四联手术治疗难治性青光眼合并白内障疗效分析

Combined phacoemulsification, foldable intraocular lens implantation, trabeculectomy and drainage device implants for patients with cataract and primary angle closure glaucoma

目的 评价白内障超声乳化摘除折叠式人工晶状体（intraocular lens,IOL）植入联合小梁切除及青光眼引流器植入术（四联手术）治疗难治性青光眼合并白内障患者的安全性、有效性.方法 采用上方3.5mm常规巩膜切口对56例（68眼）白内障合并房角关闭患者行四联手术,并分别于术后1、3、6、12、24个月进行随访,观察所有患者眼压、滤过泡、房角、视力的变化情况.结果 随访期间各时点眼压均较术前显著降低,差异均有统计学意义（均P＜0.01）.术后24个月时形成Ⅰ、Ⅱ型滤过泡59眼（86.76%）,Ⅲ、Ⅳ型滤过泡9眼（13.24%）.术后房角粘连明显改善（P＜0.05）,≤90°者46眼（67.6%）.术后12、24个月患者矫正视力≥0.5者分别为45眼（66.2%）及52眼（76.5%）,均显著优于术前（P＜0.01）.结论 四联手术是治疗难治性青光眼合并白内障的一种有效、便捷、可重复和安全的联合手术,不仅能提高患者视力而且能有效地降低眼压,延长滤过泡功能,减少瘢痕形成,提高滤过性手术的成功率.

Objective TO evaluate the therapeutic effects and safety of combined phacoemulsification, foldable intraocular lens implantation, trabeculectomy and glaucoma drainage device implants （＂Tetra-combination surgery＂） for patients with cataract and primary angle closure glaucoma. Methods The tetra-combination surgery was performed through a 3.5 mm incision by means of conventional scleral flap on 68 eyes of 56 patients with cataract and primary angle closure glaucoma,after fol- low-up of 1, 3, 6, 12 and 24 months the changes of intraocular pressure （lOP）, filtering blebs, pre-operative PAS range and corrected vision of patients were observed. Results During the follow-up the mean intraocular pressure （lOP） was decreased after surgery （P〈 0.01）. The filtering blebs of type I and II by Kronfeld＇s classification presented in 86.76% of the eyes and type III and IV in 13.24% of the eyes. The pre-operative PAS range degree reduced to ≤90° （P〈 0.05）in 46 eyes （67.6%）. After follow-up for 12 and 24 months the corrected vision was ≥0.5 in 45 eyes （66.2%） and 52 eyes （76.5%） respectively. Conclusion The te- tra-combination surgery is an effective, quick, repeatable and safe procedure for patients with cataract and intractable glaucoma. The surgery can not only increase the vision but also reduce the intraocular pressure （lOP） effectively, prolong the function of filtering blebs, increase the rate of success of filtering operation.