超声乳化吸出联合小梁切除术治疗青光眼合并白内障

Phacotrabeculectomy for glaucoma with cataract

目的评价晶状体超声乳化吸出折叠式人工晶状体植入联合小梁切除术的效果和安全性以及手术技术的进步。方法对47例（53眼）青光眼合并白内障手术进行回顾性临床分析。随访12-18个月。手术技术的改进包括抗代谢药物的使用；双切口法；可调节缝线及以穹隆为基底的结膜瓣等4方面。结果53眼中49眼（92．45％）眼压控制在21mmHg以下（1mmHg=0．133kPa），其中28眼（52．83％）在15mmHg以下。眼压由术前平均（25．17±3．70）mrnHg降至术后（16．79±2．78）mmHg，（t=21．60，P=0．000）；使用抗青光眼药物由术前平均（1．89±0．49,）种减少到术后仅8眼（15．09％）需1种。39眼（73．58％）获得≥0．5校正视力，术后视力较术前明显提高（z=-5．845，P〈0．001）。术后早期发生纤维素性葡萄膜炎9眼，浅前房2眼，低眼压黄斑水肿2眼，脉络膜脱离1眼。结论超声乳化白内障吸出人工晶状体植入联合小梁切除术可以在降低眼压的同时恢复视力，减少抗青光眼药物的使用。改良的联合手术技术提高了效果和安全性。

Objective To evaluate the therapeutic effects, safety and surgical improvements of phacotrabeculectomy and intraoeular lens implantation by the same surgeon. Methods In this retrospective study, 53 eyes of 47 patients with glaucoma and cataract accepted phacotrabeculectomy and intraocular lens implantation between Jan 2003 and Oct 2006 in our hospital . Pre-and post-operation intraocular pressure （IOP）、 glaucoma medications, bestspectacle-corrected visual acuity（BSCVA） and visual field,postoperative complications were analyzed. All cases were followed up for 12 -18 months, the average is 16.7months, Surgical improvements include ： （ 1 ） use of MMC and 5-FU ; （2） 2-site Phacotrabeculectomy; （3） adjustable suture; （4） fornix-based flap. Results Over a mean 16.7month follow-up, 49 of the 53 eyes （92.45%） achieved intraocular pressure （lOP） control （ 〈21 mm Hg） with or without medication. 28 eyes（52.83% ） had an lOP of 15 mm Hg or lower. The lOP decreased from a preoperative mean of （25.17 ± 3.70） mmHg on a mean number of （ 1.89 ± 0.49） glaucoma medications to a mean of （ 16.79 ± 2.78 ） mmHg at the final follow-up for IOP decrease and only 8 eyes （ 15.09% ） left using 1 kind of glaucoma medication. There was statistically significant difference between Pre-and post-operation lOP （ t = 21.60, P 〈 0. 000 ） . 39eyes （ 73.58 % ） obtained a best spectacle-corrected visual acuity of 0. 5 or better. The improvement in BSCVA was statistically significant difference at final visits compared with the preoperative level（z = - 5 . 845, P 〈 0. 001 ）. Post-operation 2 eyes （3.77%） shallow anterior chamber, 3eyes （5.66%） cystoid maeular edema, leye （ 1. 89% ） choroidal detachment. Conclu. sions Phacotrabeeulectomy is effective at restoring visual acuity, lowering lOP , reducing glaucoma medication and reduce the postoperative complication rate. Surgical improvements increase the safety and efficacy of Phacotrabeculectomy.