交错进行的白内障摘出联合人工晶状体植入及角膜移植术的临床观察

Clinical observation on the interlaced non-phacoemulsification cataract extraction combined with intraocular lens implantation and keratoplasty

目的观察交错进行的小切口非超声乳化白内障摘出联合人工晶状体植入及穿透性角膜移植术（交错三联手术）的临床疗效。 方法回顾性分析白内障合并角膜病浑浊进行交错三联手术12例（12只眼）。其中外伤性角膜白斑9例，带状角膜病变、病毒性角膜炎及真菌性角膜炎后遗留角膜斑翳各1例。手术方法：角膜环钻钻切2/3角膜厚度，做巩膜隧道切口、撕囊、娩核、钻透角膜，完成角膜移植术，清除晶状体皮质，植入人工晶状体。术后随访1～3年，观察术后视力、角膜透明度及并发症。 结果术后11例（91.7%）裸眼视力较术前提高。术后2周，所有角膜全部透明；术后1年，9例透明，1例半透明，2例浑浊，总透明率75.0%。术后并发症有青光眼1例，行小梁切除术后眼压正常；后发性白内障1例，行YAG激光治疗后视力提高；发生排斥2例，经抗排斥治疗后排斥控制，但角膜浑浊。 结论交错三联手术与传统三联术及分期手术相比，术后并发症较少，安全性较高。

Objective To observe the efficacy of the interlaced non-phacoemulsification catatract extraction combined with intraoeular lens implantation and keratoplasty （interlaced triple procedure ）. Methods Twelve eyes of 12 cases with cataract and keratonosus underwent the interlaced triple procedure. Nine cases of traumatic corneal leucom, 1 case of corneal degeneration, 1 case of viral keratitis and 1 case of fungal keratitis were collected. Surgery procedure： two-thirds thickness of corneal was trephined, then the scleral tunnel incision, capsulorhexis and delivery of nuclear were done. Then the cornea was trephined through and keratoplasty was completed. Finally, lens cortex was cleared and intraocular lens was implanted. Followed-up time was 1 - 3 years. The visual acuity, transparency and complications were observed. Results The uncorrected visual acuity of ll eyes（91.7% ） were improved compared with that of the preoperative. All the corneal grafts were completely transparent after operation in 2 weeks. Corneal grafts completely transparent after operation 1 year was in 9 cases. Corneal grafts of 1 case was semitransparent and 2 cases were moderately turbid. The total transparency rate was 75.00%. The complication was glaucoma in 1 case, and IOP was normal after trabeculectomy. The posterior capsule opacification occurred in 1 case, and the treatment was YAG laser. Two cases happened rejection. The rejection was controlled after anti-rejection therapy, and the corneal was opacity. Conclusion Triple procedure compared to the traditional triple procedure and staging surgery ,the interlaced triple procedure can decrease postoperative complication and is high safety.