高眼压下手法白内障摘出小梁切除联合手术的观察分析

Analysis of mannual cataract extraction combining with trabeculectomy under higher intraocular pressure.

目的探讨高眼压下白内障青光眼联合术的可行性和临床疗效。方法对21例(21眼)白内障青光眼并存者在高眼压下行手法小切口白内障囊外摘出人工晶状体植入联合小梁切除术,术后随访1-12月观察其疗效。结果所有患者术后眼压均比术前用降眼压药的情况下明显下降,平均(15.57±4.38)mmHg(P<0.01),其中18眼眼压<21mmHg,有3眼眼压在22-30mmHg。视力≤0.05者7眼,0.06-0.2者11眼,0.3-0.5者3眼。眼底检查所有患者视盘颜色均变淡,C/D>0.7,有8眼视神经已萎缩。并发症:术后前葡萄膜炎、人工晶状体表面渗出膜、角膜水肿、爆发性脉络膜出血等。结论在高眼压下行手法小切口白内障囊外摘出人工晶状体植入联合小梁切除术发生并发症的机会增多,但仍是较安全有效的手术。

Objective To discuss the feasibility and clinical effect of mannual cataract extraction combining with trabeculectomy under the higher intraocular pressure（IOP）. Methods 21 cases （21 eyes）of cafaract with glaucoma were. performed mannual small incision ECCE and Iols implantation compining with trabeculectomy under the higher IOP. All of the cases were followed up postoperatively for 1 to 12 months and observed the effect. Results IOP of all the cases decreased obviously than using drugs to reduce IOP preoperatively, average was 15.57 ± 4.38mmHg（ P 〈 0.01 ）. IOP of 18 eyes was under 21mmHg,3 eyes between 22 to 30mmHg,Vision was equal and less than 0.05 in seven eyes,0.06 ～ 0.2 in 11 eyes, 0.3 ～0.5 in 3 eyes. All of the cases had the light disc. C/D was bigger than 0.7. Complications were anterior uveitis, IOLs surface seepage membrane,cornea edema and expeditious choroidal hemorrhage,et al. Conclusions The surgery of mannual small incision ECCE and IOLs implantation compining with trabeculectomy under higher IOP increases the chance of complications,but is still salty, effective and feasible.