M形切口白内障摘除联合小梁切除术治疗青光眼合并白内障的疗效观察

M-incision extraction of cataract combined with intraocular lens implantation and trabeculectomy

目的评价M形切口白内障摘除人工晶体植入联合小梁切除术(三联手术)治疗青光眼合并白内障的安全性及有效性,并比较M形和超声乳化两种切口三联手术的临床疗效。方法按不同术式将40例(43只眼)拟行白内障摘除人工晶体植入联合小梁切除手术的患者,分为M形切口组25只眼和超声乳化组18只眼。术后随访15～37个月。结果术前平均眼压M组(25.3±9.8)mmHg,超声乳化组(25.7±9.5)mmHg,术后随访最终平均眼压M组(15.53±5.3)mmHg,超声乳化组(15.01±3.2)mmHg。术后随访最终矫正视力范围0.1～1.2,2组≥0.5者分别为15只眼(60%)及12只眼(66%),术后平均散光度M组(0.89±0.31)D,超声乳化组(0.78±0.5)D。2组术后平均眼压下降、视力及散光度数均无显著性差异(P>0.05)。结论M形小切口与超声乳化三联手术治疗青光眼合并白内障,均具有恢复有用视力、较好的降低眼压、并发症少等作用,2种术式结果则基本相同。

Objective To evaluate the thexapeutic effects and safety of the combined M-incision eatmact extraction, intraocular lens implantation and trabeculectomy （triple procedure） and compare the outcomes of the operation with two different small incision , M shape and phacemulsification. Methods Forty patients （43 eyes） with coexisting glaucoma and cataract underwent triple procedure. M-small incision approach was performed on 25 eyes, and phacoemulsification approach, on 18 eyes. The mean follow-up time was 15 - 37 montks. Results The mean preoperative intraocular pressure （IOP） in M group was （25.3 ± 9.8）mmHg （ 1 mmHg = 0.133 kPa）, phacoemulsification group was （25.7 ± 9.5）mmHg. The mean postoperative IOP in the M group was （15.53 ± 5.3）mmHg, phaeoemulsification group was （15.01 ± 3.2） mmHg.After operation, the visual acuities of the two groups were 30.5 in 15 eyes （60%） and in 12 eyes （66%） respectively,The mean magnitude of astigmatism was（ 0.89 ± 0.31 ）D in M group, and （0.78 ± 0.5） D in phacoemulisification group; There were no statistical differences for the postoperative outcomes of IOP, visual acuity, astignatism and filtering bleb between two groups （ P 〉 0.05）.Conclusion M small-incision combined with phacoemulsification triple operation is effective in treating patients with glaucoma complicated with cataract, improving the visual acuity rapidly and reducing intraocular pressure,with less postoperative complications.