小梁切除术联合白内障超声乳化及人工晶体植入术治疗青光眼合并白内障临床疗效观察

The Effect of Combined Phacoemulsification and Trabeculectomy with Intraocular Lens Implantation in Treating Glaucoma Patients with Cataract

目的 观察小梁切除术联合白内障超声乳化及人工晶体植入术 (三联术 )治疗青光眼合并白内障的临床治疗效果。方法 对同济医院眼科 1999年 1月～ 2 0 0 1年 4月施行三联术的 2 6例 2 7眼 ,随访 3～ 12个月 ,比较术前术后眼压、视力及并发症发生的情况。结果 术前最佳矫正视力 :手动 ( HM) /眼前～ 0 .6,眼压 2 2～ 65 mm Hg,平均 3 6.3m m Hg。术后最佳矫正视力 :0 .1～ 1.2 ,不用药或局部用一种 β受体阻滞剂眼压在 8～ 2 2 mm Hg,平均 16.8m m Hg。术后角膜水肿 7例 ,纤维素性渗出 5例 ,前房出血 2例 ,所有术后并发症均获治愈。结论 选择适当的病例施行三联术可获得较好疗效。前囊连续环行撕囊 ,囊袋内拦截劈核法碎核及高负压低能量完成白内障摘除手术 。

Objective To observe the effectiveness of combined phacoemulsification and trabeculectomy (phacotrabeculectomy) with intraocular lens (IOL) implantation in treating glaucoma patients with cataract.Methods 27 eyes of 26 patients undergoing phacotrabeculectomy with IOL implantation during Jan. 1999 to April 2001 were reviewed. The median of follow-up was 6.8 months (3-12 months). The intraocular pressure (IOP) and visual acuity before and after operation were compared, and the complications were analyzed. Results The average IOP was 36.3 mmHg (22-65 mmHg) with maximum anti-glaucoma therapy and 16.8 mmHg (8-22 mmHg) with or without only one kind of localβ-blocker therapy before and after operation respectively. The best corrected visual acuity was HM to 0.6 and 0.1 to 1.2 respectively. All complications after operation were cured: corneal edema in 7 cases, fibrous exudation in 5 cases and hyphema in 2 cases. Conclusion Combined phacotrabeculectomy with IOL implantation can gain good results in proper glaucoma patients with cataract. No complicated operation with continual circular anterior capsulorhexis, phacoemulsification in the capsular bag with high vacuum and lower power and IOL fixated in the capsular bag is the guarantee of a satisfactory surgical outcome.