目的：比较白内障超声乳化术联合非穿透性深层巩膜切除术( P-DS)和白内障超声乳化术联合小梁切除术( P-T)在白内障合并中度至重度原发性开角型青光眼( POAG )或假性剥脱性青光眼( PXG)患者中的疗效。方法：前瞻随机性研究。选取40例(40眼)白内障合并POAG或PXG患者,所有患者均接受全面眼部检查和青光眼测试。每组20眼,分别在局部麻醉下行P-DS或P-T。术前,术后10d,1、3、6、12mo记录视力、眼压及青光眼用药量。并对P-DS组行激光前房角穿刺、P-T组行普通穿刺的术后并发症记录。结果：两组患者年龄(P-DS组：66.3±11.0；P-T组：70.2±9.3岁)和性别(P-DS组：女7,男13；P-T组：女9,男11)分布相似( P>0.05)。 POAG 和 PXG 患者在两组( P-DS组,P-T组)中分别为12例和8例,13和7例(P>0.05)。两组在术前视力( P-DS组：0.69 ± 0.22 logMAR；P-T组：0.76±0.22 logMAR)、眼压(P-DS组：17.9±1.6 mm Hg；P-T组：18.1±1.9 mm Hg)及用药量(P-DS组：2.7±0.7；P-T组：2.9±0.8)差异均无统计学意义(P>0.05)。与术前相比,两组术后均出现视力提高,眼压和用药量减少的现象(P<0.01)。术后两组(P-DS 组,P-T 组)眼压分别为15.0±1.7mm Hg和14.5±1.6 mm Hg(P=0.472)。术后P-T 组(0.5±0.7)的用药量略少于 P-DS 组(0.8±0.9)(P=0.307)。两组中均无并发症。 P-DS 组中7眼(5眼一次；2眼两次)行激光前房角穿刺；P-T组中1眼行普通穿刺。结论：同时患有白内障和青光眼的患者行联合P-DS与P-T具有一定安全性。两组的可靠性与疗效相当。对P-DS组应进行密切随访,如果有必要应行激光前房角穿刺。%Abstract• AlM: To compare the outcomes of combined phacoemulsification and non - penetrating deep sclerectomy ( P-DS ) with combined phacoemulsification and trabeculectomy ( P-T ) in patients who have cataract and moderate-to-severe primary open angle glaucoma ( POAG) or pseudoexfoliative glaucoma ( PXG) .•METHODS: ln this prospective randomized study 40 eyes of 40 patients with cataract and POAG or PXG were evaluated. Complete eye examination and glaucoma tests were performed in all patients. Combined P-DS and P-T were performed under local anesthesia in 20 eyes in each group. Visual acuity ( VA ) , intraocular pressure ( lOP ) and number of glaucoma medications were all recorded preoperatively and postoperative on 10d, 1, 3, 6 and 12mo. Complications, laser goniopuncture in P-DS group and needling in P-T group were also recorded.•RESULTS:The age (P-DS, 66. 3±11. 0 and P-T, 70. 2± 9. 3y) and sex distribution (P-DS, 7 female and 13 male, P-T, 9 female and 11 male) were similar in both groups (P>0. 05). Number of POAG and PXG patients were 12 and 8, and 13 and 7 in P-DS and P-T groups, respectively (P>0. 05). There was no difference between groups in terms of preoperative VA (P-DS, 0. 69±0. 22 and P-T, 0. 76 ±0.22 logMAR), lOP (P-DS, 17.9±1.6 and P-T, 18.1±1.9 mm Hg) and number of medications (P-DS:2. 7±0. 7 and P-T:2. 9±0. 8), (P>0. 05). VA increased, lOP and number of medications decreased in both groups postoperatively (P<0.01). Postoperative lOPs were 15.0±1.7 and 14.5± 1. 6 mm Hg in P-DS and P-T groups respectively ( P=0. 472 ) . Postoperative number of medications were slightly better in P-T group (0. 5±0. 7) than in P-DS group (0.8±0. 9) (P=0. 307). There were no complications in both groups. Laser goniopuncture was applied in 7 eyes ( once in 5 eyes and twice in 2 eyes ) in P-DS group. Needling was performed in 1 eye in P-T group.•CONCLUSlON: ln patients with coexisting cataract and glaucoma, both combined P - DS and P - T may be performed safely. Reliability and efficacy were similar in both groups. Follow - up of P - DS should be done cautiously and when necessary laser goniopuncture should be performed.
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