摘要背景 睫状体光凝术(ECP)联合白内障超声乳化(Phaco)和人工晶状体(IOL)植入术(ECP+Phaco+IOL)在临床上广泛应用,但联合手术中睫状体光凝的范围对术后降眼压效果的影响鲜有深入研究.目的 探讨ECP+Phaco+IOL术不同范围睫状体光凝的降眼压效果. 方法 60只灰兔的双眼采用角巩膜缘小梁网组织全周光凝法建立慢性青光眼模型,造模成功共50眼,将48只模型眼采用随机数字表法随机分成4个组,其中A、B、C组模型眼分别实施180°、270°、360°ECP,同时行Phaco+IOL植入手术,D组模型眼行小梁切除术+Phaco+IOL植入术(Trab+Phaco+IOL),2只模型兔和另2只健康兔作为眼压的对照观察.分别于术前和术后1d,1周、2周,1、3、4、5和6个月用iCare回弹式眼压计测量实验兔眼压,对各组兔眼压的下降范围进行比较. 结果 兔实验眼造模前眼压为(13.31±1.85)mmHg(1 mmHg=0.133 kPa),造模后1周为(33.19±5.59) mmHg,差异有统计学意义(t=94.676,P=0.000).术前A、B、C和D组间兔眼眼压的差异均无统计学意义(均P＞0.05);术后1d,C组的眼压均明显低于A组,C组眼压明显低于B组,差异均有统计学意义(P=0.001、0.035);术后1周,C组兔眼眼压明显低于A组,差异有统计学意义(P=0.013);术后2周,B组兔眼眼压明显低于A组,而C组明显低于B组,差异均有统计学意义(P=0 002、0.006);术后1个月,C组兔眼眼压明显低于A、B、D组,差异均有统计学意义(P=0.001、0.009、0.026);术后3个月和6个月,C组兔眼眼压均明显低于A组,差异均有统计学意义(P=0.008、0.011).术后2周和术后1个月,C组兔眼的眼压下降幅度均明显大于A组和B组,差异均有统计学意义(术后2周:P=0.018、0.014;术后1个月:P=0.024、0.016).术后观察期间各组兔眼均未发现严重并发症. 结论 2种青光眼与白内障联合手术方式均能有效地降低慢性青光眼的眼压,内窥镜下睫状体光凝的范围度数越大,眼压下降的幅度越大,180°、270°睫状体光凝眼也有较好的眼压控制效果.

abstractsBackground Endoscopic cydophotoeoagulation (ECP) combined with phacoemulsification (Phaco) and intraocular lens (IOL) (ECP+Phaco+IOL) surgery has been widely used,but its lowing intraocular pressure (IOP) effect is unclear.Objectives This study was to investigate the lowing-IOP effect of ECP+Phaco+ IOL in chronic glaucoma.Methods This experimental process was approved by Experimental Animal Ethics Committee of Medical College of Nanchang University.Chronic glaucoma models were established bilateral eyes of 30 pigmented rabbits using laser 360°trabecular meshwork photocoagulation.Forty-eight model eyes were randomized to four groups.ECP of 180°,270° and 360° was performed in the A,B and C groups,respectively,and Phaco+IOL was simultaneously carried out;while trabeculectomy (Trab) combined with Phaco+IOL surgery (Trab+ Phaco+IOL) was performed in the D group.IOP was measured and compared by iCare rebound tonometer before surgery and 1 day,1 week,2 weeks,1 month,3 months and 6 months after surgery.Results The IOP was(13.31±1.85)mmHg before surgery and that in 1 week after surgery was (33.19±5.59)mmHg,with a significant difference between them (t=94.676,P=0.000).No significant difference was seen among the four groups before operation (P＞0.05).The IOP was significantly lower in the C group compared with the A group and B group in postoperative 1 day (P =0.001,0.035),and in the first week after operation,the IOP was significantly lower in the C group than that of the A group (P=0.013).In the second week after operation,the IOP of the B group was considerably lower than that of the A group,and that of the C group was significant reduced in comparison with the B group (P=0.002,0.006).The IOP was lowest in the C group in postoperative 1 month in comparison with the A,B and C groups (P=0.001,0.009,0.026),and lower IOP was found in the C group compared with the A group in 3 months and 6 months after operation (P=0.008,0.011).In addition,the lowing-IOP range was larger in the group compared with the A group and B group in2 weeks and 1 month after operation (2 weeks:P=0.018,0.014;1 month:P=0.024,0.016).No serious complication was found in various groups.Conclusions Both ECP+Phaco+IOL and Trab+Phaco+IOL can reduce IOP effectively and safely.The lowing-IOP effect is better in larger range of cyclophotocoagulation eye during the ECP+ Phaco+IOL surgery.