【摘要】目的：观察透明角膜切口白内障超声乳化人工晶状体植入联合小梁切除术(以下简称超声乳化三联术)治疗青光眼合并白内障的临床疗效和安全性。
方法：回顾性分析使用透明角膜切口超声乳化三联术治疗各种类型的青光眼合并白内障患者127例（128眼）手术前、后的视力和眼压，手术并发症和滤过泡情况。
结果：术后视力迅速恢复，矫正视力较术前明显提高，随访6mo～2a，113眼≥0.5(88.3%)；眼压较术前明显降低，112眼术后眼压<20mmHg，16眼加滴1～2种降压药后眼压控制满意且稳定。术后并发症少，功能性滤过泡83.6％。
结论：透明角膜切口超声乳化白内障吸除人工晶状体植入联合小梁切除术治疗青光眼合并白内障，不但能良好地控制眼压，迅速恢复视力。而且并发症少，手术适应证广，在白内障青光眼并存情况下采用超声乳化三联手术是安全、有效、可靠的治疗方法 。
【关键词】 白内障超声乳化术；小梁切除术；联合手术；透明角膜切口
The efficacy of clear corneal incision phacoemulsification and intraocular lens implantation combined with trabeculectomy
Yu Zheng, ShaoBin Zhang, HuiChun Huang
Shantou University/Chinese University of Hong Kong Joint Shantou International Eye Center, Shantou 515041, Guangdong Province, China
Correspondence to:Yu Zheng.Shantou University/Chinese University of Hong Kong Joint Shantou International Eye Center, Shantou 515041, Guangdong Province, [email protected]
AbstractAIM: To evaluate the clinical effect and safety of clear corneal incision phacoemulsification and intraocular lens (IOL) implantation combined with trabeculectomy for the treatment of cataract and glaucoma.METHODS: A total of 127 cases (128 eyes) with glaucoma and cataract who underwent clear corneal incision phacoemulsification and IOL implantation combined with trabeculectomy in our hospital were retrospectively analyzed. Patients visual acuity, intraocular pressure (IOP) before and after the operation were recorded as well as their surgical complication and filtering bleb condition.RESULTS: All patients visual acuity were improved soon after the operation. During the followup of 6 months to 2 years, the corrected vision of 113 eyes was ≥0.5 (88.3%). IOP was markedly reduced compared with that before the operation. IOP of 112 eyes were lower than 20mmHg, while IOP of the left 16 eyes were controlled with one or two kinds of antihypertension medicine. There were few postoperative complications. 83.6% of cases got functional filtering blebs.CONCLUSION: The combined surgery of trabeculectomy and clear corneal incision phacoemulsification and IOL implantation is a safe and effective surgery for patients with cataract and glaucoma. This combined surgery can improve visual acuity and control IOP with few complications and good recovery.
KEYWORDS:phacoemulsification;trabeculectomy;combined surgery;clear corneal incision
引言
青光眼合并白内障的患者临床常见。 随着超声乳化白内障吸除人工晶状体植入术的操作技巧、手术器械、超声乳化仪的性能的迅速发展，白内障超声乳化后房型人工晶状体植入联合小梁切除术现已成为治疗青光眼合并白内障有效的手术方法。我院自 2003/2005对青光眼合并白内障患者127例（128眼）行透明角膜切口超声乳化三联手术，取得满意效果， 报告如下。
1对象和方法
1.1对象
本组青光眼合并白内障患者127例（128眼），男 62例（63眼），女65例（65眼）；年龄43～90（平均 63.7）岁。术前视力为光感—眼前指数者39眼， 0.02～0.1者52眼，0.1～0.4者 37眼。术前眼压为 27.6～65.3mmHg（1mmHg=0.133kPa），平均（ 45.6±13.5）mmHg。晶状体核硬度均≤Ⅳ级（LOCSII分级标准）。 其中白内障合并原发性闭角型青光眼78眼，原发性开角型青光眼22眼，白内障膨胀期继发青光眼28眼。既往曾行单纯小梁切除术者26眼。
1.2方法
术前所有患者均使用药物尽量将眼压控制在30mmHg以内，高于35mmHg者术前30min快速静脉点滴200g/L甘露醇。测量眼轴和角膜曲率，计算人工晶状体所需要的度数。在表麻下术眼颞侧透明角膜切口和顺时针45°处角膜缘辅助切口。前房注入粘弹剂、连续环形撕囊、充分水分离。超乳吸出晶状体核，灌注/抽吸（I/A）清除残余皮质。囊袋内充分注入粘弹剂撑开囊袋，植入人工晶状体。I/A吸出粘弹剂，卡米可林缩瞳，水针封闭切口。局部球结膜下浸润麻醉，沿角巩缘剪开11∶00～1∶00 结膜和筋膜。平衡盐冲洗、电凝止血。做3～4mm板层巩膜隧道至透明角膜内1mm，剪开隧道两侧形成板层巩膜瓣，作2mm×1.5mm的小梁切除和常规虹膜周边切除。100尼龙线在方形巩膜瓣两角处各缝合一针，埋藏线结。连续缝合结膜，术毕结膜囊内涂典必殊眼膏。
[1] [2] 下一页 |
