作者：朱白蕾，钟丘 作者单位：（528437）中国广东省中山市，广东省中山火炬开发区医院眼科
【摘要】目的：比较小梁切除联合超声乳化白内障吸除术和分阶段手术治疗青光眼合并白内障的临床疗效。方法：青光眼合并白内障患者施行小梁切除联合超声乳化白内障吸除术82例（82眼）为联合手术组，先施行小梁切除术后施行超声乳化白内障吸除术38例（38眼）为分阶段手术组。比较两组术后视力、眼压、手术并发症和角膜内皮细胞丢失率等。结果：两组术后均随访3mo以上。视力：≥0.5联合手术组56眼（68.3％），分阶段手术组30眼（78.9％）；≥1.0联合手术组26眼（31.7％），分阶段手术组6眼（15.8％），两组比较差异无显著性（χ2=1.452和3.364，P＞0.05）。眼压：两组术后随访平均眼压分别为（11.08±4.68）mmHg和（11.57±3.25）mmHg，两组比较差异无显著性（t=0.587，P＞0.05）。手术并发症：联合手术组多于且重于分阶段手术组，但均经常规治疗后恢复正常。角膜内皮细胞丢失率：联合手术组平均为（20.06±18.03）%，分阶段手术组为（15.07±15.22）%，两组比较差异无显著性（t=0.996，P＞0.05）。结论：小梁切除联合超声乳化白内障吸除术和分阶段手术均是治疗青光眼合并白内障的安全、有效方法。
【关键词】 超声乳化白内障吸除术；青光眼；联合手术；小梁切除术
A comparative study between trabeculectomy combined with phacoemulsification and glaucoma surgery by stages
BaiLei Zhu, Qiu Zhong
Department of Ophthalmology , Hospital of Zhongshan Torch Development Zone , Zhongshan 528437, Guangdong Province China
Correspondence to:Qiu Zhong.Department of Ophthalmology , Hospital of Zhongshan Torch Development Zone , Zhongshan 528437, Guangdong Province [email protected]
AbstractAIM: To compare the clinical effects of combined procedure versus staged procedure for treatment of glaucoma with cataract.METHODS: This retrospective clinical study included 120 patients (120 eyes) In group A, 82 eyes with glaucoma and cataract underwent trabeculectomy combined with phacoemulsification and intraocular lens implantation, and in group B, 38 eyes with cataract after trabeculectomy were treated by phacoemulsification and intraocular lens implantation. The best corrected visual acuity (BCVA), intraocular pressure (IOP), complications and the loss rate of corneal endothelial cells after the operation were observed and compared.RESULTS: All cases were followed up for over 3 months. The postoperative BCVA of two groups was obviously improved, and there was no significant difference between two groups (P>0.05). Besides, the mean IOP of two groups were 11.08±4.68 mmHg and 11.57±3.25 mmHg respectively, which had no significant difference (P>0.05). The complications in group A occurred more frequently and more severely than those in group B. However, all patients recovered to normal through conventional treatment. The percentage of corneal endothelial cell loss in group A was 20.06±18.03%,and 15.07±15.22% in group B. There was no significant difference between two groups (P>0.05). CONCLUSION: Trabeculectomy combined with phacoemulsification and surgeries by stages are successful, safe and effective ways of treatment for patients with glaucoma and cataract.
KEYWORDS: phacoemulsification; glaucoma; combined surgery; trabeculectomy
引言
白内障、青光眼多为老年性眼病，分别位居致盲性眼病的第一和第二位。两者常互为因果，即白内障可因膨胀或过熟引起青光眼，青光眼本身和抗青光眼的治疗又可引起和加重白内障。对青光眼合并白内障的治疗，各家观点不一，有的单纯做白内障超声乳化手术，有的做青光眼和白内障联合手术；还有的先做青光眼手术，后做白内障手术。我们回顾性统计对比分析在我院行小梁切除联合白内障超声乳化吸出术和小梁切除术后行白内障超声乳化吸出术的临床疗效，探讨两种治疗方法的优缺点，报告如下。
1对象和方法
1.1对象
取资料完整、术后随访3mo以上在我院行小梁切除联合白内障超声乳化吸出手术的青光眼合并白内障患者82例（82眼），是为联合手术组；曾行小梁切除手术，眼压控制满意，因白内障加重又行超声乳化吸出手术的患者38例（38眼），是为分阶段手术组。两组一般资料（表1）。两组术前性别、年龄、晶状体核硬度（Emery及Little分级标准）差异均无统计学意义。术前眼压：联合手术组为13.35～71.03mmHg（1mmHg=0.133kPa），平均（35.66±13.52）mmHg，高于分阶段手术组5.87～21.0mmHg，平均（12.54±4.07）mmHg。术前视力（标准对数视力表）：联合手术组因同时有两种影响视力的疾病，故差于分阶段手术组。分阶段手术组小梁切除手术至本次手术时间间隔为0.5～22（平均5.5）a。表1 两组患者术前情况比较（略）
1.2方法
两组手术均使用同一超声乳化仪、由同一人完成。联合手术组采取单切口方式，作上方5mm×4mm巩膜隧道切口，完成白内障超声乳化吸出人工晶状体植入后，作小梁组织切除和虹膜根部切除[1]。分阶段手术组避开原滤过泡，作颞上方或颞侧透明角膜或巩膜隧道切口，同联合手术组完成白内障超声乳化吸出和人工晶状体植入。两组术毕常规球结膜下注射庆大霉素和地塞米松，术后常规全身及局部给予糖皮质激素和抗生素，2～5d出院。观察项目：记录术后视力、眼压、眼底杯盘比、滤过泡情况及术中、术后手术并发症等。采用日本Topcon公司SP2000型非接触式角膜内皮显微镜记录术前和出院角膜中央区的角膜内皮细胞密度。
统计学处理：采用SPSS统计软件包对计量资料和计数资料分别进行t检验和χ2检验。
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