徐文生 麻华忠 黄少锋

【摘要】 目的 對比观察在超声乳化白内障吸除+人工晶体植入术的基础之上，联合房角分离术与小梁切除术治疗高龄急性闭角型青光眼合并白内障的临床疗效。

方法 选择80～92岁高龄青光眼合并白内障患者42例（42眼），所有患者均接受超声乳化白内障吸除+人工晶体植入术，按照接受不同青光眼手术方法分为两组，A组21例联合房角分离术，B组21例联合小梁切除术，观察两组患者术前、术后1个月患者的眼压、视力、前房深度、并发症等。

结果 治疗后A组的临床疗效优于B组（P<0.05）。两组患者术前的视力、眼压及前房深度比较，差异均无统计学意义（P>0.05），术后1个月两组视力、眼压及前房深度均显著改善（P<0.05），A组改善更明显（P<0.01）。术后1个月内，两组并发症发生率比较差异无统计学意义（P>0.05）。

结论 高龄青光眼合并白内障患者采用超声乳化白内障吸除人工晶体植入联合房角分离术治疗的临床疗效更好，可有效改善视力、眼压及前房深度且不会增加并发症，值得临床推广。

【关键词】 青光眼;白内障;高龄;房角分离术;小梁切除术;超声乳化白内障吸除术;联合手术

中图分类号：R779. 文献标志码： DOI：10.3969/j.issn.10031383.2021.06.007

Comparison of the efficacy of ultracoemulsification combined with angle separation and trabeculectomy on advanced acute angle closure glaucoma combined with cataract

XU Wensheng， MA Huazhong， HUANG Shaofeng

（Department of Ophthalmology， People's Hospital of Pingguo， Pingguo 531499， Guangxi， China）

【Abstract】 Objective To compare the clinical effects of angle separation and trabeculectomy in the treatment of elderly patients with acute angle closure glaucoma combined with cataract base on phacoemulsification cataract aspiration + intraocular lens implantation.

Methods 42 cases （42 eyes） of 80-92yearold glaucoma and cataract patients were selected. All patients received phacoemulsification cataract aspiration + intraocular lens implantation. And they were divided into two groups according to different glaucoma surgery methods. Group A （21 cases） were combined with angle separation， and group B （21 cases） were combined with trabeculectomy. Ang then， intraocular pressures， visual acuities， anterior chamber depths and complications of the two groups were observed before operation and 1 month after operation.

Results After treatment， the clinical efficacy of the group A was better than that of the group B （P < 0.05）. There was no statistically significant difference in the visual acuities， intraocular pressures and anterior chamber depths of the two groups before operation （P > 0.05）， they significantly improved in the two groups one month after operation （P < 0.05）， and the improvement in the group A was more obvious （P < 0.01）. Within one month after surgery， there was no statistically significant difference in the incidence of complications between the two groups （P > 0.05）.

Conclusion For elderly patients with glaucoma and cataracts， phacoemulsification cataract aspiration combined with angle separation has better clinical efficacy， which can effectively improve vision， intraocular pressure and anterior atrial depth without increasing complications， and thus is worthy of clinical promotion.

【Key words】 glaucoma; cataract; old age; combined surgery; angle separation; trabeculectomy; phacoemulsification cataract aspiration

青光眼和白内障都属于我国常见的老年性致盲眼病，两种眼病可同时发生，也会相互影响，严重时能够直接导致患者失眠和疼痛。手术方式的选择一直是眼科医生探讨的热门话题，目前认为青光眼合并白内障有3种处理方法和原则[1]：①保守治疗+手术，即药物能有效控制眼压者，首选单纯超声乳化白内障摘除术，术后继续用药物控制眼压;②一次性联合手术，即同时进行白内障与抗青光眼手术，一次解决两个疾病问题;③序贯手术，首先进行抗青光眼手术，术后白内障发展至一定程度后再行白内障手术。……