背景白内障超声乳化(Phaco)联合小梁切除术和白内障囊外摘出术(ECCE)联合小梁切除术均为治疗白内障合并青光眼的主要方法，二者的疗效比较研究对治疗的选择有重要意义。
目的比较Phaco联合小梁切除术与ECCE联合小梁切除术治疗白内障合并青光眼的临床疗效及安全性。
方法采用随机对照研究方法，纳入2013年1月至2014年2月在新疆医科大学附属自治区中医医院收治的白内障合并青光眼患者63例63眼，按照随机数字表法将患者分为2个组，组间基线资料均匹配。ECCE三联术组患者33例33眼接受ECCE＋人工晶状体(IOL)植入联合小梁切除术，Phaco三联术组患者30例30眼接受Phaco＋IOL植入联合小梁切除术，术后均随访6个月，比较2个组间术眼术后视力、眼压、术后散光及并发症情况。
结果术后2个组术眼的视力均明显改善，2个组间在不同等级视力范围的眼数分布差异有统计学意义( H＝0. 125， P＝0. 032)。术后6个月Phaco三联术组和ECCE三联术组的眼压分别为(14. 13±5. 19)mmHg和(15. 18±6. 04)mmHg，2个组间眼压值差异无统计学意义( F 分组＝3. 762， P>0. 05)但术后眼压均低于术前( F 时间＝14. 991， P<0. 05)。术后Phaco三联术组术眼散光度为(1. 02±0. 44)D，明显低于ECCE三联术组的(3. 76±1. 53)D，差异有统计学意义( t＝3. 089， P＝0. 034)。Phaco三联术组和ECCE三联术组的术后并发症发生率分别为6. 67%和18. 18%，差异有统计学意义( χ 2＝6. 112， P<0. 05)。
结论与ECCE三联术比较，Phaco三联术对白内障合并青光眼进行治疗的手术创伤小，并发症少，术后散光度低。
BackgroundPhacoemulsification (Phaco) and extracapsular cataract extraction (ECCE) with trabeculectomy are primary approachs for cataract combined with glaucoma. To compare the efficiency and safety between the two methods is important for the choice of surgeries.
ObjectiveThis study was to compare the clinical outcomes between ECCE combined with trabeculectomy and Phaco combined with trabeculectomy.
MethodsA randomized controlled study was designed. Sixty-three eyes of 63 patients with cataract and glaucoma were included from January 2013 to February 2014 in Xinjiang Autonomous District Traditional Chinese Medicine Hospital under the informed consent. The patients were assigned to parallel two groups according to random number table. ECCE+ intraocular lens (IOL) implantation with trabeculectomy was performed in 33 eyes of 33 patients in the ECCE-teabelectomy group, and Phaco+ IOL implantation with trabeculetomy was carried out in 30 eyes of 30 patients in the Phaco-trabeculectomy group. The patients were followed-up for six months. Visual acuity, intraocular pressure (IOP), astigmatic degree and complication after surgery were compared between the two groups.
ResultsThe visual acuity was obviously improved after surgery in both groups. The distribution of eyes in different vision acuities was significantly different after operation between the two groups ( H=0. 125, P=0. 032). The IOP was (14. 13±5. 19)mmHg in the Phaco-trabeculectomy group and (15. 18±6. 04) mmHg in the ECCE-trabeculectomy group, without significantly interclass difference among the two groups ( F=3. 762, P>0. 05), however, the IOP were lower after surgery ( F time=14. 991, P<0. 05). The postoperative astigmatic power was (1. 02±0. 44) D in the Phaco-trabeculectomy group and (3. 76±1. 53) D in the ECCE-trabeculectomy group, showing a significant reduce in the Phaco-trabeculectomy group ( t=3. 089, P=0. 034). The incidence rates of postoperative complications were 6. 67% and 18. 18% in the Phaco-trabeculectomy group and ECCE-trabeculectomy group, respectively, with a significant difference between them ( χ 2=6. 112, P<0. 05).
ConclusionsCompared to the ECCE+ IOL implantation with trabeculectomy, Phaco+ IOL implantation with trabeculectomy for cataract combined with glaucoma shows better clinical effectiveness, less complications and lower astigmatic power.
帕尔扎提·吐尔地,吕小川. Phaco或ECCE联合小梁切除术治疗白内障合并青光眼的对照研究[J]. 中华实验眼科杂志,2015,33(9)：820-822.
DOI:10.3760/cma.j.issn.2095-0160.2015.09.011版权归中华医学会所有。
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