目的：评估飞秒激光辅助超声乳化联合Ahmed青光眼引流阀植入术治疗合并难治性青光眼的白内障的有效性和安全性。

方法：回顾性病例对照研究。2019-10/2021-10入院合并难治性青光眼的白内障患者53例53眼，依据自愿选择分为飞秒激光辅助白内障超声乳化(FLACS)组26例26眼和常规白内障超声乳化(CPCS)组27例27眼。两组分别行FLACS和CPCS联合Ahmed青光眼引流阀植入术。比较两组患者术中超声乳化能量释放量(CDE)、有效超声时间(EPT)的差异和术前与术后抗青光眼药物数量的变化，以及术后观察不同时期(1d，1wk，1、3mo)在提高最佳矫正视力(BCVA)，降低眼压、角膜内皮细胞损伤程度和手术并发症及成功率状况。

结果：FLACS组术中CDE和EPT明显低于CPCS组(t=8.50、5.16； P<0.01、=0.001)。两组术后抗青光眼药物较术前均明显减少(t=9.12、7.76； P=0.011、0.016)，但两组间无差异(t=1.79，P=0.082)。两组术后BCVA均较术前改善，眼压均较术前降低(P<0.05)。FLACS组在术后早期(1d，1wk)BCVA的改善较CPCS组更显著(t=9.74、8.49； P=0.008、0.012)，但在术后1、3mo的BCVA改善程度并无不同(t=0.62、0.44； P=1.415、2.021)。CPCS组在术后随访不同时期的角膜内皮细胞损伤较FLACS组更明显(P<0.05)。术后随访的不同时期FLACS组和CPCS组在控制眼压方面无差异(F_组间=0.64，P_组间=0.421)。FLACS组的手术并发症发生率27%(7/26)较CPCS组89%(24/27)低(χ²=20.95，P<0.01)，其中角膜水肿(8% vs 41%)、前囊撕裂(0 vs 11%)在FLACS组中明显低于CPCS组，后囊破裂(0 vs 7%)、玻璃体脱出(0 vs 4%)及人工晶状体偏位(0 vs 7%)也均发生在CPCS组。但两组的治疗总成功率相近(P=28.718)。

结论：飞秒激光辅助超声乳化联合Ahmed青光眼引流阀植入术可充分发挥联合手术的精准微创可控优势，帮助合并难治性青光眼的白内障患者有效降低眼压及更早获得视力恢复。

METHODS: Retrospective case-control study. From October 2019 to October 2021, 53 cataract patients(53 eyes)with refractory glaucoma were divided into 26 cases(26 eyes)in the femtosecond laser assisted cataract surgery(FLACS)group and 27 cases(27 eyes)in the conventional phacoemulsification surgery(CPCS)group according to their voluntary choice. The two groups underwent FLACS and CPCS combined with Ahmed glaucoma drainage valve implantation separately. The differences of intraoperative phacoemulsification energy(CDE), effective phacoemulsification time(EPT)and the changes of the number of anti glaucoma drugs before and after operation were compared between the two groups, and the effects of improving best corrected visual acuity(BCVA), reducing intraocular pressure, the degree of damage to corneal endothelial cells, the surgical complications and success rate were observed and compared between the two groups in different follow-up periods(1d,1wk, 1 and 3mo).

RESULTS: The intraoperative CDE and EPT in FLACS group were significantly lower than those in CPCS group(t=8.50, 5.16; P<0.01, P=0.001). The postoperative anti glaucoma drugs in the two groups were significantly less than those before operation(t=9.12, 7.76; P=0.011, 0.016), but there was no significant difference between the two groups(t=1.79, P=0.082).The postoperative BCVA of the two groups all improved and the intraocular pressure was all lower than that before operation(P<0.05).The improvement of BCVA in FLACS group was more significant than that in CPCS group in the early postoperative period(1d, 1wk; t=9.74, 8.49; P=0.008, 0.012), but there was no significant difference in the improvement degree of BCVA at 1 and 3mo after operation(t=0.62, 0.44; P=1.415, 2.021). The damage to corneal endothelial cell in CPCS group was more obvious than that in FLACS group at different stages of postoperative follow-up(P<0.05). There was no significant difference in controlling intraocular pressure between FLACS group and CPCS group at different stages of postoperative follow-up(F_interblock=0.64, P_interblock=0.421). The incidence of surgical complications was 27%(7/26)in FLACS group, which was lower than the 89%(24/27)in CPCS group(χ²=20.95, P<0.01). Corneal edema(8% vs. 41%), anterior capsular tear(0 vs. 11%)were significantly lower in FLACS group than in CPCS group. Posterior capsule rupture(0 vs. 7%), vitreous prolapse(0 vs. 4%)and intraocular lens deviation(0 vs. 7%)also occurred in CPCS group. However, the total success rate of the two groups was similar(P=28.718).

CONCLUSION: Femtosecond laser assisted phacoemulsification combined with Ahmed glaucoma drainage valve implantation can give full play to the precise, minimally invasive and controllable advantages of the combined operation to help patients effectively reduce intraocular pressure and recover vision earlier.