[1]毕宇,葛红岩,刘平. 不同手术方式对原发性闭角型青光眼合并白内障的疗效分析[J].眼科新进展,2015,35(5):442-445.[doi:10.13389/j.cnki.rao.2015.0120]
　BI Yu,GE Hong-Yan,LIU Ping. Different surgical types for primary angle-closure glaucoma and cataract[J].Recent Advances in Ophthalmology,2015,35(5):442-445.[doi:10.13389/j.cnki.rao.2015.0120]
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 不同手术方式对原发性闭角型青光眼合并白内障的疗效分析
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《眼科新进展》[ISSN:1003-5141/CN:41-1105/R]

卷:
35卷
期数:
2015年5期
页码:
442-445
栏目:
应用研究
出版日期:
2015-05-05

文章信息/Info

Title:
 Different surgical types for primary angle-closure glaucoma and cataract
作者:
 毕宇; 葛红岩; 刘平
 150001　黑龙江省哈尔滨市，哈尔滨医科大学第一附属医院眼科医院
Author(s):
 BI Yu ; GE Hong-Yan; LIU Ping
 Eye Hospital ,the First Clinical Hospital of Harbin Medical University , Harbin 150001 , Heilongjiang Province . China
关键词:
 ; 闭角型青光眼; 白内障; 小梁切除术; 超声乳化白内障吸出术; 人工晶状体植入术
Keywords:
 ; angle-closure glaucoma;  cataract;  trabeculectomy;  phacoemulsification ;  intraocular lens implantation
DOI:
10.13389/j.cnki.rao.2015.0120
文献标志码:
A
摘要:
 目的　探讨三种术式治疗原发性闭角型青光眼（ｐｒｉｍａｒｙａｎｇｌｅ-ｃｌｏｓｅｄｇｌａｕｃｏｍａ，ＰＡＣＧ）合并白内障的临床疗效。方法收集ＰＡＣＧ合并白内障患者１５６例（１６０眼），按房角粘连程度分４组：房角粘连≤１８０°且合并白内障的患者分别采用白内障超声乳化吸出＋人工晶状体植入（Ｐｈａｃｏ＋ＩＯＬ） ＋房角分离术（Ａ组）及Ｐｈａｃｏ＋ＩＯＬ术（Ｂ组）；对房角粘连＞１８０°且合并白内障的患者采取Ｐｈａｃｏ＋ＩＯＬ＋房角分离术（Ｃ组）及Ｐｈａｃｏ＋ＩＯＬ＋小梁切除术（Ｄ组），术后随访观察２组患者眼压、视力、前房深度、并发症等。结果　Ａ、Ｂ、Ｃ、Ｄ组术后３个月眼压分别为（１３.１４±３．０８）ｍｍＨｇ（１ｋＰａ＝７．５ｍｍＨｇ）、（１９．６８±７．５８）ｍｍＨｇ、（１３.１４±５．３２）ｍｍＨｇ、（１５．１６±５．１９）ｍｍＨｇ，与术前比较差异均有统计学意义（均为Ｐ＜０．０５），Ａ、Ｂ组术后１个月、３个月眼压之间差异有统计学意义（均为Ｐ＜０．０５），Ｃ、Ｄ组术后３ｄ、１周眼压之间差异有统计学意义（均为Ｐ＜０．０５），Ａ、Ｃ组术后眼压差异无统计学意义（Ｐ＞０．０５）。Ａ、Ｂ、Ｃ、Ｄ组术后视力较术前均明显提高，视力构成比差异均有统计学意义（均为Ｐ＜０．０５），Ａ、Ｂ组，Ｃ、Ｄ组术后视力构成比差异无统计学意义（Ｐ＞０．０５），Ａ、Ｃ组术后视力构成比差异有统计学意义（Ｐ＜０．０５）。Ａ、Ｂ、Ｃ、Ｄ组术后中央前房深度（ｃｅｎｔｒａｌｃｈａｍｂｅｒｔｈｉｃｋｎｅｓｓ，ＣＣＴ）分别为（３．５６±０．２６）ｍｍ、（２．９６±０．３３）ｍｍ、（３．２７±０．３２）ｍｍ、（３．１２±０．３８）ｍｍ，较术前均明显增加，差异均有统计学意义（均为Ｐ＜０．０５），Ａ、Ｂ、Ｃ、Ｄ组ＣＣＴ加深幅度分别为（１．７５±０．３２）ｍｍ、（１．１４±０．２３）ｍｍ、（１．５７±０．３４）ｍｍ、（１．３８±０．２７）ｍｍ，除Ａ、Ｄ组之间外，余组间两两比较差异均有统计学意义（均为Ｐ＜０．０５）。结论　三种手术方式均是解决ＰＡＣＧ合并白内障的有效办法，具体要依照患者眼内环境、病情严重程度、经济状况以及依从性好坏等多方面选择治疗方案。
Abstract:
 Objective To propose the preliminary clinical results of three types of nucrosurgery on primary angle-closure glaucoma ( PACG) and cataract. Methods One hundred and fifty-six patients ( 160 eyes) with cataract and PACG were divided into four groups by anterior chamber angle adhesion degree. The patients with angle adhesion degree≤ 1800 were treated by phacoemulsification cataract extraction and intraocular lens implantation ( Phaco + IOL) combined with goniosynechialysis ( group A) , and Phaco + IOL ( group B) , respectively. The patients with angle adhesion degree > 180。 were treated by Phaco + IOL combined with goniosynechialysis ( group C) , and Phaco + IOL combined with trabeculectomy ( group D) , respectively. The intraocular pressure, visual acuity and anterior chamber depth of four groups were compared after the surgery. Results The postoperative intraocular pressure at 3 months of group A, B , C , D were ( 13. 14 + 3. 08) mmHg( I kPa = 7. 5 mmHg) , ( 19. 68 + 7. 58 ) mmHg , ( 13. 14 +5. 32 ) mmHg , ( 15. 16 + 5. 19 ) mmHg , respectively , there were significant differences compared with pre-operation ( all P < 0. 05 ) . There were statistical differences in postoperative intraocular pressure between I month and 3 months of group A and B (P < 0. 05 ) , between 3 days and I week of group C and D (P < 0. 05 ) .and no statistical difference was found between group A and C (P > 0. 05 ) . The postoperative visual acuity of group A, B ,C .D were increased. there were sigruficant differences in constituent ratio ( all P < 0. 05 ) . and significant difference between group A and group C in constituent ratio (P < 0. 05 ) . The postoperative central chamber thickness of group A, B,C ,D were ( 3. 56 +0. 26 ) mm . ( 2. 96 + 0. 33) mm , ( 3. 27 + 0. 32 ) mm , ( 3. 12 + 0. 38 ) mm , respectively , there were statistical differences compared with pre-operation ( all P < 0. 05 ) . The increased values of postoperative central chamber thickness in group A, B , C , D were ( 1. 75 + 0. 32) mm . ( 1. 14 + 0. 23 ) mm . ( 1. 57 + 0. 34 ) mm . ( 1. 38 + 0. 27 ) mm , respectively , which showed statistical differences between group A and B , group C and D , group A and C ( all P < 0. 05 ) . Conclusion The three types of microsurgery are effective for PACG and cataract.but which is the best way for the patient should be depend on intraocular environment , severity of illness , financial situation.

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备注/Memo

备注/Memo:
 国家自然科学基金（青年项目）资助（编号：８１３００７２８）
更新日期/Last Update: 2015-04-27