1.8mm微切口白内障超声乳化吸除联合青光眼小梁切除术临床观察

Clinical research of 1. 8mm microincision phacoemulsification and intraocular lens implantation combined with trabeculectomy

目的:观察同轴1.8mm微切口白内障超声乳化吸除超薄人工晶状体植入联合小梁切除术治疗青光眼合并白内障的临床疗效和安全性,并与传统的同轴3.0mm小切口超声乳化吸除折叠人工晶状体植入联合小梁切除术进行比较。方法:前瞻性对照研究。收集在我院眼科行超声乳化白内障手术的青光眼合并白内障患者36例36眼随机分为2组。微切口组:同轴1.8mm微切口白内障超声乳化吸除超薄人工晶状体植入联合小梁切除手术18例18眼:小切口组:传统同轴3.0mm小切口超声乳化吸除折叠人工晶状体植入联合小梁切除术18例18眼。分别记录两组1wk;1,3mo的视力、角膜内皮细胞密度、手术源性散光、眼压、滤过泡的形成和并发症的情况。采用均数t检验和χ2检验对数据进行统计学分析。结果:术后1wk微切口组裸眼视力优于小切口组,差异有统计学意义(P<0.05)。术后1,3mo两组矫正视力差异无统计学意义(P>0.05)。术后1wk;1,3mo两组手术源性散光差异有统计学意义(P<0.05)。术后1wk两组角膜内皮细胞密度差异有统计学意义(P<0.05)。术后1,3mo两组角膜内皮细胞密度差异无统计学意义(P>0.05)。术后微切口组平均眼压15.26±3.12mm Hg,小切口组平均眼压14.57±2.86mm Hg,两组术后眼压差异无统计学意义(P>0.05),两组术后功能型滤过泡和非功能型滤过泡比较,差异无统计学意义(P>0.05)。两组术中均未出现虹膜损伤、后囊膜破裂、前房出血等并发症。结论:同轴1.8mm微切口白内障超声乳化吸除超薄人工晶状体植入联合小梁切除术与传统同轴3.0mm小切口超声乳化吸除植入折叠人工晶状体联合小梁切除术相比,能有效减少手术源性散光,是一种安全、有效、便捷的治疗白内障合并青光眼的手术方法。

AIM：To evaluate the effect and safety of 1. 8mm coaxial microincision phacoemulsification - trabeculetomy with ultra-thin intraocular lens （ IOL ） implants for treating glaucoma complicated with cataract, and to compare with the traditional 3. 0mm small phacoemulsification-trabeculetomy with foldable IOL implantion. METHODS： In this prospective study, 36 patients （ 36 eyes） with glaucoma and cataract in lnner Mongolia Autonomous Regian People’s Hospital were collected and randomly divided into 2 groups. For the small incision group： 18 cases （ 18 eyes ） underwent 3. 0mm coaxial incision phacoemulsification-trabeculetomy with foldable IOL implantion; ln th microincision group： 18 cases （ 18 eyes ） underwent 1. 8mm microincision phacoemulsification-trabeculetomy with ultra-thin IOL implantion. The two groups were recorded for 1wk, 1 and 3mo of visual acuity, corneal endothelial cell density, surgically induced astigmatism, intraocularpressure （ IOP ） , filtering bleb and complications. Pearson’s Chi-square test ande t-test were used to determine differences between the two groups. RESULTS：At 1wk postoperatively, visual acuity in the microincision group was better than that of small incision group, the difference was statistically significant （ P〈0. 05）. At 1 and 3mo, the difference in corrected visual acuity between the 2 groups had no significant difference （P〉0. 05）. At 1wk, 1 and 3mo, there was a significant different between the 2 groups in surgically induced astigmetism （P〈0. 05）. At 1wk postoperatively, there was a significant difference in corneal endothelial cells density between 2 groups （P〈0. 05）. But there were no significant difference at 1 and 3mo （ P 〉 0. 05 ）. IOP reduced after surgy （ microincision group： 15. 26 ±3. 12mmHg, small incision group： 14. 57±2. 86mmHg）, there was no significant difference between the 2 groups （P〉0.05）. There was no significant different between the 2 groups in blebs （P〉0. 05）. Neither iris injury, posterior capsule rupture nor anterior chamber bleeding complications was found in any groups. CONCLUSION： TBy compared with traditional 3. 0mm coaxial small incision phacoemulsification -trabeculectomy with foldable IOL implantion, 1. 8mm microincision phacoemulsification-trabeculectomy withe ultrathin IOL implantion can effectively reduce the astigmatism operation. This operation is safe, effective, convenient surgy for treating cataract and glaucoma.