方法：连续随机的前瞻性临床病例对照研究。对药物控制不理想的62例70眼合并白内障的原发性闭角型青光眼患者进行手术，随机分为试验组34眼，行微切口超声乳化联合Ex-press引流钉植入术； 对照组36眼，行微切口超声乳化联合小梁切除术。收集术前、术后1d，1wk，1、3、6、12mo的最佳矫正视力、眼压、角膜内皮细胞密度、中央前房深度、手术成功率、手术并发症等基本数据，并比较两种手术方式的治疗效果。

结果：试验组术后12mo平均最佳矫正视力(LogMAR)为0.53± 0.19，优于术前的0.83± 0.41，差异有统计学意义(P=0.001)； 试验组术前眼压为31.3±6.85mmHg，术后1d，1wk，1、3、6、12mo分别降至7.37±2.94、9.88±3.18、10.84±2.68、12.28±2.81、12.82±2.84、14.14±3.41mmHg，试验组术后各期平均眼压较术前均下降，差异有统计学意义(P<0.05)，试验组与对照组术后眼压之间比较无统计学差异(P>0.05)； 试验组和对照组手术前后中央前房深度、角膜内皮细胞密度差异无统计学意义(P>0.05)； 试验组、对照组术后12mo时手术相对成功率分别为97.1%、94.4%，差异无统计学意义(P>0.05)。

结论：Ex-press引流钉联合微切口白内障术用于合并白内障的原发性闭角型青光眼患者是安全而有效的，且能有效控制患者眼压和提高视力，是Ex-press引流钉植入术又一适应证。

METHODS:Sixty-two cases(70 eyes)of primary angle-closure glaucoma with cataract were randomly divided into clinical trail group(34 eyes)and control group(36 eyes). The clinical trail group was treated with Ex-press miniature drainage device implantation combined with phacoemulsification and intraocular lens implantation. The control group was treated with trabeculectomy combined with phacoemulsification and intraocular lens implantation. The best corrected visual acuity(BCVA), intraocular pressure(IOP), corneal endothelium and central anterior chamber depth(ACD), complications were recorded preoperatively as well as postoperatively on day 1, 7 and at 1, 3, 6, and 12mo.

RESULTS: At the last review of trail group after operation, the best visual acuity(Log MAR)was 0.53± 0.19, which was better than the preoperative visual acuity 0.83± 0.41(P=0.001). The postoperative IOP in the clinical trail group decreased, which was 7.37±2.94, 9.88±3.18, 10.84±2.68, 12.28±2.81, 12.82±2.84 and 14.14±3.41mmHg at 1d, 1wk, 1, 3, 6, 12mo compared with the preoperative one(31.3±6.85mmHg)(P<0.05). There were no differences on postoperative IOP between the two groups(P>0.05). The ACD, corneal endothelial cell density of the clinical trail group and the control group obviously increased after operation, and the difference in ACD between the two groups after operation was not statistically significant(P>0.05). The relative success rates of the clinical trail group and the control group were 97.1% and 94.4% respectively at 12mo after surgery, and the difference was not statistically significant(P>0.05).

CONCLUSION: The operation of Ex-press miniature glaucoma drainage device implantation combined with phacoemulsification and intraocular lens implantation, which can reduce IOP and improve visual acuity evidently with less complications, is a safe and effective combined operation for primary angle-closure glaucoma with cataract.