青光眼术后白内障超声乳化术中肝素处理人工晶状体植入的临床观察

Clinical study of implantation of heparin-surface-modified foldable intraocular lens in cataract after glaucoma surgery

目的观察青光眼术后白内障超声乳化吸除联合肝素表面处理折叠型人工晶状体植入术后对前房炎症反应的影响。方法对21例(34眼)青光眼术后白内障患者施行超声乳化吸除术,所有病例随机植入两种折叠型人工晶状体。应用裂隙灯检测测量并比较术前及术后1天、7天、30天及90天人工晶状体表面细胞沉积数,以评价前房炎症反应;并观察手术前后的视力、眼压及滤过泡和角膜内皮计数情况。结果术前二组患者房水闪辉值差异无统计学意义,植入肝素表面处理折叠型人工晶状体者,手术后7天内的人工晶状体表面细胞沉积数低于未经肝素处理组,而术后30天、90天时两种人工晶状体植入者之间差异无统计学意义。两组术后视力均明显提高,眼压控制稳定,角膜内皮功能正常。结论抗青光眼术后行白内障手术会使眼血-房水屏障功能受损,植入肝素表面处理折叠型人工晶状体能显著减轻白内障术后短期内的炎症反应,增加手术安全性。

OBJECTIVE To observe the inflammation in anterior chamber after phacoemulsification with implantation of 2 types of foldable intraocular lens （IOL） in cataract patients after glaucoma surgery. METHODS Phacoemulsification surgeries were performed in 34 eyes of 21 cataract patients after glaucoma surgery and heparin - surface - modified foldable IOL and single - piece acrylic UV block foldable IOL were implanted randomly. The aqueous humor flare value was examined preoperatively and on day 1,7,30 and 90 after surgery with a laser flare cell meter. Visual acuity （VA） ,filter bleb,intraocular pressure （IOP） and corneal endothelium were examined.RESULTS Before surgery,there was no significant difference between 2 groups. Flare was significantly lower in patients with implantation of heparin - sur- facemodified IOL on day 7 postoperatively than patients with implantation of no - heparin - surface - modified I- OL. There was no significant difference on day 30,90 postoperatively. VA, filter bleb and IOP were well in all patients postoperatively, and the counts of corneal endothelium were in normal range. CONCLUSIONS The blood- aqueous barrier was damaged in patients after glaucoma surgery. The inflammation in anterior chamber can be reduced with implan- tation of heparin - surface - modified IOL.