青光眼白内障联合手术中晶状体前囊膜的应用

Application of anterior lens capsule in combined glaucoma and cataract surgery

目的:探讨青光眼白内障联合手术中晶状体前囊膜应用效果。方法:对23例25眼青光眼合并白内障患者行小梁切除白内障超声乳化联合折叠式人工晶状体植入,术中环形撕自体前囊膜用BSS液反复冲洗后衬垫在巩膜瓣下。主要观察患者术后1d;1,3wk;1,6mo的眼压、视力,另外记录视野、滤过泡及术后并发症情况。结果:患者术后1d;1,3wk;1,6mo的平均眼压分别为18.3±1.5,17.32±0.82,15.71±0.71,16.17±0.52,16.87±0.71mmHg(1kPa=7.5mmHg),与术前45.16±4.41mmHg比较,差异有统计学意义(均为P<0.05)。术前平均视力为0.12±0.08,术后2mo为0.1以下者2眼(8%),0.1～0.2者3眼(12%),0.3～0.6者13眼(52%),0.8～1.2者7眼(28%),术后视力较术前明显提高,差异均有统计学意义(P<0.05),术前、术后平均视野缺损值与平均标准值差异无统计学意义(均为P>0.05)。术后形成功能性滤过泡23眼(92%),非功能性2眼(8%)。术中出现晶状体后囊膜破裂1眼,未出现玻璃体脱出等其他并发症。结论:晶状体前囊膜应用于青光眼白内障联合手术中可有效降低眼压,长期有效保留功能性滤过泡改善视力,且成功率高,无明显的并发症,联合性手术又能减少患者经济负担。

AIM：To explore application results of anterior lens capsule in combined glaucoma and cataract surgery . METHODS：Twenty-three cases（25 eyes）of glaucoma complicated cataract underwent trabeculectomy, phacoemulsification and foldable intraocular lens implantation surgery. The curvilinear autologous anterior capsule was placed under the scleral flap after repeated washing with BSS liquid intraoperatively. Intraocular pressure and visual acuity were mainly observed in patients 1 day, 1 week, 3 weeks, 1 month and 6 months after operation and field of vision, filtering bleb and complications were recorded. RESULTS： The average IOPs of 1 day, 1 week, 3 weeks, 1 month and 6 months after operation were 18.3±1.5,17.32±0.82,15.71±0.71,16.17±0.52,16.87±0.71mmHg （1kPa=7.5mmHg） respectively, compared with the preoperative （45.16±4.41） mmHg, the differences were statistically significant （all P0.05）. The mean preoperative visual acuity was 0.12±0.08, 2 months after operation ,the visual acuity was below 0.1 in 2 eyes （8%）, 0.1 to 0.2 in 3 eyes （12%）, 0.3-0.6 in 13 eyes （52%）, 0.8 to 1.2 in 7 eyes （28%）, postoperative visual acuity improved significantly, the differences were statistically significant （all P0.05）. Preoperative and postoperative mean visual field defect value and the average standard value of the difference were not statistically significant （all P0.05）. After operation, functional bleb formed in 23 eyes, accounting for 92%,non-functional bleb in 2 eyes, accounting for 8%. Intraoperative posterior capsular rupture occurred in 1 eye, no vitreous prolapse and other complications occurred. CONCLUSION：Anterior lens capsule used in combined glaucoma and cataract surgery can effectively reduce intraocular pressure with long-term and effective retention of functional bleb to improve vision, the success rate is high with no significant complications, and patients with combined surgery can reduce the economic burden.