巩膜下小梁咬切、白内障超声乳化、人工晶状体植入三联术65例临床分析

Phacoemulsification combined with trabeculectomy and intraocular lens implantation in 65 cases of glaucoma with cataract

目的:观察巩膜下小梁咬切联合白内障超声乳化及人工晶状体植入三联术治疗青光眼并发白内障的临床治疗效果。方法:对我院眼科1999-04/2003-04施行三联术的65例(65眼),随访3～48mo,比较手术前后眼压、视力及并发症发生的情况。结果:术前最佳矫正视力:光感/5m～0.6,眼压22～65(平均36.3)mmHg。术后最佳矫正视力:0.1～1.2,不用药或局部用一种β受体阻滞剂眼压在8～22(平均16.8)mmHg。术后角膜水肿7例,纤维素性渗出5例,前房出血2例,所有术后并发症均获治愈。结论:三联手术对白内障、青光眼治疗效果良好,术后无不良反应,是治疗青光眼并发白内障患者的首选方法。前囊连续环行撕囊,囊袋内拦截劈核法碎核及高负压低能量完成白内障摘除手术,人工晶状体囊袋内植入是取得良好手术效果的有力保证。

AIM: To evaluate the effectiveness of phacoemulsification combined with trabeculectomy (phaco trabeculectomy) and intraocular lens (IOL) implantation in treating glaucoma patients with cataract.· METHODS: A total of 65 eyes of 65 patients undergone phaco trabeculectomy with IOL implantation from April 1999 to April 2003 were followed up for 26mo on average(4-48mo).The intraocular pressure (IOP) and visual acuity before and after operation were compared, and the complications were analyzed. · RESULTS: The average IOP was 36.3mmHg (22-65mmHg) with maximum anti-glaucoma therapy and 16.8mmHg (8-22mmHg) with or without only one kind of local β-blocker therapy before and after operation respectively. The best corrected visual acuity was HM to 0.6 and 0.1 to 1.2 respectively. All complications after operation were cured, including corneal edema in 7 cases, fibrous exudation in 5 cases and hyphema in 2 cases.· CONCLUSION: Combining phaco trabeculectomy with IOL implantation can achieve good results in proper glaucoma patients with cataract, thus could be considered the primary method, with continual circular anterior capsular hexis, phacoemulsification in the capsular bag with high vacuum and lower power, and IOL fixation in the capsular bag as the guarantee of a satisfactory outcome.