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目的探讨合并白内障的闭角型青光眼患者选择单纯的白内障超声乳化手术或者联合小梁切除术的手术方式,了解术后眼压、视野、角膜内皮细胞数量的变化以及视力的恢复情况。方法对33例40眼合并白内障的闭角型青光眼患者,根据患者青光眼病情及自身情况,20眼选择单纯的白内障超声乳化手术,20眼选择联合小梁切除术的手术方式,术后随访监测眼压,视野,角膜内皮细胞数及视力情况。结果单纯白内障超声乳化手术组中,术后第1天,11眼眼压升高,占55%,升高幅度为5～17mmHg,8眼用药后1周内眼压恢复正常,3眼因用药后眼压仍不稳定,高达30mmHg以上,3个月内二期行小梁切除术,占15%。联合小梁切除术组术后19眼眼压正常,1眼眼压为27mmHg,略有升高,用药两天后眼压恢复正常,占5%,随访无眼压升高;单纯的白内障手术的患者术后局部视野缺损4眼,包括二期行小梁切除术术前旁中心暗点2眼中1眼术后发展成弓形暗点,随访无变化,与术前比较(7眼)明显减少;联合手术组术前进行性视野缩小9眼中,术后有2眼明显改善,11眼严重视野缺损中,4眼不同程度改善,其余视野与术前比较无改变;接受单纯的白内障手术的患者术前平均角膜内皮细胞密度为(2221±331)个/mm2,术后为(2018±326)个/mm2,接受联合手术的患者术前平均角膜内皮细胞密度为(2184±317)个/mm
Objective To investigate the surgical methods of phacoemulsification and trabeculectomy in patients with angle-closure glaucoma with cataract. To study the changes of intraocular pressure (IOP), visual field, corneal endothelial cells and visual acuity after operation. Methods Thirty eyes of 40 patients with angle-closure glaucoma with cataract were enrolled in this study. According to the glaucoma condition and their condition, 20 eyes were selected for phacoemulsification and 20 eyes for trabeculectomy. The follow-up surveillance eyes Pressure, visual field, corneal endothelial cells and visual acuity. Results In the simple cataract phacoemulsification group, the intraocular pressure was increased in 11 eyes (55%) on the first postoperative day, with an increase of 5-17 mmHg. The intraocular pressure returned to normal within 1 week after 8 eyes, Posterior pressure is still unstable, up to 30mmHg or more, within 3 months two trabeculectomy, 15%. In the combined trabeculectomy group, the intraocular pressure was normal in 19 eyes and the intraocular pressure in 1 eye was 27 mmHg after operation. The intraocular pressure returned to normal after 5 days, and no intraocular pressure (IOP) was observed. The simple cataract surgery Four patients with partial visual field defect, including two trabeculectomy in 2 cases of paracentesis, developed into bow-shaped dark spots after surgery, no change at follow-up, compared with preoperative (7 eyes) was significantly reduced; In the 9 eyes of the joint surgery group, 2 eyes were significantly improved after operation. Among the 11 eyes with severe visual field defects, 4 eyes improved to some extent, and the rest had no change compared with that before operation. Patients undergoing simple cataract surgery The average corneal endothelial cell density was (2221 ± 331) / mm2 before surgery and (2018 ± 326) / mm2 after surgery, respectively. The mean corneal endothelial cell density before surgery was (2184 ± 317) / mm