青光眼术后低角膜内皮细胞密度白内障手术26例临床分析

Clinical analysis of cataract surgery with low corneal endothelial cell density after glaucoma surgery of 26 cases

目的观察抗青光眼小梁切除术后低角膜内皮细胞密度白内障患者行巩膜隧道小切口摘出联合肝素修饰人工晶状体植入术的疗效及并发症。方法选取我院抗青光眼小梁切除术后低角膜内皮细胞密度白内障患者22例(26眼),行巩膜隧道小切口白内障摘出联合肝素修饰人工晶状体植入术,对比观察术前与术后视力、眼压、角膜内皮细胞密度及术后并发症。结果术前与术后3个月矫正视力比较,除1眼患者术后因视神经萎缩明显、视力无明显改善外,余25眼患者术后视力较术前均有不同程度的提高;术前角膜内皮细胞密度(946～520mm-2)与术后3个月(920～499mm-2)比较,差异无统计学意义(P>0.05)。术后3d有2眼出现一过性高眼压,1周后恢复;术后1个月黄斑囊样水肿1眼,2个月后消失;术后3个月视力下降1眼,为视神经萎缩引起。术后随访期间未见角膜内皮失代偿、虹膜粘连、后囊膜破裂等严重并发症发生。结论抗青光眼小梁切除术后低角膜内皮细胞密度白内障患者行巩膜隧道小切口白内障摘出联合肝素修饰人工晶状体植入术是安全、有效的,但术前评估、手术技巧及术后处理是非常重要的。

Objective To observe the complications and clinical effects of cataract extraction with small scleral tunnel incision and heparin surface modified intraocular lens（IOL） implantation for cataract patient with low corneal endothelial cell density after trabeculectomy for glaucoma.Methods The cataract extraction with small scleral tunnel incision and heparin surface modified IOL implantation was performed in of 22 cataract patients（26 eyes） with low corneal endothelial cell density after trabeculectomy for glaucoma.The preoperative and postoperative visual acuity,intraocular pressure and corneal endothelial cell density were measured and compared.The postoperative complications were also observed.Results Compared with preoperative the visual acuity,the postoperative visual acuity improved in 25 eyes at 3 months,only 1 eye had no obvious improvement due to optical nerve atrophy.The preoperative and postoperative corneal endothelial cell density were from 520 mm-2 to 946 mm-2 and from 499 mm-2 to 920 mm-2,respectively,there was no statistical difference（P〉0.05）.The temporary high intraocular pressure was observed in 2 eyes at postoperative 3 days,and recovered after 1 week.The cystoid macular edema appeared in 1 eye at postoperative 1 month,and disappeared after 2 months.There was no serious complications,such as corneal endothelial decompensation,iris adhesions,posterior capsule rupture,et al.Conclusion The cataract extraction with small scleral tunnel incision and heparin surface modified IOL implantation for cataract patient with low corneal endothelial cell density after trabeculectomy for glaucoma is safe and effective,but the postoperative evaluation,surgery manner and postoperative treatment are very important.