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。

AIM: 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: In 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(IOP)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), IOP(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, IOP and number of medications decreased in both groups postoperatively(P<0.01). Postoperative IOPs 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.

CONCLUSION: In 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.