作者：王淑霞，支洪峰，王丹，燕洪涛
【摘要】 目的 探讨小梁切除联合白内障超声乳化吸出后房型人工晶体植入术，对治疗青光眼合并白内障患者的疗效。方法 采用隧道内小梁切除对34例（40眼）青光眼合并白内障患者进行三联手术，术后随访6～18个月。结果 术前平均眼压34.34mmHg，术后平均眼压15.66mmHg，P＜0.05。术前视力指数至0.5，术后最终矫正视力≥0.6，26眼，占65%，≥0.2，36眼,P＜0.01。术后30眼散光度数在2.0D以下，平均散光度数为0.92D。术后早期并发症为角膜水肿16眼，纤维素性渗出4眼，大部分患者有瞳孔散大、不规则移位、对光反射减弱。在随访期间内后发障3眼。结论 小梁切除联合白内障超声乳化吸除、后房型人工晶体植入术治疗青光眼合并白内障，能有效控制眼压，迅速恢复视力，是一种安全、有效、经济的手术方法。
【关键词】 青光眼；白内障；超声乳化；小梁切除
A clinical study of trabeculectomy combined with phacoemulsification for the treatment of glaucoma patients complicated by cataract
WANG Shu-xia,ZHI Hong-feng,WANG Dan,et al.
Department of Ophthalmology, People's Hospital in Jilin Province, Changchun 130021, China
【Abstract】 Objective To investigate the effects of trabeculectomy combined with phacoemulsification and post-chamber intraocular lenses implantation for the treatment of patients with glaucoma and cataract. Methods Triple procedure was performed through a tunnel incision on 40 eyes of 34 patients with glaucoma and cataract, inside that incision trabeculectomy was finished, the follow-up time was 6～18 months. Results Mean intraocular pressure was 34.34mmHg before operations comparing with postoperative IOP 15.66mmHg, there was statistical difference (P＜0.05). Preoperative visual acuities ranged from fingers to 0.5, but 26 eyes (65%) had the best corrected visual acuities≥0.6 and 36 eyes(90%) was ≥0.2.Also, there was significantively statistical difference (P＜0.01). Operatively, the degree of astigmatism below 2.0D appeared in 30 eyes (mean 0.92D). As early sequelae after operations, 16 eyes had corneal edema, 4 eyes had fibrous effusion, the majority of which had enlargement, shift and light-response slowness of pupil. In addition, developed after cataract were found in 3 eyes in the long-term observation.Conclusion Trabeculectomy combined with phacoemulsification and post-chamber intraocular lenses implantation is a safe, effective and economical surgery for the treatment of patients with glaucoma and cataract, and it can reduce intraocular pressure and improve visual acuity rapidly.
【Key words】 glaucoma; cataract;phacoemulsification;trabeculectomy
小梁切除联合白内障超声乳化吸除及折叠式人工晶状体植入治疗青光眼合并白内障的临床效果确切。随着超声乳化白内障吸出技术日臻成熟该手术更加简单、安全和有效，现将我院自2004年初所实行的三联手术34例（40眼），报告如下。
1 资料与方法
1.1 一般资料 收集2004年初～2005年3月在我院住院患者行三联手术的青光眼合并白内障患者，男13例16眼，女21例24眼；年龄42～91岁，平均68.47岁。闭角型青光眼伴白内障27例(31眼)，其中急性闭角型青光眼15例(17眼)，慢性闭角型青光眼12例(14眼)。开角型青光眼伴白内障6例（8眼），外伤性白内障继发青光眼1例(1眼)。术前眼压24.48～69.12mmHg，平均34.34mmHg。术前视力指数至0.5，晶状体核硬度Ⅱ～Ⅳ级。随访时间6～18个月。
1.2 术前准备 术前检测眼压、房角镜检查、前房深度测量，检查A/B超、角膜曲率和计算人工晶体度数，局部应用抗生素及非甾体眼药水点眼，眼压尽量降至正常范围，如降不到正常，术前30min静脉滴注20%甘露醇250ml。术前1h 美多利-P散瞳。
1.3 手术方法 球周麻醉，做以角膜缘为基底结膜瓣长4mm，角膜缘保留1mm结膜组织。距角膜缘2.5mm处做水平切口长约3.2mm，做板层巩膜隧道，分离至透明角膜内1mm，2点位做透明角膜内辅助切口，然后用3.2mm穿刺刀刺入前房。前房内注适量粘弹剂后，以截囊针做环形撕囊，直径5.5mm，充分水分离。采用美国Alcon公司生产的超声乳化仪乳化晶状体核，吸净皮质，前房及囊袋内注入粘弹剂，植入直径为6.0mm可折叠式后房型人工晶体。卡米可林缩瞳，巩膜隧道内切除1.5mm×2.5mm的小梁组织［１］，行虹膜周边切除，吸出前房及囊袋内残留的粘弹剂。10-0线连续缝合球结膜，结膜下注射庆大霉素2万U，地塞米松2mg。
1.4 术后处理 术后3天静点抗生素每日1次，术后第一天开放点眼用激素＋抗生素＋非甾体抗炎药物，每隔2h 1次，3～5天后减为每日4次，视炎症情况可持续1～2个月，术后随访，1周、2周、4周，以后每2个月复诊。
2 结果
2.1 眼压变化 术前眼压24.48～69.12mmHg，平均眼压34.34mmHg，术后最终眼压12.23～22.38mmHg，平均眼压15.66mmHg，配对t检验P＜0.05，术后2周内无使用降眼压药物者，手术后1周均在医生指导下按摩眼球。术后前房深度(2.28±0.3)mm，较术前的(1.69±0.46)mm明显加深（配对t检验，P＜0.005)其中以闭角型青光眼患者加深最明显。
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