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目的比较单纯白内障超声乳化摘除术和联合房角分离术治疗不同房角关闭状态的闭角型青光眼的效果。设计前瞻性同期对照研究。研究对象闭角型青光眼合并白内障需行手术的患者48例(60眼)。方法在闭角型青光眼合并白内障患者中非随机选取房角关闭<180度患者30眼,房角关闭>180度30眼两组。两组患眼随机再分两组各15眼,其中一组行单纯白内障超声乳化摘除术,另一组行白内障超声乳化摘除联合房角分离术。观察手术前后眼压、前房深度、房角开放(Goldmann房角镜,应用Stratus相干光断层扫描仪检测术后早期房角形态)情况,平均随访(6.60±2.34)个月。对结果进行统计学分析。主要指标视力,眼压,中央前房深度,房角。结果全部患者术后视力均有提高,术后眼压均较术前明显下降。房角关闭<180度患眼中,最后随访时两种方法术后眼压分别为(13.26±3.21)mmHg、(12.87±2.66)mmHg(P=0.51);前房深度分别为(2.86±0.42)mm、(2.96±0.50)mm(P=0.47);房角开放程度亦无显著差异。房角关闭≥180度患眼中,最后随访时两种方法术后眼压分别为(17.35±4.18)mmHg、(13.81±3.06)mmHg(P=0.02);前房深度分别为(2.91±0.47)mm、(3.05±0.44)mm(P=0.42);但行房角分离术组房角开放更宽。结论对房角未完全关闭的闭角型青光眼合并白内障,超声乳化白内障吸除术可以有效地达到控制眼压、开放房角、加深前房、提高视力的治疗目的。但对于房角关闭>180度患眼应行房角分离术。
Objective To compare the effects of phacoemulsification alone and combined with room angle separation in the treatment of angle-closure glaucoma in different angles. Design prospective concurrent control study. Forty-eight patients (60 eyes) undergoing surgery for angle-closure glaucoma with cataract were included. Methods In the patients with angle-closure glaucoma and cataract, there were two groups of non-randomly selected patients with angle closure of 30 eyes <180 degrees and angle closure> 180 degrees and 30 eyes. The two groups of eyes were randomly divided into two groups of 15 each, one of which was performed with simple cataract phacoemulsification and the other with cataract phacoemulsification combined with room angle separation. The intraocular pressure (IOP), the depth of the anterior chamber and the open angle of the anterior chamber (Goldmann angle glimpse, Stratus coherence tomography before operation) were observed before and after the operation. The average follow-up time was (6.60 ± 2.34) months. The results were statistically analyzed. Main indicators of visual acuity, intraocular pressure, the central anterior chamber depth, angle. Results All patients had improved visual acuity, postoperative intraocular pressure were significantly decreased compared with preoperative. The intraocular pressure of the two methods at the final follow-up were (13.26 ± 3.21) mmHg and (12.87 ± 2.66) mmHg respectively (P = 0.51), and the anterior chamber depth was (2.86 ± 0.42) mm mm, (2.96 ± 0.50) mm (P = 0.47). There was no significant difference in the degree of opening angle. The intraocular pressure of the two methods at the last follow-up were (17.35 ± 4.18) mmHg and (13.81 ± 3.06) mmHg respectively (P = 0.02), and the anterior chamber depth were (2.91 ± 0.47) and mm, (3.05 ± 0.44) mm (P = 0.42). However, the angle of the angle of the angle group was wider. Conclusion The angle closure glaucoma with cataract and phacoemulsification can not effectively control the intraocular pressure, open the angle, deepen the anterior chamber and improve the visual acuity. But for angle closure> 180 degree eyes should be line angle separation.