目的：分析超声乳化白内障摘除(PHACO)和人工晶状体植入术(IOL)联合房角分离(GSL)治疗原发性闭角型青光眼(PACG)合并白内障疗效及对视网膜微结构变化的影响。

方法：回顾性收集 2021年1月至2023年6月我院收治的 PACG 合并白内障患者，根据治疗方式不同分为接受 PHACO+IOL+GSL 治疗(A 组)与接受PHACO+IOL+小梁切除术治疗(B 组)。比较两组术前及术后不同时间点最佳矫正视力(BCVA)、眼压、前房深度、黄斑中心凹无血管区(FAZ)周长、面积、圆度指数及并发症发生情况。

结果：纳入PACG合并白内障患者259例259眼，其中A 组131例131 眼，男68例，女63例，平均年龄65.29±5.88岁； B 组128例128 眼，男70例，女58例，平均年龄65.39±6.42岁。术后1 wk，3 mo，B组眼压明显低于A组(均P<0.001)。两组术后3 mo前房深度较术前明显增加(均P<0.001)，组间比较无差异(P>0.05)。术后1 wk，3 mo，A组FAZ周长、FAZ圆度指数均显著大于B组(均P<0.01)。A组并发症总发生率低于B组(P<0.05)。

结论： PHACO+IOL+GSL与PHACO+IOL+小梁切除术均可有效治疗PACG合并白内障。在术后3 mo的随访期内，前者在促进视网膜微结构恢复及降低并发症发生率方面效果更显著； 后者在短期眼压控制方面效果更明显。

METHODS: Patients with PACG and cataract admitted to the hospital between January 2021 and June 2023 were retrospectively collected. According to the treatment modality, patients were divided into a group receiving PHACO+IOL+GSL(Group A)and a group receiving PHACO+IOL+trabeculectomy(Group B). Best-corrected visual acuity(BCVA), intraocular pressure(IOP), anterior chamber depth, foveal avascular zone(FAZ)perimeter, area, circularity index, and complications were compared between the two groups preoperatively and at different postoperative time points.

RESULTS: A total of 259 eyes of 259 patients with PACG and cataract were included and divided into two groups. Group A comprised 131 eyes of 131 patients(68 males, 63 females)with a mean age of 65.29±5.88 y; Group B comprised 128 eyes of 128 patients(70 males, 58 females)with a mean age of 65.39±6.42 y. At 1 wk and 3 mo postoperatively, IOP in Group B was significantly lower than that in Group A(both P<0.001). Anterior chamber depth at 3 mo postoperatively was significantly increased compared with preoperative values in both groups(both P<0.001), with no statistically significant difference between the groups(P>0.05). At 1 wk and 3 mo postoperatively, FAZ perimeter and FAZ circularity index in Group A were significantly greater than those in Group B(all P<0.01). The total incidence of complications in Group A was lower than that in Group B, and the difference was statistically significant(P<0.05).

CONCLUSION: Both PHACO+IOL+GSL and PHACO+IOL+trabeculectomy are effective in treating PACG with cataract. During the 3-month postoperative follow-up period, the former demonstrates a more pronounced effect in promoting retinal microstructural recovery and reducing the incidence of complications, whereas the latter is more effective in short-term IOP control.