冯鑫 余适 陈立

【摘要】 目的：分析经内路房水通路重建术联合微切口超声乳化白内障吸除术治疗原发性开角型青光眼合并白内障的效果。方法：纳入2021年1月—2023年1月孝感市第一人民医院眼科收治的120例原发性开角型青光眼合并白内障患者为研究对象，用随机数字表法分为两组。对照组（n=60）采用超声乳化术+人工晶状体植入术+小梁切除术，观察组（n=60）采用经内路房水通路重建术联合微切口超声乳化白内障吸除术治疗。对比两组眼压、最佳矫正视力、黄斑区神经节细胞复合体（GCC）厚度、角膜中央厚度（CCT），以及角膜内皮功能指标、视盘血流情况。结果：术后3个月观察组眼压、术眼最佳矫正视力均低于对照组，术后1周黄斑区GCC厚度大于对照组、CCT小于对照组（P<0.05）；术后1周两组角膜内皮细胞密度、六角形细胞比例均有所降低，但观察组上述指标均高于对照组（P<0.05）；术后1周，观察组角膜内皮细胞变异系数低于对照组（P<0.05）；术后3个月观察组视盘内所有血管血流密度、毛细血管血流密度均高于对照组（P<0.05）。结论：原发性开角型青光眼合并白内障患者采用经内路房水通路重建术联合微切口超声乳化白内障吸除术治疗能减轻对角膜内皮细胞功能的损伤，降低眼压，促进视力恢复。

【关键词】 原发性开角型青光眼 白内障 经内路房水通路重建术 微切口超声乳化白内障吸除术

Effect of Intraaqueous Access Reconstruction Combined with Microincision Phacoemulsification in the Treatment of Primary Open-angle Glaucoma Complicated with Cataract/FENG Xin， YU Shi， CHEN Li. //Medical Innovation of China， 2024， 21（15）： 00-009

[Abstract] Objective： To analyze the effect of intraaqueous access reconstruction combined with microincision phacoemulsification in the treatment of primary open-angle glaucoma complicated with cataract. Method： A total of 120 patients with primary open-angle glaucoma complicated with cataract admitted to Department of Ophthalmology， Xiaogan First People's Hospital from January 2021 to January 2023 were included as the study objects， they were divided into two groups by random number table method. The control group （n=60） was treated with intraocular lens implantation + ultrasonic phaco + trabeculectomy， and the observation group （n=60） was treated with intraaqueous access reconstruction combined with microincision phacoemulsification. Intraocular pressure， best corrected vision， macular area ganglion cell complex （GCC） thickness， central corneal thickness （CCT）， corneal endothelial function indexes and optic disc blood flow were compared between the two groups. Result： The intraocular pressure and best corrected vision in the observation group were lower than those in the control group 3 months after surgery， and the thickness of GCC in the macular area was higher than that in the control group and CCT was lower than that in the control group 1 week after surgery （P<0.05）. The density of corneal endothelial cells and the proportion of hexagonal cells were decreased in two groups 1 week after surgery， but the above indexes in observation group were higher than those in control group （P<0.05）. 1 week after surgery， the coefficient of variation of corneal endothelial cells in observation group was lower than that in control group （P<0.05）. The blood flow density of all blood vessels and capillary blood flow density in the observation group were higher than those in the control group 3 months after surgery （P<0.05）. Conclusion： In patients with primary open-angle glaucoma complicated with cataract， intraaqueous access reconstruction combined with microincision phacoemulsification can reduce the damage of corneal endothelial cell function， reduce intraocular pressure and promote vision recovery.

[Key words] Primary open-angle glaucoma Cataract Intraaqueous access reconstruction Microincision phacoemulsification

First-author's address： Department of Ophthalmology， Xiaogan First People's Hospital， Xiaogan 432000， China

doi：10.3969/j.issn.1674-4985.2024.15.002

原发性开角型青光眼为青光眼较为常见类型之一，与病理性高眼压及缺血等因素密切关系。多数青光眼患者合并有白内障，都好发于老年患者，可使其视力情况进一步降低[1-2]。目前临床针对原发性开角型青光眼合并白内障患者多予以手术治疗，以达到降低其眼压，促进视力恢复的目的。超声乳化白内障吸除术为治疗白内障的首选，经内路房水通路重建术于2015年问世，研究表明该种术式有利于生理性房水流出通路的恢复，降低眼压，且不影响后续可能进行的滤过性抗青光眼手术[3-4]。鉴于此，本次研究采用经内路房水通路重建术联合微切口超声乳化白内障吸除术治疗，获得较好效果，现报道如下。……