膨胀期白内障继发性青光眼的治疗

A study on the treatment of secondary glaucoma due to intumescent senile cataract

目的 探讨膨胀期白内障继发性青光眼的手术治疗方法。方法 选择老年性白内障膨胀期继发性青光眼的入院患者 47例 (4 9只眼 ) ,对其中 2 8例 (30只眼 )施行 4类不同方式的手术 :(1)虹膜周边切除联合囊外白内障摘除术 (extracapsularextractionofcataract,ECCE)及人工晶状体植入术(intraocularlens,IOL) (ECCE +IOL) ;(2 )虹膜节段性切除联合ECCE +IOL ;(3)小梁切除联合ECCE +IOL ;(4 )五联手术 ,即后巩膜环钻 +睫状体剥离 +抽取玻璃体囊腔积液 +ECCE +IOL。结果 矫正视力进步者 2 8只眼 ;无进步者 2只眼 ,均为视神经萎缩者。眼压正常者 18只眼 ,12只眼需局部滴用降眼压药后方可控制眼压。结论 大多数膨胀期白内障继发性青光眼患者可通过虹膜切除或小梁切除联合ECCE +IOL治愈。对发病时间长、用药后眼压未控制、晶状体膨胀合并无前房的青光眼患者施行五联手术 ,可取得满意效果。

Objective To discuss surgical methods of treating secondary glaucoma due to intumescent senile cataract. Methods Of 47 inpatient cases (49 eyes) who suffered from secondary glaucoma due to intumescent senile cataract, 28 cases (30 eyes) had been performed the following four different types of operation: (1) extracapsular cataract extraction (ECCE) and posterior chamber intraocular lens (PC IOL) implantation with peripheral iridectomy, (2) ECCE and PC IOL implantation with segmental iridectomy, (3) ECCE and PC IOL implantation with trabeculectomy, and (4) five combined operation including scleral trephination, cyclodialysis, vitreous paracentesis, ECCE and PC IOL implantation. Results The corrected visual acuities in 28 eyes had improved, whereas that in 2 eyes did not improve because of optic nerve atrophy. All the intraocular pressure in 30 eyes was within normal limit, including 12 eyes topically using antiglaucoma drugs. Conclusion Most of patients with secondary glaucoma due to intumescent senile cataract can be cured surgically by iridectomy or trabeculectomy combined with ECCE and PC IOL implantation. The five combined operation is an effective way to treat difficult cases such as long term disease course, result with antiglaucoma drugs not satisfactory and swelling lens with flat anterior chamber.