低角膜内皮细胞密度青光眼并白内障的“三联手术”效果分析

Analysis on the clinical effect of "the triple surgery" for patients of low density corneal endothelial cells associated with glaucoma and cataract

目的观察低角膜内皮细胞密度青光眼并白内障患者"三联手术"的疗效及安全性。方法选取笔者所在医院2010-05—2012-10低角膜内皮细胞密度(<1500/mm2)青光眼并白内障患者27例(27眼),行白内障超声乳化联合小梁切除人工晶状体植入术,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。分析角膜内皮保护因素。结果术前与术后3个月最佳矫正视力比较,除2例患者因视神经萎缩术后视力无明显改善外,余25例患者术后视力较术前均有明显提高;术前与术后3个月角膜内皮细胞密度比较,无统计学差异(P>0.05)。无角膜内皮失代偿发生。结论手术方式的选择、娴熟的手术技巧等因素可有效控制低角膜内皮细胞密度青光眼白内障患者"三联手术"中对角膜内皮细胞的损害,术前准确的评估及术后的处理也非常重要。

Objective To evaluate the clinical effect and feasibility of phacomulsification “triple surgery” for patients of low density corneal endothelial cells associated with glaucoma and cataract. Methods A total of 27 patients （27eyes） of low density corneal endothelial cells associated with glaucoma and cataract（〈1500/m㎡） underwent “the triple surgery” of phacoemulsification, trabeculectomy and intraocular lens （IOL） implantation. The visual acuity, IOP and density of corneal endothelial cells at preoperation were compared with that at postoperation. The factors influencing corneal endothelial cells in operation were analyzed. Results Compared with those later 3 monthes after surgery the postoperative visual acuity improved obviously in 25 eyes, and rest 2 eyes had no obvious improvement due to optical nerve atrophy. The corneal endothelial cell densities was observed preoperatively and postoperatively, and there was no statistical differences （P〉0.05）. No case was suffered from corneal endothelial cells decompensation. Conclusion Appropriate operative incision, rich experience of operator and his skillful surgery techniques are essential factors to decrease corneal endothelial cells injuries in these patients treated with the triple surgery. While the postoperative evaluation,surgery manner and postoperative management are also very important.