摘要目的:评价超声乳化白内障吸除人工晶状体植入联合直视下房角分离术治疗原发性闭角型青光眼(PACG)伴发白内障的临床效果。方法:回顾性队列研究。纳入2023年1月至2024年4月120例(120眼)新疆生产建设兵团第七师医院收治的PACG合并白内障患者，按照不同手术方式分为观察组60例(60眼)和对照组60例(60眼)。观察组进行超声乳化白内障吸除人工晶状体植入联合房角分离术，对照组进行超声乳化白内障吸除人工晶状体植入联合小梁切除术。比较两组眼压、最佳矫正视力(BCVA，logMAR)、房角周边虹膜前粘连(PAS)范围及术后并发症。结果:术前、术后1周、术后1个月及3个月，观察组BCVA分别为1.08±0.26、0.87±0.22、0.78±0.16、0.52±0.09，对照组BCVA分别为1.04±0.28、0.94±0.24、0.83±0.22、0.79±0.12；观察组眼压分别为(47.80±5.13)、(18.95±3.92)、(17.92±3.61)、(13.44±3.07)mmHg(1 mmHg＝0.133 kPa)，对照组眼压分别为(46.79±5.08)、(19.01±3.88)、(18.42±3.78)、(17.55±3.16)mmHg。术前房角PAS范围，观察组(233.11±73.37)°，对照组(213.10±63.56)°；术后房角PAS范围，观察组(55.83±58.62)°，对照组(148.00±62.58)°。术后两组患者BCVA均改善，且术后3个月观察组BCVA高于对照组( t＝2.42， P＝0.009)。两组患者术后各时间点眼压均较术前降低(均 P<0.05)。术后3个月，观察组眼压较对照组明显降低( t＝1.80， P＝0.037)。两组患者术后PAS范围小于术前。观察组术后PAS范围小于对照组( t＝3.92， P＝0.005)。观察组患者术后并发症9眼(15.00%)，低于对照组的24眼(40.00%)( χ2＝5.46， P＝0.023)。 结论:超声乳化白内障吸除人工晶状体植入联合直视下房角分离术治疗PACG伴发白内障，可改善视力，降低眼压，术后并发症少。

abstractsObjective:To evaluate the clinical efficacy of phacoemulsification and intraocular lens implantation combined with goniosynechialysis (GSL)under gonioscopy in the treatment of primary angle-closure glaucoma(PACG) with cataract.Methods:A retrospective cohort study was carried out. A total of 120 patients (120 eyes) with PACG with cataract in the 7th Division Hospital, Xinjiang Production and Construction Corps, from Jan. 2023 to Apr. 2024 were divided into an observation group [with 60 cases (60 eyes)]and a control group [with 60 cases (60 eyes)]based on different surgical methods. The observation group was given phacoemulsification and IOL implantation combined with GSL, and the control group was given phacoemulsification and IOL implantation combined with trabeculectomy. Intraocular pressure, best corrected visual acuity (BCVA, logMAR), the range of peripheral anterior synechiae(PAS)and the incidence of postoperative complications between the two groups were compared.Results:Before operation, at 1 week, 1 month and 3 months after surgery, BCVA of the observation group were 1.08±0.26, 0.87±0.22, 0.78±0.16 and 0.52±0.09; BCVA of the control group were 1.04±0.28, 0.94±0.24, 0.83±0.22, 0.79±0.12; intraocular pressure of the observation group were(47.80±5.13), (18.95±3.92), (17.92±3.61), and (13.44±3.07)mmHg (1 mmHg=0.133 kPa); and intraocular pressure of the control group were (46.79±5.08), (19.01±3.88), (18.42±3.78), and (17.55±3.16)mmHg, respectively. The range of preoperative PAS was(233.11±73.37)° in the observation group, and (213.10±63.56)° in the control group. The range of postoperative PAS was (55.83±58.62)° in the observation group, and (148.00±62.58)° in the control group. BCVA of both groups improved significantly after operation. BCVA of the observation group was higher than that of the control group at 3 months after surgery ( t=2.42, P=0.009). Intraocular pressure of both groups at all postoperative time points was lower than that before surgery(all P<0.05). Intraocular pressure of the observation group was significantly lower than that of the control group at 3 months after surgery ( t=1.80, P=0.037). The range of postoperative PAS in both groups was smaller than that before operation.The range of PAS after operation in the observation group was significantly smaller than that in the control group ( t=3.92, P=0.005).The incidence of postoperative complications in the observation group (9 eyes, 15.00%) was lower than that in the control group (24 eyes, 40.00%) ( χ2=5.46, P=0.023). Conclusion:Phacoemulsification and IOL implantation combined with GSL under gonioscopy can improve the patients’ vision, reduce intraocular pressure, reduce postoperative complications. It is worthy of clinical application for PACG with cataract.