儿童抗青光眼联合晶状体摘除手术的远期疗效分析

Effectiveness of anti-Glaucoma Operation with extraction cataract in Childhood

目的评价儿童青光眼合并晶状体异常病例联合白内障摘除及抗青光眼手术的效果。方法对21例32眼青光眼合并晶状体异常的儿童进行了抗青光眼手术及晶状体摘除手术。其中同期手术13例21眼,设为A组,行小梁切开或/和小梁切除、白内障摘除、后囊环形撕囊及前部玻璃体切除术。8例11眼为无晶状体眼,设为B组做为对照组,行小梁切除术或联合小梁切开术。术后随访平均46m。结果术前检查：全部病例均具有光觉反应,能合作检查视力者为光感视力。眼压平均45.11mmHg,A组平均43.16mmHg,B组平均49.20mmHg。术中检查多数都伴有眼前节发育异常,包括：房角发育不良、晶状体囊膜异常,小球状晶状体继发晶状体半脱位等。术后情况：术后近期平均眼压为20.66mmHg,21眼（65.6%）眼压控制正常。A组平均眼压20.78mmHg,17眼（81.0%）眼压控制正常,4眼发生一过性瞳孔阻滞。B组平均眼压20.35mmHg,10眼（90.9%）眼压控制在正常范围。至随访末期平均眼压为20.65mmHg,20眼（62.5%）眼压得到控制;A组5眼（23.8%）有再次手术史,其中3眼为瞳孔阻滞,随访末期平均眼压为19.79mmHg;B组4眼（36.4%）有再次手术史,无瞳孔阻滞发生。随访末期平均眼压为23.23 mmHg。结论对先天性白内障合并青光眼的儿童可以实施青光眼白内障联合手术,其手术风险小,效果好,并发症少。

Objective To evaluate the effectiveness of extraction cataract combine anti-glaucoma surgery in childhood with congenital glaucoma and congenital abnormal lens.Methods This study comprised 32 eyes of 21 patients with congenital abnormal lens and glaucoma.There are 21 eyes of 13 patients in group A. They were performed the trabeculotomy, extraction cataract and posterior continuous curvilinear capsulorhexis. two of them were underwent trabeculectomy simultaneously. 11 eyes of 8 patients with aphakia in group B were performed the trabeculotomy and/or trabeculectomy.Mean follow-up was 46 months.Results The preoperative state：The mean intraocular pressure （IOP） was 45.11mmHg,which be 43.16mmHg in group A and 49. 20mmHg in group B.The lens capsules in 8 eyes （53.3%） were abnormal.Most of them,the dysplasia of anterior chamber angle were existence.After operation,the mean IOP in all cases was 20.66mmHg and the IOP of 21 eyes（65.6%）were controlled in normal.In group A, the mean IOP were 20.78mmHg and the IOP were controlled in 17eyes（81.0%）.In group B,the mean IOP were 20.35mmHg and the IOP were controlled in 10 eyes （90.9%）. In end of follow-up,the mean IOP in all cases was 20.65mmHg and the IOP of 20 eyes （62.2%） were controlled. 4 eyes required the secondary procedure because IOP couldn＇t be controlled.Other 3 eyes required a capsulotomy. Conclusions anti-glaucoma operation combine extraction cataract may be useful in management of childhood congenital cataract and glaucoma.