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| 两种手术方式治疗原发性闭角型青光眼临床疗效对比 |
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作者：朱炎华 张… 文章来源：湖北省荆州市第一人民医院 长江大学医学院眼科 邮编：434000 点击数：1125 更新时间：2007/5/14 23:04:10 
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| 【摘要】 目的 探讨治疗原发性闭角型青光眼两种手术方式的适应症和临床疗效观察。方法 采用非随机临床对照研究方法。对临床收治的26例36眼原发性闭角型青光眼进行手术处理：单纯抗青光眼手术——复合式小梁切除术（Ｔｒａｂｅｃｕｌｅｃｔｏｍｙ，Ｔｒａｂ）、青－白联合手术——复合式小梁切除联合超声乳化白内障吸除＋人工晶体植入术（Ｐｈａｃｏｔｒａｂｅｃｕｌｅｃｔｏｍｙ＋ＩＯＬ，ＰｈａｃｏＴｒａｂ＋ＩＯＬ）比较不同适应症下两种手术方式的临床疗效。包括眼压控制情况、前房深度、房水和滤过泡，以及用抗青光药物辅助情况及并发症等。随访时间平均（6.5 ±2．1）个月。结果 两组术后在随访期内均能将眼压控制在正常范围，术后眼压较术前明显降低（两组 Ｐ 值均＜ ０．００１），前房深度：Ｐｈａｃｏ+Ｔｒａｂ＋ＩＯＬ组术后明显较术前加深，差异有统计学意义（Ｐ值均＜０．００１），但Ｔｒａｂ组术前后改变不明显（Ｐ ＞ ０．０５）；术后早期炎症反应Ｐｈａｃｏ＋ＩＯＬ组比Ｔｒａｂ组轻；远期并发症Ｔｒａｂ组有2眼发生低眼压。Ｐｈａｃｏ＋ＩＯＬ组后期眼压高于18mmHg的比例比Ｔｒａｂ组高，两组比较有统计学意义（p<0.05）。结论 超声乳化白内障吸除术因其具有相对房角开放和视力提高等优势，可考虑作为原发性闭角型青光眼治疗的选择性手段之一，但晚期眼压控制不如复合式小梁切除手术。
关键词 青光眼； 闭角型； 小梁切除术；超声乳化白内障吸除术；人工晶体植入术
Ａ ｐｒｅｌｉｍｉｎａｒｙ ｃｏｍｐａｒｉｓｏｎ ｓｔｕｄｙ ｏｆ two ｔｙｐｅｓ ｏｆ ｍｉｃｒｏｓｕｒｇｅｒｙ ｏｎ ｍａｎａｇｅｍｅｎｔ ｏｆ ｐｒｉｍａｒｙ ａｎｇｌｅ－ｃｌｏｓｕｒｅ ｇｌａｕ-ｃｏｍａ
[Ａｂｓｔｒａｃｔ] Ｏｂｊｅｃｔｉｖｅ To propose the indications and preliminary clinical results of two types of microsurgery on management of primary angle-closure glaucoma. Ｍｅｔｈｏｄｓ The indications of two types of microsurgery were set up for a non-randomized comparison study on 36 eyes (26 cases) with primary acute or chronic angle-closure glaucoma which were performed trabeculectomy only (Trab group), phacortrabeculectomy plus intraocular lens implantation (Phaco Trab+IOL group) .The preliminary clinical results of two groups were compared. The mean follow-up was 6.5±2.1months. Ｒｅｓｕｌｔｓ The post operative IOP in two groups were well controlled post operatively vs. preoperatively (All P<0.001). The anterior chamber depth was seen deeper in Phaco Trab+IOL vs. Trab (P<0.001), while in Trab group wasn't seen significantly change (P>0.05); The mildest postoperative inflammatory response was seen in Phaco+IOL group. There were 2 eyes happened sustained hypotension Trab group. Ｃｏｎｓｌｕｓｉｏｎ The indications of two types of microsurgery will be benefits for management primary angle-closure glaucoma. Phaco Trab+IOL group have better improvement in visual acuity, angle reopened, and could be considered as new alternative for managed primary angle-closure glaucoma.
[Ｋｅｙ ｗｏｒｄｓ] Glaucoma; Angle-closure; Trabeculectomy; Phacoemulsification; Intraocular lens implantation
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