内镜下睫状体光凝联合白内障超声乳化手术治疗合并白内障的难治性青光眼的观察研究

Observation study on endoscopic cyclophotocoagulation combined with phacoemulsification in the treatment of refractory glaucoma and cataract

目的观察眼内窥镜下睫状体光凝术（endoscopic cyclophotocoagulation,ECP）联合白内障超声乳化吸除加人工晶体植入术（Phaco＋IOL）治疗合并白内障青光眼的疗效。方法应用E2激光内窥镜系统,对24例（28只眼）合并有白内障难治性青光眼患者进行ECP联合Phaco＋IOL治疗,比较术前和术后眼压、视力,观察术后前房炎症反应、人工晶体位置以及并发症等情况。术后随访6-12个月。结果 28只眼术前眼压21.3-63（37.69±13.41）mmHg,术后第6个月眼压7-29（14.36±4.98）mmHg,术前、术后眼压差异有统计学意义（P〈0.000 1）。术后6月后无需药物治疗而眼压≤21 mmHg者21眼（75.00%）,术后视力提高者19只眼（67.86%）。28只眼中有6只眼术后第1天出现眼压高,1周后仍有2只眼在未用降眼压药物的情况下眼压偏高。所有患者术后均未出现人工晶状体偏位或脱位、视网膜或脉络膜脱离、眼内炎、低眼压等并发症。结论内窥镜下睫状体光凝术联合白内障超声乳化吸除加人工晶体植入术能安全有效地治疗青光眼合并白内障。

Objective To evaluate the efficacy and safety of endoscopic cyclophotocoagulation（ ECP）combined with phacoemulsification and intraocular lens implantation（ Phaco ＋ IOL） treatment for patients with glaucoma and cataract. Methods 24 cases（ 28 eyes） underwent ECP united Phaco ＋ IOL by using E2 laser endoscope system. Intraocular pressure（ IOP）,visual acuity before and after operation were compared,and anterior chamber inflammation,and intraocular lens position and complications after operation were observed. All patients were followed-up for 6 to 12 months. Results The preoperative IOP（ 37. 69 ± 13. 41 mmHg） was significantly greater than the 6 months postoperative one（ 14. 36 ± 4. 98 mmHg）（ P 〈0. 0001）; during 6 months postoperative,21（ 75. 00%） eyes achieved an intraocular pressure of or = 21 mmHg,and 19（ 67. 86%） eyes received improved vision. Of all 28 eyes,6 eyes were of high IOP in1 day after surgery,and 1 week later,2 eyes＇ IOP still were of 21 mmHg or higher without using ocular hypotensive medication. No artificial lens deviation or dislocation, retinal or choroidal detachment,endoophthalmitis,or ocular hypotension occurred. Conclusions ECP united Phaco ＋ IOL is safe and effective as therapeutic modality for combined glaucoma and cataract.