| 摘要: |
| ［摘要］ 目的 观察超声乳化白内障吸除+人工晶状体（IOL）植入术联合房角分离术治疗原发性急性闭角型青光眼（APACG）合并白内障的效果，并分析其对视神经结构的影响。方法 招募2021年6月至2025年1月铜仁市人民医院收治的APACG合并白内障患者128例，采用随机数字表法将其分为观察组和对照组，每组64例。观察组予超声乳化白内障吸除+IOL植入术联合房角分离术，对照组予超声乳化白内障吸除+IOL植入术联合小梁切除术。比较两组术前（T0）、术后1周（T1）和术后1个月（T2）的视神经纤维厚度、前房深度、前房角度及眼压。比较两组T0、T2、术后3个月（T3）和术后6个月（T4）的最佳矫正视力（BCVA）。比较两组并发症发生情况及房角粘连复发情况。结果 两组术后前房深度和前房角度均呈上升趋势（P<0.05），眼压均呈下降趋势（P<0.05），观察组T1、T2时间点的前房深度和前房角度大于对照组，眼压低于对照组，差异有统计学意义（P<0.05）。两组术后视神经纤维厚度均呈先下降后上升趋势（P<0.05）。观察组T1时间点视神经纤维厚度显著大于对照组（P<0.05）。在T2时间点，两组视神经纤维厚度与同组T0时间点比较差异无统计学意义（P>0.05），组间比较差异亦无统计学意义（P>0.05）。两组术后BCVA均呈上升趋势（P<0.05），观察组T2、T3和T4时间点的BCVA均高于对照组，差异有统计学意义（P<0.05）。观察组并发症总发生率低于对照组，差异有统计学意义（3.13% vs 14.06%； χ2=4.873，P=0.027）。两组术后6个月内均无房角粘连复发。结论 超声乳化白内障吸除+IOL植入术联合房角分离术治疗APACG合并白内障可获得较为理想的效果，能有效控制眼压，改善视力，对视网膜损伤轻，安全性好。 |
| 关键词: 原发性急性闭角型青光眼 白内障 超声乳化白内障吸除 人工晶状体植入术 房角分离术 小梁切除术 疗效 |
| DOI：10.3969/j.issn.1674-3806.2026.09.15 |
| 分类号:R 775 |
| 基金项目: |
|
| Observation on efficacy of phacoemulsification cataract extraction+intraocular lens implantation combined with angle recession surgery in treatment of acute primary angle-closure glaucoma complicated by cataract and its effects on optic nerve structure |
|
Xu Li, Wang Ting, Liu Huiqin
|
|
Department of Ophthalmology, Tongren People′s Hospital, Tongren 554300, China
|
| Abstract: |
| ［Abstract］ Objective To observe the efficacy of phacoemulsification cataract extraction+intraocular lens(IOL) implantation combined with angle recession surgery in treatment of acute primary angle-closure glaucoma(APACG) complicated by cataract and to analyze its effects on optic nerve structure. Methods A total of 128 patients with APACG complicated by cataract who were admitted to Tongren People′s Hospital from June 2021 to January 2025 were recruited. The patients were randomly divided into observation group and control group, with 64 patients in each group. The observation group was treated with phacoemulsification cataract extraction+IOL implantation combined with angle recession surgery, while the control group was treated with phacoemulsification cataract extraction+IOL implantation combined with trabeculectomy. The optic nerve fiber thickness, anterior chamber depth, anterior chamber angle and intraocular pressure were compared between the two groups before the operation(T0), 1 week after the operation(T1) and 1 month after the operation(T2). The best corrected visual acuity(BCVA) was compared between the two groups at T0, T2, T3(3 months after the operation) and T4(6 months after the operation). The incidence of complications and the recurrence of goniosynechia were compared between the two groups. Results The anterior chamber depth and anterior chamber angle in both groups showed an upward trend postoperatively(P<0.05), while the intraocular pressure showed a downward trend(P<0.05). The anterior chamber depth and anterior chamber angle in the observation group were greater than those in the control group at the time points of T1 and T2, while the intraocular pressure in the observation group was lower than that in the control group, with statistically significant differences(P<0.05). The thickness of optic nerve fibers in both groups showed a trend of first decreasing and then increasing after the operation(P<0.05). At the time point of T1, the optic nerve fiber thickness in the observation group was significantly greater than that in the control group(P<0.05). At the time point of T2, no statistically significant difference in optic nerve fiber thickness was observed compared with that at the time point of T0 within the same group(P>0.05), with no statistically significant difference between the two groups at the time point of T2(P>0.05). The postoperative BCVA in both groups showed an upward trend(P<0.05), and the BCVA in the observation group was higher than that in the control group at the time points of T2, T3 and T4, with statistically significant difference(P<0.05). The total incidence of complications in the observation group was lower than that in the control group, and the difference was statistically significant(3.13% vs 14.06%; χ2=4.873, P=0.027). No recurrence of goniosynechia occurred in either group within 6 months postoperatively. Conclusion Phacoemulsification cataract extraction+IOL implantation combined with angle recession surgery can achieve a relatively satisfactory outcome in the treatment of APACG complicated by cataract. The combined treatment can effectively control intraocular pressure, improve vision, cause minimal damage to the retina, and has good safety. |
| Key words: acute primary angle-closure glaucoma(APACG) cataract phacoemulsification cataract extraction intraocular lens(IOL) implantation angle recession surgery trabeculectomy efficacy |
