[1]任　虹,张　良.小梁消融术联合白内障超声乳化及房角分离术治疗老年原发性闭角型青光眼合并白内障疗效观察[J].新乡医学院学报,2020,37(11):1062-1067.[doi:10.7683/xxyxyxb.2020.11.013]
　REN Hong,ZHANG Liang.Effect of trabecular ablation combined with cataract phacoemulsification and atrial angle separation in the treatment of senile primary angle-closure glaucoma combined with cataract[J].Journal of Xinxiang Medical University,2020,37(11):1062-1067.[doi:10.7683/xxyxyxb.2020.11.013]
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小梁消融术联合白内障超声乳化及房角分离术治疗老年原发性闭角型青光眼合并白内障疗效观察
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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
37
期数:
2020年11
页码:
1062-1067
栏目:
临床研究
出版日期:
2020-11-05

文章信息/Info

Title:
Effect of trabecular ablation combined with cataract phacoemulsification and atrial angle separation in the treatment of senile primary angle-closure glaucoma combined with cataract
作者:
任　虹1; 张　良2
(1.航天中心医院眼科，北京　100049；2.沈阳市第四人民医院眼科，辽宁 沈阳　110000)
Author(s):
REN Hong1; ZHANG Liang2
（1.Department of Ophthalmology,Space Center Hospital,Beijing 100049,China；2.Department of Ophthalmology,the Fourth People′s Hospital of Shenyang,Shenyang 110000,Liaoning Province,China）
关键词:
小梁消融术; 白内障超声乳化术; 房角分离术; 原发性闭角型青光眼; 白内障; 眼压; 最佳矫正视力
Keywords:
trabecular ablation; cataract phacoemulsification; atrial angle separation; primary angle-closure glaucoma; cataract; intraocular pressure; best corrected vision
分类号:
R779.66
DOI:
10.7683/xxyxyxb.2020.11.013
文献标志码:
A
摘要:
目的　探讨小梁消融术联合白内障超声乳化及房角分离术在老年原发性闭角型青光眼（PACG）合并白内障患者治疗中的应用价值。方法　选择2015年6月至2018年6月航天中心医院收治的120例老年PACG合并白内障患者为研究对象，根据手术方法不同分为对照组和观察组，每组60例。2组患者均行白内障超声乳化术及联合房角分离术，在此基础上，对照组患者给予小梁切除术，观察组患者给予小梁消融术。比较2组患者术前、术后1 d及术后1、3、6、12个月时眼压、最佳矫正视力（BCVA）及降眼压药物使用种类等。观察组患者根据术中不同消融弧度分为消融弧度90°组、消融弧度100°组和消融弧度120°组，比较3组患者术前、术后1 d及术后1、3、6、12个月时眼压、BCVA及降眼压药物使用种类等。结果　对照组和观察组患者术前眼压、BCVA及降眼压药物使用种类比较差异均无统计学意义（P>0.05）。与术前比较，术后各时间点，对照组和观察组患者眼压均显著降低，BCVA均显著增高，降眼压药物使用种类均显著减少（P<0.05）。观察组患者术后各时间点眼压与对照组比较差异均无统计学意义（P>0.05）。观察组患者术后1 d时BCVA与对照组比较差异无统计学意义（P>0.05），术后1、3、6、12个月BCVA显著高于对照组（P<0.05）；与术后1 d时比较，对照组和观察组患者术后1、3、6、12个月时BCVA均显著增高（P<0.05）。对照组和观察组患者术后1、3、6、12个月降眼压药物使用种类均少于术后1 d时，术后3、6、12个月降眼压药物使用种类均少于术后1个月时，术后6、12个月降眼压药物使用种类均少于术后3个月时（P<0.05）；对照组和观察组患者术后各时间点降眼压药物使用种类比较差异均无统计学意义（P>0.05）。不同消融弧度患者术后1 d及术后1、3、6、12个月时眼压均显著低于术前（P<0.05）；消融弧度120°组患者术后3、6、12个月时眼压均显著低于同时间点消融弧度90°组和消融弧度100°组（P<0.05）。不同消融弧度患者术后1、3、6、12个月时 BCVA均显著低于术前及术后1 d（P<0.05）；不同消融弧度组患者术后同时间点比较差异无统计学意义（P>0.05）。不同消融弧度组患者术后6、12个月降眼压药物使用种类均显著低于术前、术后1 d及术后1、3个月时（P<0.05）；消融弧度120°组患者术后6、12个月时降眼压药物使用种类显著少于同时点消融弧度90°组和消融弧度100°组（P<0.05）；消融弧度90°组患者术后各时点降眼压药物使用种类与消融弧度100°组比较差异无统计学意义（P>0.05）。结论　对具有滤过性手术联合白内障手术指征的老年PACG合并白内障患者择期行白内障超声乳化术和房角分离术联合小梁消融术治疗能有效降低眼压，减少其术后降眼压药物的使用种类，近期与远期疗效均良好，且消融弧度120°时降眼压效果更明显。
Abstract:
Objective　To explore the application value of trabecular ablation combined with cataract phacoemulsification and atrial angle separation in patients with senile primary angle-closure glaucoma (PACG) combined with cataract.Methods　One hundred and twenty elderly PACG combined with cataract patients who were admitted to Space Center Hospital from June 2015 to June 2018 were selected as research subjects.They were divided into the control group and the observation group according to the surgical method,with 60 case in each group.The cataract phacoemulsification+atrial angle separation was performed in all the patients of the both groups,and then the patients in the control group were treated with trabeculectomy,the patients in the observation group were treated with trabecular ablation.The intraocular pressure(IOP),best corrected visual acuity (BCVA) and the types used of IOP lowering-drugs of the patients between the control group and the observation group were compared before surgery,1 d and 1,3,6，12 months after operation,respectively.The patients in the observation group were divided into the ablation radian 90° group,ablation radian 100° group and ablation radian 120° group according to the different ablation radians during the operation,and the IOP,BCVA and the types used of IOP lowering-drugs of the patients among the three groups were compared before surgery，1 d and 1,3,6,12 months after operation,respectively.Results　There was no significant difference in IOP,BCVA and types used of IOP lowering-drugs between the control group and the observation group before surgery(P>0.05).Compared with before operation,the IOP significantly decreased,BCVA significantly increased,and the amount used of IOP lowering-drugs reduced of the patients in the control group and the observation group at each time point after operation (P<0.05).There was no significant difference in IOP of the patients between the control group and observation group at each time point after operation(P>0.05).There was no significant difference in the BCVA of the patients at 1 d after operation between the control group and the observation group(P>0.05),the BCVA of the patients in the observation group was significantly higher than that in the control group at 1,3,6 and 12 months after operation (P<0.05);compared with 1 d after operation,the BCVA of the patients in the control group and the observation group at 1,3,6 and 12 months after operation significantly increased(P<0.05).The types of IOP lowering-drugs use in the control group and the observation group at 1,3,6 and 12 months after operation was less than that at 1 d after operation,the types used of IOP lowering-drugs in the control group and the observation group at 3,6 and 12 months after operation was less than that at 1 month after operation,the types of IOP lowering-drugs use in the control group and the observation group at 6 and 12 months after operation was less than that at 3 months after operation(P<0.05);there was no significant difference in the types of IOP lowering-drugs use of the patients between the control group and observation group at each time point after operation(P>0.05).The IOP of patients in the different ablation radians groups at 1 d and 1,3,6,12 months after operation was significantly lower than that before surgery (P< 0.05).The IOP of patients in the ablation radian 120° group was significantly lower than that in the ablation radian 90° group and 100° group at 3,6 and 12 months after operation (P<0.05).The BCVA of the patients in the different ablation radians groups at 1 d and 1,3,6,12 months after operation was significantly higher than that before operation (P< 0.05);there was no significant difference in the BCVA of the patients in the different ablation radians groups at different time point after operation(P>0.05).The types used of IOP-lowering drugs of the patients in the different ablation radians group at 6,12 months after operation were significantly less than those before operation and at 1 d,1 month,3 months after operation (P< 0.05).The types of IOP-lowering drugs use in the ablation radians 120° group at 6,12 months after operation was significantly less than that in the ablation radian 90° group and 100° group (P<0.05).Conclusion　Phacoemulsification + intraocular lens implantation and atrial angle separation combined with trabecular ablation can effectively reduce IOP and the types used of IOP lowering-drugs after operation for senile PACG combined with cataract patients who have indications of filtering surgery combined with cataract surgery.The short-term and long-term effects are good and the safety is high,and the effect of reducing IOP is more obvious when the ablation radian is 120°.

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更新日期/Last Update: 2020-11-05