改良的小梁切除联合晶状体超声乳化术疗效分析

The effect of combined phacoemulsification and modified trabeculectomy.

目的回顾性分析改良的小梁切除术联合晶状体超声乳化术的临床效果。方法2005年1月至2008年4月进行改良的小梁切除联合超声乳化术79例（95眼）。手术由同一术者施行，手术采用单一巩膜隧道切口小梁切除术联合晶状体超声乳化术。记录术后第1天、1周、1个月、3个月、1年及最后一次随访时的最佳矫正视力、眼压及并发症。结果平均随访（16．9±7．2）个月。术前平均视力为0．25±0．27，术前平均眼压为（20．1±7．3）mmHg；术后1d、1周、1个月、3个月、1年及最后一次随访时的眼压依次为（16．3±9．2）mmHg、（12．3±4．2）mmHg、（14．8±5．2）mmHg、（15．1±3．1）mmHg、（14．8±2．7）mmHg、（14．5±2．8）mmHg，不同时期眼压与术前相比差异具有统计学意义（P〈0．05）。术后1年的最佳矫正视力为0．74±0．34，与术前相比差异具有统计学意义（P〈0．05）。术后浅前房发生率为6．3％（6／95），平均持续时间为（6．5±3．8）d；术后脉络膜脱离的发生率为11．6％（11／95）；术后需要辅助5一氟尿嘧啶局部注射者占41．1％（39／95），平均注射次数（3．5±4．2）次；27．4％（26／95）的术眼需要应用1种以上局部降眼压药物治疗。1年时的手术成功率为93．7％（89／95），完全成功率为66．3％（63／95）。结论单一巩膜隧道切口小梁切除联合晶状体超声乳化术可以明显减少手术创伤、缩短手术时间，但术后早期需密切观察，联合局部抗代谢药物注射，随访期内手术效果好，远期疗效需进一步继续随访。

Objective To analyze retraspectively the effect of combined phacoemulsification with modified trabeculectomy. Methods A retrospective analysis was performed on 95 eyes of 79 patients with combined phacoemulsification and modified trabeculectomy from January 2005 to April 2008. Then procedure started as a one-site approach with phacoemulsification and trabeculectomy through a short scleral tunnel incision. All surgeries were performed by one surgeon. To test the best corrected visual acuity（BCVA） , introcular pressure, and complications at 1 day, 1 week, 1 month, 3 months after surgery. Results Follow-up （ 16.9 ± 7.2） mohths, BCVA and IOP were 0.25 ± 0.27 and （ 20. 1 ± 7.3 ） mmHg before Surgery. The IOP was respectively （16.3 ±9.2） mmHg, （12.3 ±4.2） mmHg, （14.8 ±5.2） mmHg, （15.1 ±3.1） mmHg, （14.8 ±2.7） mmHg and （14.5 ±2.8） mmHg at 1 day, 1 week, 1 month, 3 month, I year and last time after surgery. There were statistically difference in lOP between before surgery and every timepoint after surgery （P 〈 0.05）. The BCVA 0.74 ± 0.34 at 1 year after surgcry, showed significent defference with pro - surgery. Complications included temporary shallow anterior chamber （6.3 % of eyes）, transient cho- roidal detachment （11.6% ）. Postoperatively, 27.4% （26/95） of eyes required one or more medications for IOP control ; 41.1% （39/95） of eyes required additional 5-Fluorouracil （5-FU） injections （ average 3. 5 ±4.2 injections per eye）. 93.7% （89/95） of eyes achieved qualified success, while 66.3% （63/95） of eyes achieved complete success at 1 year after surgery. Conclusion Combined phacoemulsification and modified trabeculectomy could reduce the surgical trauma, shortern operation time. However, it still requires intensive observation in the early stage, with the use of antimetabolitis when necessary.