超声乳化联合内窥镜睫状体光凝术治疗青光眼合并白内障的临床效果

The preliminary efficacy of cataract phacoemulsification and aspiration combined endoscopic cyclo- photocoagulation in patients of glaucoma with cataract

目的观察超声乳化吸出人工晶状体植入联合眼内窥镜睫状突光凝术（三联手术）治疗晚期青光眼抗青光眼术后眼压失控合并白内障患者的疗效。方法晚期青光眼术后眼压失控合并白内障65例（66只眼）。均选取角膜缘切口进行三联手术。记录术后1d、3d、1周和末次随访的视力和眼压，炎症反应情况，记录术前术后使用降眼压药物的数量。记录术中和术后眼部并发症情况。结果术前在最大量降眼压药物的使用下，眼压平均（28．4±10．3）mmHg。术后末次随访的眼压为（15．2±4．1）mmHg（1mmHg=0．133kPa），眼压下降46．5％（F=112．96，P〈0．001）。术前视力范围无光感～0．5，术后末次随访视力提高者49眼（74．2％），视力不变者16眼（24．2％），视力轻度下降者1眼（1．5％）（P〈0．001）。术前局部用降眼压药物（3．58±0．84）种。末次随访局部使用降眼压药物（0．12±0．48）种（P〈0．001）。术中术后无严重并发症发生。结论此种三联手术作为一种晚期抗青光眼术后眼压失控的青光眼合并白内障的联合治疗手段是安全有效的。

Objective To assess the efficacy of cataract phacoemulsification and aspiration, in- traocular lens implantation combined with endoscopic cyelophotoeoagnlation in uncontrolled late stage glauco- ma after anti-glaucoma surgery combined with cataract. Methods Prospective case series. 66 eyes of 65 patients with uncontrolled glaucoma combined with cataract of Beijing Tongren Hospital during July 2010 and June 2012 underwent cataract phacoemulsification and aspiration and endoscopic cyclophotocoagulation. The preoperative visual acuity and intraocular pressure （IOP） were analyzed, as were the visual acuity and in- traocular pressure of 1 d, 3 d, 1 week and the last follow-up postoperation. The numbers of preoperative and postoperative anti-glaucoma agents were recorded. Complications during and after operation were recorded. Results The preoperative IOP was （ 28.4± 10.3 ） mm Hg （ 1 mm Hg = 0. 133 kPa） using maximum a- mount of anti-glaucoma agents while the IOP of last follow-up was （ 15.2 ±4.1 ） mm Hg. The reduction was 46.5% and there was statistical significance（ P 〈 0. 001 ）. The preoperative visual acuity was NLP- 0.5, The visual acnities of the last follow-up were improved in 49 eyes （74.2%） and 16 eyes （24.2%） re- mained the same as preoperative vision. One eye decreased slightly （from 0.04 to 0.02） （ 1.5% ）. There was statistical significance between preoperative and postoperative visual acuity（ P 〈 0. 001 ）. The number of preoperative local anti-glaucoma agents was 3.58 ± 0.84 while that of last follow-up was 0.12± 0.48. There was statistical significance （P 〈 0.001 ）. No choroidal detachment or expulsive haemorrhage occurred during operation. No hypotony, phthisis bulbi, endophthalmitis or macular edema occurred at the last follow-up.Conclusion Cataract phacoemulsification and aspiration combined with endoscopic cyclophotocoagulation to treat uncontrolled late stage glaucoma combined with cataract is effective and safe.