粘弹剂小管扩张联合超声乳化白内障吸除折叠式人工晶状体植入术治疗白内障合并青光眼

Combined surgery for cataract and glaucoma:Phacoemulsification,foldable intraocular lens implantation and viscocanalostomy

目的 :评价粘弹剂小管扩张联合超声乳化白内障吸除折叠式人工晶状体 (IOL)植入手术治疗白内障合并青光眼的安全性及有效性。方法 :对 19例 (2 1只眼 )白内障合并青光眼患者行上方粘弹剂小管扩张术和透明角膜切口超声乳化折叠式人工晶状体植入联合手术。结果 :术后随访 3～ 6个月 ,粘弹剂小管扩张联合手术组 (P- C组 )平均眼压 (14 .80± 2 .6 3) mm Hg,较术前降低 9.73mm Hg,差异有显著性 (P=0 .0 0 0 ) ;与小梁切除联合手术组 (P- T组 )相比 ,术前和术后 1周、1个月、3～ 6个月差异均无显著性 (P=0 .85 3、0 .338、0 .970、0 .72 5 )。P- C组术后 1周和3～ 6个月 ,视力≥ 0 .5者分别为 16只眼 (76 .2 %)和 17只眼 (80 .95 %) ,与 P- T组相比 ,两组差异均无显著性 (P=0 .777、0 .80 7)。P- C组术中并发症包括小梁网 Descemet膜穿破 2只眼和 Schlemm管刺破 2只眼 ;术后 2 4 h一过性眼压升高 3只眼。P- T组术后并发症包括炎症反应较明显 3只眼 ,少量前房出血 1只眼和脉络膜脱离 1只眼。结论 :粘弹剂小管扩张联合超声乳化白内障吸除折叠式人工晶状体植入术是治疗开角型青光眼合并白内障安全、有效、可重复的联合手术。

Objective: To assess the outcome of phacoemulsification-intraocular lens (IOL) implantation combined with viscocanalostomy (P-C group), compared with that of phacoemulsification-IOL implantation combined with trabeculectomy (P-T group). Methods: Combined phacoemulsification with corneal incision, foldable intrao-cular lens implantation and viscocanalostomy was performed in 21 eyes of 19 cataract patients with primary open- angle glaucoma. All patients were followed up for 3~6 months. Results: Intraocular pressure (IOP) was significantly lower in both P-C group and P-T group (P=0.000). There was no statistically significant difference between two groups. Visual outcome was similar in both groups. Complications of P-C group included Descemet's membrane puncture in 2 eyes, Schlemm's tube puncture in 2 eyes and IOP spikes in 3 eyes (at 24 hours postoperatively). The P-C group experienced significantly less inflammation than the P-T group. Conclusion: Phacoemulsi-fication-IOL implantation combined with viscocanalostomy is a safe and effective surgery, with lower complicatin rate and easier ambulatory care.