目的：比较分析小梁切除术联合超声乳化人工晶状体植入术与缝线引导下穿透性Schlemm管成形术联合超声乳化人工晶状体植入术治疗原发性开角型青光眼(POAG)患者的临床效果。

方法：回顾性病例对照研究。收集2021-06/2022-06在我院住院手术治疗的晚期POAG合并白内障患者53例53眼，其中26眼行小梁切除术联合超声乳化人工晶状体植入(A组)，27眼行缝线引导下穿透性Schlemm管成形术联合超声乳化人工晶状体植入(B组)。比较两组患者手术前后最佳矫正视力(BCVA)、眼压、使用降眼压药水数量。记录术中及术后并发症、手术成功率。

结果：两组患者术后1 wk，1、3、6 mo眼压均低于术前(均P<0.017)。两组前房出血并发症比较有差异(P<0.05)，浅前房和脉络膜脱离比较无差异(均P>0.05)。术后6 mo两组患者BCVA(LogMAR)比较无差异(A组：1.29±1.19，B组：0.78±1.01， P=0.098)，抗青光眼药物数量比较无差异\〖A组：0(0， 2.75)种，B组：0(0， 1)种，P=0.209\〗。术后6 mo两组患者手术成功率比较无差异(Z=0.448，P=0.654)。

结论：缝线引导下穿透性Schlemm管成形术治疗晚期原发性开角型青光眼安全有效，手术成功率与小梁切除术相当。

METHODS: A retrospective case-control study was conducted on 53 cases(53 eyes)with advanced-stage POAG and cataract that received surgery at our hospital from June 2021 to June 2022, among which 26 eyes underwent trabeculectomy combined with phacoemulsification and intraocular lens implantation(group A), and 27 eyes underwent suture-guided penetrating Schlemm canaloplasty combined with phacoemulsification and intraocular lens implantation(group B). The best-corrected visual acuity(BCVA), intraocular pressure, and the number of intraocular pressure lowering drugs were compared between the two groups. Furthermore, the intraoperative and postoperative complications and success rate of surgery were recorded.

RESULTS: The intraocular pressure of two groups of patients at 1 wk, 1, 3 and 6 mo after surgery were lower than that before preoperatively(all P<0.017). There was a notable disparity in the frequency of anterior chamber hemorrhage between the two groups(P<0.05), but there was no significant variance in the occurrence of superficial anterior chamber and choroid detachment(all P>0.05). There was no significant difference in BCVA(LogMAR)between the two groups at 6 mo after surgery(group A: 1.29±1.19, group B: 0.78±1.01, P=0.098), and there was no significant difference in the number of anti-glaucoma drugs \〖group A: 0(0, 2.75), group B: 0(0, 1), P=0.209\〗. Additionally, there was no significant difference in the success rate of surgery between the two groups at 6 mo postoperatively(Z=0.448, P=0.654).

CONCLUSIONS: Suture-guided penetrating Schlemmcanaloplasty is a safe and effective treatment for advanced-stage POAG, with a success rate comparable to that of trabeculectomy.