目的：对比房角分离、小梁切除分别联合白内障超声乳化治疗青光眼合并白内障的临床疗效。

方法：选取2019年1月至2024年1月在本院确诊的青光眼合并白内障患者为研究对象，根据手术方式的不同分为小梁切除组(采用白内障超声乳化术联合小梁切除治疗)和房角分离组(采用白内障超声乳化术联合房角分离治疗)。比较两组视力改善情况、前房深度、房角宽度及眼压、视盘及盘周整体血流密度、并发症。

结果：本研究共纳入120例120眼青光眼合并白内障患者，其中小梁切除组60眼，房角分离组60眼。小梁切除组年龄60.72±6.16岁，男28例，女32例。房角分离组年龄61.04±6.24岁，男31例，女29例。术后3 mo，两组患者的视力均有显著改善，房角分离组视力显著优于小梁切除组(均P<0.01)； 术后3 mo，两组患者的前房深度、房角宽度均高于术前，且房角分离组高于小梁切除组(均P<0.01)，眼压均低于术前，且房角分离组低于小梁切除组(均P<0.01)； 术前两组患者视盘整体血流密度无差异(P>0.05)，与术前相比，术后1 d两组视盘整体血流密度显著降低(均P<0.05)； 与术后1 d比较，术后1 wk，1、3 mo明显上升(均P<0.05)； 房角分离组术后各个时间点的视盘整体血流密度显著高于小梁切除组(均P<0.05)。术前术后各时间点两组盘周整体血流密度无差异(均P>0.05)； 术后3 mo内，房角分离组并发症发生率(8.3%)显著低于小梁切除组(21.7%)(P<0.05)。

结论：房角分离联合超声乳化术较小梁切除联合超声乳化术治疗青光眼合并白内障患者有效改善患者视力及视盘整体血流密度，提高前房深度、房角宽度，降低眼压及并发症风险，安全性高，短期疗效理想。

METHODS:From January 2019 to January 2024, patients with glaucoma complicated with cataract diagnosed in our hospital were included as the study subjects. They were assigned into trabeculectomy group and goniosynechialysis group based on different surgical methods. The trabeculectomy group was treated with cataract phacoemulsification combined with trabeculectomy, while the goniosynechialysis group was treated with cataract phacoemulsification combined with goniosynechialysis. The improvement of visual acuity, anterior chamber depth, chamber angle width, intraocular pressure, whole en face vessel density within the optic disc head and in the peripapillary region, and complications were compared between two groups.

RESULTS: A total of 120 patients(120 eyes)with glaucoma combined with cataract were included in this study, among which 60 eyes were in the trabeculectomy group and 60 eyes in the goniosynechialysis group. The age of the trabeculectomy group was 60.72±6.16 years, including 28 males and 32 females. The age of the goniosynechialysis group was 61.04±6.24 years, including 31 males and 29 females. At 3 mo after surgery, the visual acuity of patients in both groups improved significantly, and the improvement of visual acuity in the goniosynechialysis group was significantly better than that in the trabeculectomy group(all P<0.01). At 3 mo after surgery, the anterior chamber depth and chamber angle width of patients in both groups were higher than those before surgery, and with the goniosynechialysis group being higher than the trabeculectomy group(all P<0.01), while the intraocular pressure was lower than that before surgery, and with the goniosynechialysis group being lower than the trabeculectomy group(all P<0.01). Before surgery, there was no significant difference in the whole en face vessel density within the optic disc head between the two groups(P>0.05), however, the whole en face vessel density within the optic disc head in both groups on 1 d after surgery were significantly lower than before surgery(all P<0.05); and compared with 1 d after surgery, there was a significant increase at 1 wk, 1, and 3 mo after surgery(all P<0.05); the whole en face vessel density within the optic disc head in the goniosynechialysis group was significantly higher than that in the trabeculectomy group at various time points after surgery(all P<0.05). However, there was no significant difference in the whole en face vessel density in the peripapillary region between the two groups before surgery and various time points after surgery(all P>0.05). Within 3 mo after surgery, the incidence of complications in the goniosynechialysis group(8.3%)was significantly lower than that in the trabeculectomy group(21.7%; P<0.05).

CONCLUSION:Goniosynechialysis combined with phacoemulsification is more effective than trabeculectomy combined with phacoemulsification in the treatment of patients with glaucoma complicated with cataract in improving the visual acuity and whole en face vessel density within the optic disc head of patients, increasing the anterior chamber depth and chamber angle width, reducing intraocular pressure and the risk of complications. It has high safety and ideal short-term efficacy.