高眼压下青光眼白内障联合术中前房注射曲安奈德观察

Clinical observation of injecting triamcinolone acetonide into anterior chamber after the combination surgery of cataract extraction and trabeculectomy under high intraocular pressure

目的观察在高眼压下行小切口白内障囊外摘除人工晶状体植入联合小梁切除术（简称青白联合术）中前房注射曲安奈德（TA）的有效性和安全性。方法临床病例对照研究。对2009年1月至2012年10月在肇庆医学高等专科学校收集行青白联合术且术前眼压控制不良患者46例（46只眼），按入院时间随机分为二组：实验组（TA组）28例（28只眼）术毕前给以前房内注射曲安奈德混悬液1mg（0．025m1）；对照组18例（18只眼）术毕给以球结膜下注射地塞米松2mg（0．4ml）。观察比较两组术后第1、3、7天前房反应、眼压及角膜内皮水肿情况。结果术后第1、3、7天前房反应（r值分别为10．97、16．02、7．94）以及眼压（t值分别为3．08、2．78、3．02）实验组明显低于对照组，差异有统计学意义（P〈0．05）。角膜内皮水肿情况实验组与对照组比较两者差异无统计学意义（χ2值分别为2．49、0．11、0．84，P〉0．05）。结论TA抑制高眼压下青白联合术后前房炎症反应效果明显，并且能有效控制术后眼压，对角膜内皮无明显影响，提高了手术成功率。

Objective To observe the efficacy and safety of injecting triamcinolone acetonide （TA） into the anterior chamber after trabeculectomy combined with cataract extraction and intraocular lens implantation through small tunnel incision under high intraocular pressure. Methods Forty-six cases （46 eyes） with glaucoma and cataract under high intraocular pressure underwent the combination surgery of cataract extraction and trabeculectomy. All cases were randomly divided into two groups： experimental group （TA group）, 28 cases （28 eyes）, received anterior chamber injections of TA lmg （0.025ml） after the combination surgery of cataract extraction and trabeculectomy; control group, 18 cases （18 eyes） received subconjunctival injection of dexamethasone 2.5mg after operation. Anterior chamber exudation, intraocular pressure, and the edema of corneal endothelial were observed at 1 day, 3 days, 7 days after operation. Results Anterior chamber exudation and intraocular pressure in experimental group were less than that of control group （P 〈0.05） and the edema of corneal endothelial was no statistical difference between the two groups at 1 day, 3 days, 7 days after operation. Conclusions TA is effect to decrease anterior chamber exudation and for cases with glaucoma and cataract under high intraocular pressure underwent the combination surgery of cataract extraction and anti-glaucoma, and after operation at the same time. Injecting TA into the anterior chamber in trabeculectomy with cataract surgery can significantly reduce the postoperative anterior chamber reaction and control the intraocular pressure of postoperative and not affect the corneal endotheliurn, it can effectively improve the success rate of surgery.