目的：观察超声乳化联合EX-PRESS引流钉植入治疗难治性开角型青光眼合并白内障的疗效。

方法：选取难治性开角型青光眼合并白内障患者共66例67眼。试验组采用超声乳化吸除联合EX-PRESS引流钉植入术，对照组采用超声乳化吸除联合小梁切除术。术前进行BCVA、IOP检查； 观察并发症、手术时间，术后观察视力、眼压、滤过泡改变； 随访时间为术后1d，1wk，1、6mo，1a。

结果：试验组手术时间为23.26±2.00min，对照组手术时间为31.73±2.17min，两组间有差异(t=16.68，P<0.01)。试验组术后发生浅前房和滤过泡瘢痕化者各1眼； 对照组术后发生低眼压3眼，前房出血和脉络膜脱离各1眼，滤过泡瘢痕化者5眼。滤过泡Kronfeld 分型无差异(Z=-0.775， P=0.438)。两组干预因素及时间对患者术后眼压均有影响(F_组间=8.67，P_组间<0.01； F_时间=127.58，P_时间<0.01； F_{组间×时间}=7.5，P_{组间×时间}<0.01)。干预因素对患者术后视力无影响，两组术后视力同术前相比均有差异(F_组间=0.35，P_组间=0.55； F_时间=34.92，P_时间<0.01； F_{组间×时间}=0.38，P_{组间×时间}=0.86)。

结论：超声乳化联合EX-PRESS引流钉植入治疗难治性开角型青光眼合并白内障安全有效、手术时间短，可作为一种常规青白联合手术方式。

METHODS: Totally 66 patients(67 eyes)with refractory open-angle glaucoma and cataract were selected.There were 34 eyes in the phaco-EX-PRESS and 33 eyes in the phacotrabeculectomy. Preoperative best corrected visual acuity(BCVA)and intraocular pressure(IOP), intraoperative complications, operation time, postoperative BCVA and IOP, postoperative complications were observed. The follow-up time were 1d, 1wk, 1mo, 6mo and 1a.

RESULTS: The operation time in experimental group was 23.26±2.00min, while the control group was 31.73±2.17min. The difference between the two groups was statistically significant(t=16.68, P<0.01). In the experimental group, superficial anterior chamber and filtering bubble scar occurred in 1 eye each. In the control group, low IOP occurred in 3 eyes, anterior chamber hemorrhage and choroid detachment in 1 eye and filtering bubble scar in 5 eyes.There was no statistically significant difference in follicular Kronfeld classification(Z=-0.775, P=0.438). Intervention factors and time in both groups had an effect on postoperative IOP. Intervention factors had no effect on postoperative visual acuity, and the difference in postoperative visual acuity between the two groups was statistically significant.

CONCLUSION: Phaco-EX-PRESS for the refractory open-angle glaucoma combined with cataract is safe and effective, and the operation time is shorter, so it can be used as a conventional combination surgery.