外引流术后的白内障超声乳化手术

Phacoemulsification for eyes having received trabeculectomy

目的 :探讨抗青光眼外引流术后的白内障患眼进行超声乳化吸除术的手术入路、操作方式及临床效果。方法 :避开功能性滤过泡 ,选择角巩膜隧道切口或透明角膜切口。瞳孔麻痹性散大时 ,做一个完美的直径约 5mm的连续环形撕囊以补偿之 ;恰当处理虹膜后粘连后 ,在病理性小瞳孔下完成超声乳化手术 ;眼压失控者行青光眼白内障人工晶体植入三联术。结果 :无后囊破裂 ,人工晶体全部囊袋内植入。术后 1周视力≥ 0 .5者 2 0只眼 (6 4 .5 % ) ,0 .1～ 0 .4者 8只眼 (2 5 .8% ) ,<0 .1者 3只眼 (9.7% )。随访 1～ 16个月 ,眼压均在 2 0 .5 5mmHg以下。 结论 :外引流术后的白内障患眼 ,超声乳化手术因其切口小、并发症少、不破坏功能性滤过泡、不损伤瞳孔 。

Objective:To investigate the surgical approaches,techniques and clinical effects of phacoemulsification for patients with glaucoma who have undergone trabeculectomy once or twice before.Methods:Limbus tunnel incision or clear corneal tunnel incision was made without damaging the functional filtering blebs.A small perfect circular tear capsulorraxis with a diameter of 5 mm was made for the compensation of palsied large pupils.Phacoemulsification was completed through small carefully trimmed synechia pupils.Phacotrabeculectomy with intraocular lens implantation(triple surgery) was performed for cases with cataract and glaucoma.Results:No posterior capsule rupture occurred and all the lenses were inserted into the capsular bags.The visual acuities were ≥0.5 in 20 eyes(64.5%),0.1 to 0.4 in 8 eyes(25.8%) and <0.1 in 3 eyes(9.7%) one week after the operation,and the intraocular pressure was below 20.55 mmHg in all eye during the follow up of 1 to 16 months.Conclusions:Phacoemulsification has the advantages of small incision,less complications,and no damage to filtering blebs and pathological small pupils.It is the choice of operation for eyes with cataract and former trabeculectomy.