| Purpose:To compare the clinical efficacy and safety of combined and staged Ahmed glaucoma drainage valve implantation with phacoemulsification and intraocular lens implantation in the treatment of refractory glaucoma with cataract.Methods:Methods the clinical data of 27 eyes(25 patients)with refractory glaucoma treated with cataract in our hospital from December 2014 to April2016 were retrospectively analyzed.The patients were divided into the observation group and the control group according to the different surgical methods in the treatment.The observation group:Ahmed glaucoma drainage valve implantation combined with phacoemulsification and intraocular lens implantation were performed in 11 eyes(11 patients);the control group:Glaucoma drainage valve implantation and phacoemulsification combined with intraocular lens implantation were performed at twice,with a total of 16 eyes(14 patients);Analysis and comparison of preoperative and postoperative patients after 1 week,6 to 12 months,visual acuity,corneal endothelial cell count(Corneal endothelial cell count,CEC),central anterior chamber depth,angle and intraocular pressure(Intraocular pressure,IOP)and the change of intraocular pressure reducing drug use;complications;surgery success rate.Results:(1)Uncorrected visual acuity:The mean value of UCVA in the 11 eyes of the observation group was(1.98±0.88),and the mean value was(1.11±0.77)after the operation for the last 1 weeks.The difference was statistically significant(t=3.096,p=0.011).The mean value of UCVA after operation on 6-12 months was(0.98±0.85),and the difference was statistically significant(t=3.399,p=0.007).The mean value of UCVA in the16 eyes of the control group was(2.34±1.16),and the mean value was(1.61±1.08)after the operation for the last 1 weeks,The difference was statistically significant(t=3.112,p=0.007);The mean value of UCVA after operation on 6-12 months was(1.54±0.89),and the difference was statistically significant(t=4.231,p=0.001).There was no significant difference in UCVA between two groups at each time point(P > 0.05).(2)Best corrected visual acuity:The mean value of BCVA in the 11 eyes of the observation group was(1.37±1.06),and the mean value was(0.709±0.78)after the operation for the last 1 weeks.The difference was statistically significant(t=2.312,p=0.043).The mean value of BCVA after operation on6-12 months was(0.77±0.91),and the difference was statistically significant(t=2.375,p=0.039).The mean value of UCVA in the 16 eyes of the control group was(1.63±1.42),and the mean value was(1.01±1.05)after the operation for the last 1 weeks,The difference was statistically significant(t=3.231,p=0.006);The mean value of UCVA after operation on 6-12 months was(1.02±1.04),and the difference was statistically significant(t=2.946,p=0.010).There was no significant difference in UCVA between two groups at each time point(P > 0.05).(3)CEC:The average value of CEC was(2397.9±461.5)/mm2 in the observation group before operation,the mean value of CEC after the operation was(2055.5±337.9)/mm2 and the mean value was lower than that before operation,the difference was statistically significant(t=5.128,p=0.001),The average decrease was(342.4±221.4)/mm2,which accounted for about 14.3%preoperatively.The average value of CEC was(2286.8±555.8)/mm2 in the control group before operation,the mean value after the operation of CEC was(1727.9±437.6)/mm2 and the mean value was lower than that before operation,the difference was statistically significant(t=7.859,p=0.000),The average decrease was(559.1±284.9)/mm2,which accounted for about 24.4%preoperatively.There was no significant difference between the two groups before surgery(P > 0.05).The CEC of the observation group after the operation was higher than that of the control group,the difference was statistically significant(P < 0.05).(4)Central anterior chamber depth:The average depth of central anteriorchamber before operation was(2.42±0.66)mm in the observation group,and the average depth of the central anterior chamber after operation was(3.48±0.56)mm,and the difference was statistically significant(t=-3.799,p=0.003).The average depth of central anterior chamber before operation was(2.85±0.68)mm in the control group,and the average depth of the central anterior chamber after operation was(3.68±0.60)mm,and the difference was statistically significant(t=-4.755,p=0.000).There was no significant difference between the two groups before and after operation(P > 0.05).(5)Anterior chamber angle:The average degree of anterior chamber angle before operation in the observation group was(27.20±7.66)°,and the average number of anterior chamber angle was(39.33±8.52)° after operation.The difference was statistically significant(t=-4.827,p=0.001)The average degree of anterior chamber angle before operation in the control group was(31.43±4.08)°,and the average number of anterior chamber angle was(39.96±6.85)° after operation.The difference was statistically significant(t=-4.535,p=0.000).There was no significant difference between the two groups before and after operation(P > 0.05).(6)IOP:The average degree of IOP before operation in the observation group was(35.18±11.66)mm Hg,and the average number of IOP was(13.82±5.93)mm Hg after operation.The difference was statistically significant(t=4.922,p=0.001).The mean value of 6-12 months after operation was(18.00±5.83)mm Hg,which was lower than that before operation,thedifference was statistically significant(t=3.825,p=0.003).The average degree of IOP before operation in the control group was(42.94±11.04)mm Hg,and the average number of IOP was(15.00±7.79)mm Hg after operation.The difference was statistically significant(t=7.309,p=0.000).The mean value of 6-12 months after operation was(16.38±6.76)mm Hg,which was lower than that before operation,the difference was statistically significant(t=9.406,p=0.000).There was no significant difference between the two groups at each time(P > 0.05).(7)IOP lowering medicications:All patients in the observation group and the control group were treated with IOP before operation.2 eyes(18.18%)in the observation group were treated with topical IOP lowering drugs at 1 weeks after surgery.3 eyes(27.27%)in the observation group were treated with topical IOP lowering drugs at 6-12 months after surgery.There was significant difference between preoperative and postoperative(P < 0.05).2 eyes(12.5%)in the control group were treated with topical IOP lowering drugs at 1 weeks after surgery.4 eyes(25%)in the control group were treated with topical IOP lowering drugs at 6-12 months after surgery.There was significant difference between preoperative and postoperative(P < 0.05).There was no significant difference between the two groups at each time(P > 0.05).(8)Complication:In the observation group,2 eyes(18.18%)had hyphema,and transient ocular hypertension was found in 2 eyes(18.18%).In the 1 eyes(9.09%),there was a shallow anterior chamber with low intraocular pressure(IOP).The incidence of complications was 45.45%.The control group aftersurgery in 2 eyes(12.5%)occurred hyphema,2 eyes(12.5%)had a temporary high intraocular pressure,1 eyes(6.25%)showed low intraocular pressure and shallow anterior chamber,1 eyes(6.25%)presented with posterior cataract after surgery for 2 months,the total complication rate was 37.5%.All patients were followed up for 6-12 months without serious complications.(9)Operation success rate:In the observation group,8 eyes were completely successful at 6-12 months after operation,1 eyes was Partial successful,and the total success rate was 81.81%.In the control group,12 eyes were completely successful at 6-12 months after operation,1 eyes was Partial successful,and the total success rate was 81.25%.There was no significant difference in the total success rate between the two groups(P > 0.05)Conclusion:(1)Combined and staged AGV implantation and PHACO+IOL implantation are safe and effective in the treatment of refractory glaucoma with cataract(2)AGV implantation combined with PHACO+IOL implantation in the treatment of refractory glaucoma with cataract was less than that of stage AGV implantation and PHACO+IOL implantation on Corneal endothelial cell injurying. |
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