【摘要】目的：探讨抗青光眼药物在防治粘弹剂辅助白内障超声乳化手术后早期眼压升高中的作用。方法：150例150眼白内障患者行玻璃酸钠辅助超声乳化术，术程顺利无并发症。按术后抗青光眼药物将患者随机分为5组：10g/L派立明组，2g/L阿法根组，口服醋氮酰胺250mg组，5g/L噻马心安组及未用药组（空白对照组）。术前、术后6，12，24h及1wk测量眼压。结果：术前各组间眼压均值无明显差别。术后6，12h及24h用药组眼压较对照组低(P<0.01)，术后6h各组眼压均升高，以对照组显著。各组术后12h眼压达峰值。此时眼压>21mmHg所占比例，抗青光眼药物组各组间比较无差异，对照组明显高于其它组。术后24h用药组眼压均降低，对照组仍保持高值。术后1wk，各组间无明显差异。结论：抗青光眼药物对玻璃酸钠辅助超声乳化手术后引起的眼压增高均有降低作用。
【关键词】 粘弹剂；青光眼；白内障；眼压
Effect of antiglaucoma agents on postoperative intraocular pressure after phacoemulsification with viscoelastics
XianHua Xie, AnZhen Mao
Department of Ophthalmology, the Second Peoples Hospital, Yueyang 414000, Hunan Province，China
Correspondence to: XianHua Xie. Department of Ophthalmology, the Second Peoples Hospital, Yueyang 414000，Hunan Province，China. [email protected]
AbstractAIM:To investigate the effectiveness of antiglaucoma agents in preventing intraocular pressure (IOP) elevation during the early period after phacoemulsification with the help of viscoelastics.METHODS: One hundred and fifty patients (150 eyes) with uncomplicated cataract were scheduled for phacoemulsification using sodium hyaluronate as adjunct. Patients were randomly assigned to five groups: postoperative application of topical Azopt 10g/L, Alphagan 2g/L, oral acetazolamide 250mg, timolol 5g/L, and no ocular hypotensive agent (control group). The IOP was measured preoperatively as well as 6 hours, 12 hours, 24 hours, and 1 week after surgery. RESULTS: The mean preoperative IOP values were not significantly different between groups. At 6, 12 and 24 hours postoperatively, the mean IOP was significantly lower in all groups receiving an ocular hypotensive agent than that in the control group (P<0.01). At 6 hours after surgery, the mean IOP significantly increased in all groups but was not as prominent as the control group. At 12 hours after surgery the mean IOP was at the peak in all groups. The percentage of eyes with IOP higher than 21mmHg at 12 hours after phacoemulsification were not significantly different between antiglaucoma agent groups, but IOP is obviously higher in the control group. At 24 hours after surgery, the mean IOP decreased significantly in all ocular hypotensive agent groups, but remained significantly high in the control group. One week after surgery, there were no significant differences between groups.CONCLUSION: All of the hypotensive agents have similar effects in reducing IOP increase after phacoemulsification performed with sodium hyaluronate as adjunct.
KEYWORDS: viscoelastics; glaucoma; cataract; intraocular
pressure
白内障超声乳化作为治疗白内障的成熟手术方式而得到广泛应用，也从单纯的复明手术逐步发展为屈光手术。不但要得到视力的提高，视功能的全面恢复也是当今研究的热点。手术并发症的防治是视力恢复及各项视功能保护的基础之一。白内障术后24h内眼压增高是术后的主要并发症之一。眼压的增高可由于角膜水肿、前部缺血性视神经病变、视网膜血管损伤等使患者出现疼痛、视力恢复不佳及色觉、对比敏感度等视功能的损害。粘弹剂作为白内障超声乳化手术的软工具，在稳定维持前房，保护角膜内皮等方面大大提高了手术成功率减少了手术并发症。但粘弹剂在前房内的残留可引起机械性堵塞小梁网而至眼压增高。本研究应用抗青光眼药物进行干预，探讨其对白内障术后早期眼压升高的作用。
1对象和方法
1.1对象
200701/06医院眼科白内障患者150例150眼（年龄38～72岁，男78例，女72例，老年性白内障112例，并发性白内障22例，代谢性白内障16例），白内障核分级为 1～4级。所有患者均被告知，自愿参加研究并签署同意书。行常规眼科检查，排除术前高眼压（>21mmHg）、色素播撒综合征、青光眼。对磺胺药物过敏及慢性堵塞性肺部疾病患者亦不纳入研究。行小切口晶状体超声乳化白内障吸出加折叠人工晶状体植入术，所有病例手术均顺利，无晶状体囊破裂或玻璃体溢出等并发症发生。按术后抗青光眼药物将所有患者随机分为5组每组各30例：组1：10g/L派立明；组2：2g/L阿法根；组3：口服醋氮酰胺250mg；组4：5g/L噻马心安；组5：空白对照组。
1.2方法
手术均由同一操作熟练的术者完成。以20g/L利多卡因做球周阻滞麻醉。做颞侧透明角膜切口，长为3.0mm；前房穿刺刀于上方角膜缘做辅助切口。前房内注入黏弹剂（透明质酸钠，正大福瑞达公司）后，行直径约6.0mm的连续环形撕囊，水分离和水分层后使用超声乳化仪（Stroz公司Protégé型）乳化吸出晶状体核，平均超声时间为24.1s，平均超声能量为12.8%。使用自动灌注/抽吸系统清除晶状体皮质，前房内注入黏弹剂，将折叠型人工晶状体植入晶状体囊袋内，术后常规冲洗前房，清除干净残留的黏弹剂及皮质。Schiotz眼压计测量眼压，通过辅助切口调整前房内平衡盐液体使眼压调整至10mmHg。术毕予以相应抗青光眼药物，典必殊眼膏点眼后眼垫遮盖。手术均于上午11点前完成。由同一熟练操作者应用美国非接触式眼压计AT500进行术后眼压测量，均取3次平均值为测量值；术后6h第一次测量眼压，并再次予以抗青光眼药物，组3于晚上10点再予口服醋氮酰胺250mg一次。术后12h及24h分别测量眼压。术后24h如眼压≤21mmHg则停药，否则予以噻马心安2次/d直至眼压低于21mmHg。术后24h常规扩瞳、局部抗炎抗感染。随访至术后1wk再次行眼压测量。
统计学处理：使用SPSS 12.0统计软件，术前术后眼压组间比较采用方差分析，各组不同时间段眼压变化采用配对t检验，各组术后眼压>21mmHg所占比例采用χ2检验。检验水准为α＝0.05，以 P<0.05为差异具有统计学意义。
2结果
术前及术后各组不同时间段所测眼压（表1），术前各组间差异无显著性，术后6，12，24h眼压用药组均低于对照组，1wk后各组间差异无显著性。术后不同时段各组眼压较术前波动均值(表2)。各组术后6h眼压均较术前升高12h达高峰，且均以对照组升高最大。术后24h用药组眼压均降低，对照组仍保持高值各组术后12h眼压峰值均有>21mmHg者，各组术后12h眼压>21mmHg例数及其所占比例为：组1，组4各2例（6.7%），组2，组3各3例（10.0%），组5为9例（30%）。抗青光眼药物组各组间眼压高峰值所占比例无差异，对照组明显高于其它组。术后24h各组眼压峰值均<25mmHg。术后1wk各组眼压峰值均<21mmHg。表1术前及术后各组眼压均值（略）表2各组不同时间段术后平均眼压波动值（略）
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