小梁切除联合超声乳化白内障吸除术治疗青光眼合并白内障

Trabeculectomy combined with phacoemulsification for treatment of glaucoma with cataract

目的观察小梁切除联合超声乳化白内障吸除术治疗青光眼合并白内障的临床疗效。方法回顾分析1999年4月～2004年9月收住我院资料完整的原发性闭角型、原发性开角型或继发性闭角型青光眼合并白内障患者82例(82只眼),行小梁切除联合超声乳化白内障吸除人工晶体植入术,记录手术前、后的视力和眼压,记录手术并发症和滤过泡情况。术后随访至少3个月。结果术后1周和3个月眼压分别为(10.51±5.13)和(11.12±5.13)mmHg,与术前眼压(35.66±13.52)mmHg比较,差异有非常显著性意义(P<0.001);术后1周与3个月眼压比较,差异无显著性意义(P>0.05);术后1周及3个月矫正视力较术前明显提高,与术前视力比较,差异有非常显著性意义(P<0.001);术后1周与3个月视力比较,差异亦有显著性意义(P<0.05)。术后无严重并发症发生。术后1周82只眼均有扁平弥散型滤过泡,但术后3个月滤过泡均缺如,仅2只眼眼压≥21mmHg。结论小梁切除联合超声乳化白内障吸除人工晶体植入术,可有效治疗青光眼合并白内障,手术安全、便捷。

Objective To evaluate the clinical effect of trabeculectomy combined with phacoemulsification for treatment of glaucoma with cataract. Methods This retrospective study included 82 cataract patients (82eyes) with primary angle-closure glaucoma or primary open-angle glaucoma or secondary angle-closure glaucoma, who underwent the combined surgery of trabeculectomy and phacoemulsification with posterior chamber intraocular lens implantation. Best-corrected visual acuity (BCVA)and intraocular pressure (IOP) of pre- and post-operation, postoperative bleb formation and postoperative complications were analyzed. All cases were followed up for over 3 months. Results The mean IOP of 82 eyes in 1 week and 3 months postoperation was (10.51±5.13)mmHg and (11.12±5.13)mmHg(1mmHg=0.133kPa), which were obviously lower than that of preoperation[(35.66±13.52)mmHg,t=15.77,14.60,P<0.001]. There was no obviously difference between the mean IOP of 1 week and 3 months postoperation. The postoperative BCVA was significantly improved (χ2=110.12,P<0.001), and there was significant difference between 1 week and 3 months postoperation (χ2=12.51,P=0.014). No severe postoperative complications were revealed in all of operated eyes. 1 week postoperatively, the filtering blebs of typeⅡ presented in all eyes, but all disappeared in 3 months postoperation. Only two eyes’ IOP was ≥21mmHg. Conclusion Trabeculectomy combined with phacoemulsification and posterior chamber intraocular lens implantation is a successful, safe and effective method for patients with glaucoma and cataract.