曲安奈德在白内障超声乳化吸除联合小梁切除术中的应用

Clinical observation of triamcinolone acetonide in phacoemulsfication and trabeculectomy

目的 观察白内障超声乳化吸除联合小梁切除术中应用曲安奈德（TA）治疗青光眼合并白内障的术后效果.方法 青光眼合并白内障患者23例23只眼,眼压（25.17±2.18） mmHg（1 mmHg=0.133 kPa）,视力：＜0.1 9只眼（39.1％）,0.1～0.5 14只眼（60.9％）.施行白内障超声乳化吸除人工晶状体植入联合标准小梁切除术,手术结束时予前房注入少量TA,术后随诊12个月,观察患者眼压、视力及术后并发症情况.结果 1.术后6个月视力,＜0.1 5只眼（21.7％）,0.1～0.55只眼（21.7％）,＞0.5 13只眼（56.5％）;术后12个月视力,＜0.12只眼（8.7％）,0.1～0.55只眼（21.7％）,＞0.5 16只眼（69.6％）,均好于术前（P＜0.05）.2.术后6个月及术后12个月眼压分别为（17.25±2.76） mmHg、（15.69±2.89） mmHg,明显低于术前（P＜0.05）.3.术后浅前房8只眼（34.8％）,包扎3d后恢复.4.功能性滤过泡,术后6个月22只眼（95.7％）,术后12个月21只眼（91.3％）.结论 联合手术治疗青光眼合并白内障可以在降低眼压的同时恢复视力,术中应用TA有助于减轻术后反应及减少并发症.

OBJECTIVE To observe the clinical effect of anterior chamber injection of triamcinolone acetonide （TA） after the combined surgery of phacoemulsification and trabeculectomy treating glaucomatous cataract. METHODS The clinical data of 23 eyes （23 cases） whose intraocular pressure （IOP） was （25.17±2.18） mmHg and vision less than 0.1 （9 eyes, 39.1%）, 0.1～0.5 （ 14 eyes, 60.9%） underwent the combination surgery of pha- coemulsification and trabeculectomy with drop of TA were retrospectively reviewed and analyzed. During 12 months follow-up, IOP, eyesight and complications were observed. RESULTS 1.The visual acuity of 6 months after opera- tion were 〈0.1 （5 eyes, 21.7%）, 0.1～0.5 （5 eyes, 21.7%）, 〉0.5 （13 eyes, 56.5%）, while 12 months after surgery were 〈0.1 （2 eyes, 8.7%）, 0.1～0.5 （5 eyes, 21.7%）, 〉0.5 （16 eyes, 69.6%）. After operation, the numbers of eyes with improved visual acuity were significantly increased. 2.The IOP of 6 and 12 months after operation were decreased （ 17,25±2.76, 15.69±2.89 mmHg）. 3. The number of shallow anterior chamber after operation was 8, recover after 3 days therapy. 4. The number of functional filtering bleb after operation in 6 months was 22 （95.7%）, in 12 months was 21 （91.3）. CONCLUSIONS The surgery of phacoemulsification with intraocular lens implantation and trabeculectomy could reduce intraocular pressure and restore vision. TA could effectively reduce postoperative reaction and complications.