目的：分析白内障超声乳化摘除人工晶状体植入(Phaco+IOL)联合经内窥镜睫状体光凝术(ECP)治疗原发性青光眼合并白内障患者的临床价值。

方法：选取2019-01/12在本院眼科诊治的58例64眼原发性青光眼合并白内障患者，按入院顺序，依据患者及其家属意愿将研究对象分为ECP组27例30眼、小梁切除术(TRAB)组31例34眼； ECP组接受Phaco+IOL联合ECP，TRAB组接受Phaco+IOL联合TRAB； 比较两组手术效果及手术前后视力、眼压、角膜内皮细胞、光学相干断层扫描(OCT)相关参数变化。

结果：ECP组手术完全成功率高于TRAB组(83% vs 59%，P<0.05)； 两组术后视力情况优于术前，术后眼压均下降(P<0.05)，但组间无差异(P>0.05)； ECP组术后角膜内皮面积变异系数、六角形细胞比例、平均细胞面积、角膜中心厚度均低于TRAB组，角膜内皮细胞密度高于TRAB组(P<0.05)； 两组患者术后前房深度(ACD)、房角开放距离500(AOD₅₀₀)、小梁虹膜夹角(TIA)、房角隐窝面积(ARA)均上升(P<0.05)，但组间均无差异(P>0.05)； ECP组患者中需药物控制的高眼压、高眼压总发生率显著低于TRAB组(均P<0.05)。

结论：较TRAB治疗青光眼合并白内障，ECP治疗可获得更佳的手术完全成功率，对角膜细胞的影响也更小。

METHODS: Between January and December 2019, 58 patients(64 eyes)with primary glaucoma and cataract diagnosed and treated in Ophthalmology Department of the hospital were enrolled in this study. According to the patients' and their family members' willingness, the study subjects were divided into ECP group(27 cases, 30 eyes, Phaco+IOL+ECP)and trabeculectomy(TRAB)group(31 cases, 34 eyes, Phaco+IOL+TRAB). Surgical results, changes in visual acuity, intraocular pressure, corneal endothelial cells, and optical coherence tomography(OCT)parameter were compared between the two groups.

RESULTS: The complete success rate of surgery in ECP group was 83%, higher than 59% in TRAB group(P<0.05). After surgery, visual acuity of the two groups was improved, and intraocular pressure was reduced(P<0.05), without statistical difference between groups(P>0.05). After surgery, the coefficient of variation of corneal endothelial area, proportion of hexagonal cells, average cellular area, and central corneal thickness of ECP group were lower and smaller than those of TRAB group, while corneal endothelial cell density was higher than TRAB group(P<0.05). After surgery, anterior chamber depth(ACD), angular opening distance 500(AOD₅₀₀), trabecular iris angle(TIA), and angular recess area(ARA)were increased in the two groups(P<0.05), without statistically significant differences between groups(P>0.05). The incidence of ocular hypertension requiring drug control and the total incidence of ocular hypertension were significantly lower in ECP group than in TRAB group(all P<0.05).

CONCLUSION: Compared with TRAB, ECP can achieve a higher complete success rate in the treatment of glaucoma with cataract, with less influence on corneal cells.