青光眼伴白内障双切口三联手术的效果观察

Clinical observation of triplex surgery for the treatment of glaucoma with cataract

目的探讨双切口小梁切除联合超声乳化人工晶状体植入三联手术治疗青光眼伴有白内障的效果。方法回顾性分析双切口小梁切除联合超声乳化人工晶状体植入三联手术治疗急慢性闭角型青光眼伴有白内障30例（34眼）的资料。分析术前术后视力、眼压、前房深度以及12点位、3点位、6点位、9点位4个方向的房角开放距离、前房角开放范围（度数）情况，以及术中、术后的并发症和术后滤过泡情况。术后随访6—12个月。结果术后1周矫正视力〉0．3者19眼（55．88％），明显高于术前者的5眼（14．71％），（t=5．942，P=0．015）。眼压由术前的（25．98±2．31）mmHg降为（13．98±4．29mmHg）（1mmHg=0．133kPa），（t=33．520，P=0．005）。并发症有角膜轻度水肿、虹膜出血以及前房及滤过泡均形成良好。术后的中央前房深度（t=33．542，P=0．000）、前房角开放距离（t=5．783，P=0．002）及前房角开放范围（度数）（t=5．747，P=0．000）均有明显增加。结论双切口三联手术治疗青光眼伴有白内障术后能较好控制眼压，并可提高视力。

Objective To investigate the clinical effects of double incision triplex operation of trab- eculectomy, phacoemulsification and intraocular lens implantation for treatment of glaucoma with cataract. Methods Retrospective analysis of double incision triplex operation in the treatment of acute and chronic angle closure glaucoma with cataract was done in 34 eyes of 30 cases. The items of analysis included preop- erative and postoperative visual acuity, intraocular pressure, anterior chamber depth （ACD）, angle opening distance （AOD） at 12 o＇ clock, 3 o＇ clock, 6 o＇ clock and 9 o＇ clock, extent of opening of anterior chamber angle, intraoperative and postoperative complications, and postoperative bleb formation. Postoperative follow- up was 6 - 12 months. Results Visual acuity was over 0.3 in 19 eyes （55.88%） in one week after the surgery,which was significantly higher than the preoperative one, （5 eyes, 14.71% ） （t = 5. 942, P = 0. 015 ）. The intraocular pressure reduced from （ 25.98 ± 2.31 ） mmHg preoperatively to （ 13.98 ± 4.29 ） mmHg postoperatively （t =33. 520, P =0.005） （ 1 mmHg =0. 133 kPa）. Complications were mild corneal edema, anterior chamber hemorrhage and iris, and intraocular lens surface fibrinous exudation. The bleb for- mation was good in all patients. Preoperative, postoperative central ACD （ t = 33. 542, P = 0. 000 ）, AOD （ t = 5. 783, P = 0. 002）, and anterior chamber angle opening degree （ t = 5. 747, P = 0. 000） were signifi- cantly increased. Conclusion Double incision triple operation for treatment of glaucoma with cataract sur- gery can improve visual acuity with good intraocular pressure controlling.