超声乳化联合复合式小梁切除术治疗青光眼合并白内障的临床研究

Clinical effect of phacoemulsification combined with trabeculectomy in glancoma patients

目的观察超声乳化联合小梁切除术，术中应用丝裂霉素（MMC）及经角膜的调整缝线治疗青光眼合并白内障的临床效果。方法69例（72眼）术中做以角膜缘为基底的结膜瓣，再以角膜缘为基底做5mm×4mm 1／2板层厚巩膜瓣，0．2—0．4mg／ml MMC棉片置于结膜和巩膜瓣下3—5min，再以大量BSS冲洗，继之进行超声乳化及人工晶体植入术，切除小梁2mm×2．5mm，剪除周边虹膜少许。巩膜瓣顶端间断缝合2针，侧面缝经角膜的调整缝线。间断缝合Tenon’s囊，结膜连续缝合。结果平均随访（7．36±4．64）个月，术后视力提高者46眼（63．89％），不变19眼（26．39％），下降7眼（9．27％）。术前平均眼压（28．67±10．69）／mm Hg（1mm Hg=0．133KPa）。术后随访期末眼压21mmHg以下66眼（91．67％），功能性滤过泡91．67％，非功能滤过泡6眼（8．33％）。并发症包括角膜水肿，浅前房、前房渗出等。结论超声乳化联合小梁切除及术中应用丝裂霉素、调整缝线是治疗青光眼合并白内障的有效方法。

Objective To observe the clinical effects of phacomulsification. IOL implantation combined with trabeculectomy, MMC and transcornea adjustable suture in glaucoma. Methods 69 patients （ 72 eyes ） were treated, reading conjunctive petal base in fomix madng scleral flap 5 mm ×4 mm, base in limbus corneae, setting 0. 2 - 0. 4 mg/ml MMC cotton disk under conjunctive petal and sclera petal, stopping 3 - 5 min, washing with normal saline then phacoemulsification . IOL trabeculectomy implantation trabeculectomy and transcornea adiustale suture. Results The mean follow up time was 7.36±4. 64 months. Best corrected visual acuity improved in 46 eyes（63.89% ） of the patients,fixed in 9 eyes（26. 39% ） ,dropped in 7 eyes （9. 72% ）. Preoperative IOP was 28.67 ±10. 69 mm Hg. Final IOP of 66 eyes（91.67% ） were controlled （ 〈21 mm Hg）. The rate of functional fitering bled was 91.67%. unfunctional bleb was 8. 33%, complication included correal edema shallow anterior chamber, effusion in anterior chamber in early postoperative days. Conclusion Phacoemulsification combined with trabeculectomy and adjustable suture in glaucoma patients was effective method to treat patients of glaucoma and cataract.