无缝线巩膜隧道瓣小梁切除联合白内障超声乳化摘除在人工晶体植入术中的应用

Clinical efficacies of scleral tunnel sutureless trabeculectomy plus phacoemulsification and intraocularlens implantation A

目的探讨无缝线巩膜隧道瓣小梁切除联合白内障超声乳化人工晶体植入术治疗青光眼合并白内障的临床疗效。方法选择深州市医院眼科2009年2月至2012年6月49例（52只眼）视力在0．3以下，眼压控制不理想或需要多种降眼压药物的青光眼合并自内障患者，采用Phaeo隧道刀做4mm×4mm巩膜隧道瓣，深度为1／2-2／3巩膜全层，超声乳化仪乳化吸除白内障，植入折叠式人工晶体，巩膜隧道瓣下行2mm×1．5mm小梁切除，巩膜瓣平铺不缝合，严密缝合结膜瓣。结果随访观察12个月，视力〉0．5者42只眼，占80．8％，眼压为11．32mmHg-17．63mmHg（1mmHg=0．133kPa），平均（13．59±4．26）AmHg，与术前的平均眼压（24．53±5．71）mmHg相比，经t检验差异具有统计学意义（t’11．073，P〈0．01），Ⅰ-Ⅱ型滤过泡43只眼，占82．6％，中央前房深度术前平均为（1．79±0．31）mm，术后平均深度为（3．28±0．42）mm，两者比较差异有统计学意义（t’=20．486，P〈0．01），角膜散光52只眼角膜平均散光度术前为（1．13±0．74）D，术后为（1．01±0．62）D，两者比较差异无统计学意义（F=2．0673，P〉0．05），全部病例均未发现严重并发症。结论该术式是对传统小梁切除术的改良和发展，也是对青光眼白内障“三联术”的更新，既降低了眼压，又提高了视力，还减少了并发症，是一种安全、合理、快速、有效地治疗青光眼合并白内障的手术方法。

Objection To explore the clinical efficacies of scleral tunnel sutureless trabeculectomy plus phacoemulsifieation and intraocular lens implantation in the treatment of glaucoma and cataract. Methods A total of 49 cataract patients with glaucoma （52 eyes ） from our hospital during the period of February 2009 to June 2012. Their visual acuities were 〈 0.3 and intraocular pressure was not desirable or in need of various ocular hypotensive drugs. A phaco tunnel knife was employed to prepare a 4 mm × 4 mm scleral tunnel flap with 1/2 - 2/3 whole layer of sclera depth. Phacoemulsification instrument was used to emulsify cataracts. Foldable intraocular lens was implanted. A trabecular cut of 2 mm× 1.5 mm was made under the scleral tunnel. Tile scleral flap was not sutured and conjunetival flap tightly closed. Results After a 12-month follow-up, 〉 0.5 in 42 eyes （80.8%）. The intraoeular pressure was 11.32 - 17.63 mm Hg （ 1 mm Hg =0. 133 kPa） and the mean intraocular pressure （ 13.59±4.26） mm Hg. There was a mean pressure reduction of 11.2 mm Hg from （24.53 ± 5.71 ）mm Hg pre-operation. Statistical significance existed （ t＇ = 11.073, P 〈0.01）. The filtering blebs of type I -ll was 43 eyes （82.6%） and the mean central anterior chamber 3.28 mm± 0.42 ram. There was statistical difference （ t＇ = 20. 486, P 〈 0.01 ） with （1.79 ± 0.31 ）mm at pre-operation. On 52 eyes, the mean postoperative astigmatism was （1.01 ± 0. 62 ） D versus （1.13 ± 0.74） D at pre-operation. There was no statistical significance （F = 2. 0673, P 〉 0. 05 ）. No severe complication occurred in all cases. Conclusion Compared with traditional trabeeulectomy and triple procedure, this improved and updated procedure lowers intraocular pressure, improves visual acuity and decreases the occurrences of complications. It is a safe, reasonable, quick and effective treatment for cataract patients with glaucoma.