第三人民医院收治的90例白内障合并ACG患者的临床资料.根据患者的治疗方式分为GSL组(n=45)和TM组(n=45).2组均采用超声乳化白内障吸除的基础治疗,GSL组采用基础治疗联合房角分离术,TM组采用基础治疗联合小梁切除术.比较2组疗效差异、手术相关指标值、角膜变化差异及并发症发生率.结果 治疗1个月后,GSL组患者临床疗效高于TM组;视力、眼压以及前房深度治疗前后差值绝对值均高于TM组;角膜内皮细胞个数和角膜内皮细胞平均面积治疗前后差值(绝对值)均低于TM组;差异均有统计学意义(P＜0.05).2组中央角膜厚度前后差值差异无统计学意义(P＞0.05).GSL组患者并发症发生率低于TM组(P＜0.05).结论 GSL治疗可能是白内障合并ACG患者的推荐手术方法;与Phaco-TM比较,接受Phaco-GSL治疗的患者并发症风险降低,且对患者视力和眼压的改善效果更优,对角膜的影响较小,具有一定的临床应用价值.

英文摘要:

      Objective To investigate the effects of phacoemulsification(Phaco)combined with either trabeculectomy(TM)or goniosynechialysis(GSL)in the treatment of cataract complicated with angle-closure glaucoma(ACG).Methods A retrospective analysis was conducted on the clinical data of 98 patients with cataract and ACG admitted to Third People's Hospi-tal of Chengdu City from October 2020 to October 2023.According to the treatment methods,they were divided into GSL group and TM group,with 49 cases in each group.Both groups received basic treatment of Phaco.The GSL group received basic treatment combined with goniosynechialysis,while the TM group received basic treatment combined with TM.The differ-ences in the therapeutic effects,surgery-related index values,corneal changes and the incidence of complications were com-pared between the two groups.Results After 1 month of treatment,the clinical efficacy in the GSL group was significantly higher than that in the TM group.The absolute values of the differences in visual acuity,intraocular pressure and anterior cham-ber depth before and after treatment in the GSL group were all higher than those in the TM group,while the absolute values of the differences in the corneal endothelial cell count and average area of corneal endothelial cells before and after treatment were both lower than those in the TM group.The differences were all statistically significant(P＜0.05).There was no statistical difference in the difference of central corneal thickness before and after treatment between the two groups(P＞0.05).The incidence rates of complications in the GSL group were significantly lower than those in the TM group(P＜0.05).Conclusion GSL may be a recommended surgical method for patients with cataract complicated with ACG.Compared with Phaco-TM,Phaco-GSL can significantly reduce the risk of complications,has better improvement effects on visual acuity and intraocular pressure,and less impact on the cornea.It has certain clinical application value.