作者：方繁 张华英 刘阳    作者单位：九江学院附属都昌医院、都昌县人民医院 江西都昌

    【摘要】  目的：观察闭角型青光眼合并白内障行小切口白内障摘除联合小梁切除术的临床效果。方法：对21例21眼闭角型青光眼合并白内障行小切口白内障摘除人工晶状体植入联合小梁切除术，观察术后视力、眼压、滤过泡及眼底改变。结果：术后6月视力达0.3及以上者18眼(85.71%),眼压控制在正常范围内(＜20.55mmHg)者19眼(90.48%),功能性滤过泡19眼(90.48%),无严重并发症发生。结论：小切口白内障摘除人工晶状体植入联合小梁切除术是治疗闭角型青光眼合并白内障的有效方法。

    【关键词】  小切口；青光眼；闭角型；白内障摘除；小梁切除

    CLINICAL EFFECT OF COMBINED SURGERY OF CATARACT

    EXTRACTION THROUGH SMALL  INCISION  AND  TRAOCULAR

    LENS IMPLANTATION  WITH  TRABECULECTOMY  IN  PATIENTS

    WITH  CATARACT  AND  ANGLE-CLOSURE  GLAUCOMA

    FANG Fan；ZHANG Huaying；LIU Yang

    （Jiujiang University Duchang Hospital，Duchang County People's Hospital，Duchang,  Jiangxi 332600）

    ABSTRACT  OBJECTIVE：To evaluate clinical effect of combined surgery of cataract extraction through small incision and intraocular lens implantation with trabeculectomy in patients with cataract and angle-closure glaucoma.METHOD：21 eyes with cataract and angle-closure glaucoma were performed cataract extration through small incision and intraocular lens implantation with trabeculectomy. The changes of vision, intraocular pressure(IOP), filtering bleb and ocular fundus were observed.RESULTS：After follow-up of six months, visual acuity in 18 eyes had been improved more than 0.3 (85.71%); IOP in 19 eyes had been reduced to less than 20.55mmHg(90.48%) and 19 eyes (90.48%) had the functional filtering bleb. There were no serious complications.CONCLUSION：The combination operation of cataract extration through small incision and intraocular lens implantation with trabeculectomy is an effective method in treating patients with cataract and angle-closure glaucoma.

    KEY WORDS  small incision；glaucoma；angle-closure；cataract extration；trabeculectomy

    闭角型青光眼和白内障都是眼科常见病，多发病，两者常同时存在且相互影响。我院对闭角型青光眼合并白内障的患者采用小切口非超声乳化白内障摘除人工晶状体植入联合小梁切除术进行治疗，取得较好的临床效果，现报告如下：

    1  资料和方法

    1.1 一般资料  本组21例21眼均为闭角型青光眼并发白内障，其中男8例8眼，女13例3眼，年龄49～84岁，平均年龄63.70岁。其中急性闭角型青光眼6例6眼，慢性闭角型青光眼10例10眼，外伤后继发性青光眼3例3眼，白内障膨胀期继发青光眼2例2眼。晶状体核硬度：Ⅰ级1眼，Ⅱ级8眼，Ⅲ级9眼，Ⅳ级3眼。入院时眼压：20.55～61.75mmHg。术前视力：光感～0.3。

    1.2 术前准备  ①术前进行常规全身及眼部检查。②术前用药物将眼压降至正常或接近正常范围。③术前24h停用缩瞳剂，对于眼压高者，术前30min快速静脉滴注20%甘露醇250mL。④测定角膜曲率、眼轴并根据SRKⅡ公式计算出所需人工晶体屈光度数。

    1.3 手术方法  术前30min滴美多丽3次散大瞳孔。球周或球后麻醉，加压软化眼球。作上直肌牵引线固定眼球。做以穹窿部为基底切口长为5～6mm的结膜瓣，并向后稍作分离。距角膜缘2.0～2.5mm作1/2巩膜厚度的水平切口长约5～6mm,板层巩膜隧道式向前分离至透明角膜内约1～2mm,以3.2mm穿刺刀刺入前房,并向前房内注入黏弹剂,环形撕囊或开罐式截囊后充分水分离,使晶状体核上浮于前房内。扩大隧道内切口用注水圈套器娩出晶状体核，注吸皮质。前房及囊袋内注入黏弹剂，囊袋内植入工晶状体。BSS液置换黏弹剂，向前房内注入卡米可林缩瞳。隧道内切口切除1mm×2mm的小梁组织，于相应处作虹膜周边切除，隧道外切口缝合2～3针，缝合结膜瓣。球结膜下注入庆大霉素2万U+地塞米松2.5mg。

    1.4 术后处理  局部和全身应用抗生素，皮质类固醇3～5d，每日点复方托品酰胺滴眼液1～2次活动瞳孔。术后眼压仍高者给予0.25%噻码心胺滴眼液，必要时加服乙酰唑胺片。术后随访6～36月，平均12月。

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