Evaluation of the Ex-PRESS~ P-50 implant under scleral flap in combined cataract and glaucoma surgery

AIM： To evaluate the efficacy and safety of glaucoma drainage device Ex-PRESS~ P-50 for combined cataract surgery and glaucoma.·METHODS： Patients having cataract and open angle glaucoma or patients with open advanced glaucoma which needed two or more antiglaucoma medications were included. Combined cataract surgery and glaucoma with Ex-PRESS~ P-50 model placed under scleral flap was performed.·RESULTS： Out of 40 eyes of 40 patients（55% male and45% female） completed the study during one-year follow-up. The mean of age was 76.6 ±11.02 y. The intraocular pressure（IOP） decreased significantly during the 12-month follow-up from 23.5 mm Hg to 16.8 mm Hg（Wilcoxon signed ranks test, P 〈0.001）. A 59.5% of patients did not need any topical treatment, 10.8% of them needed one active principle, 27% needed two active principles, and 2.7% of them needed three active principles for successful IOP control（〈21 mm Hg）.·CONCLUSION：Combinedsurgeryofphacoemulsification with Ex PRESS~ P-50 lowers IOP from the preoperative baseline and reduces significantly the number of antiglaucoma active principles for IOP control after the operation.

Meta-analysis of the efficacy and safety of combined surgery in the management of eyes with coexisting cataract and open angle glaucoma

AIM： To conduct a systematic review and quantitative Meta-analysis of the efficacy and safety of combined surgery for the eyes with coexisting cataract and open angle glaucoma.METHODS： We performed a systematic search of the related literature in the Cochrane Library, PubM ed, EMBASE, Web of Science databases, CNKI, CBM and Wan Fang databases, with no limitations on language or publication date. The primary efficacy estimate was identified by weighted mean difference of the percentage of intraocular pressure reduction（IOPR%） from baseline to end-point, the percentage of number of glaucoma medications reduction from pre-to post-operation, and the secondary efficacy evaluations were performed by odds ratio（OR） and 95% confidence interval（CI） for complete and qualified success rate. Besides, ORs were applied to assess the tolerability of adverse incidents. Meta-analyses of fixed or random effect models were performed using Rev Man software 5.2 to gather the consequences. Heterogeneity was evaluated by Chi^2 test and the I^2 measure.RESULTS： Ten studies enrolling 3108 patients were included. The combined consequences indicated that both glaucoma and combined cataract and glaucoma surgery significantly decreased IOP. For deep sclerectomy vs deep sclerectomy plus phacoemulsification and canaloplasty vs phaco-canaloplasty, the differences in IOPR% were not all statistically significant while trabeculotomy was detected to gain a quantitatively greater IOPR% compared with trabeculotomy plus phacoemulsification. Furthermore, there was no statistical significance in the complete and qualified success rate, and the rates of adverse incidents for trabeculotomy vs trabeculotomy plus phacoemulsification.CONCLUSION： Compared with trabeculotomy plus phacoemulsification, trabeculectomy alone is more effective in lowering IOP and the number of glaucoma medications, while the two surgeries can not demonstrate statistical differences in the complete success rate, qualified success rate, or incidence of adverse incidents.

Ex-PRESS implantation for different types of glaucoma

AIM: To evaluate the clinical results, efficacy and safety of Ex-PRESS P200 glaucoma shunt implant in different types of medically uncontrolled glaucoma. METHODS: The study included 31 eyes of 31 patients that were unresponsive to medical antiglaucomatous therapy in whom Ex-PRESS P200 glaucoma shunt implantation was performed. The demographic characteristics of the patients, type of glaucoma, complete ocular examination results, number of antiglaucomatous drugs before and after surgery, early and late complications of surgery, additional surgical and nonsurgical medical interventions, and success rates were investigated from the patients’ files, retrospectively. RESULTS: The mean postoperative follow-up time was 16.4±7.5 mo. The preoperative mean corrected intraocular pressure(IOP) was 28.7±10.3 mm Hg and postoperative mean corrected IOP was 15.3±5.2 mm Hg(P<0.05) at the last visit. The mean IOP reduction was 39.9% when the preoperative and postoperative values of the last visits were compared. The average number of antiglaucomatous drug use decreased from 3.9±0.3 to 1.7±1.7 postoperatively(P<0.05). The use of antiglaucomatous medications at the last visit was more than in other studies in the literature. The most common complication was conjunctival leakage, which was seen in 7 patients. Other early complications were iris touch, intravitreal hemorrhage, hyphema, choroidal effusion, early transient hypotonia and corneal edema. One of the late complications was endophthalmitiswhich was seen in one case 6 mo after the operation, and the other late complication was opacification of the cornea in one patient. Twelve additional surgical operations associated to Ex-PRESS surgery and 3 bleb needling have done. At the last visit, the complete success rate was 32.3% and the qualified success rate was 77.5% in all patients. CONCLUSION: Ex-PRESS P200 glaucoma shunt implantation may be an effective procedure for medically uncontrolled glaucoma with significantly lower use of antiglaucomatous medications.

P50型与P200型Ex-PRESS引流器植入术对开角型青光眼疗效及安全性的随机对照研究

背景 目前国外对Ex-PRESS引流器植入术治疗开角性青光眼的临床应用效果已有报道,在中国临床上使用的Ex-PRESS引流器有内径分别为50μm和200μm的P50型和P200型,但2种类型引流器的临床效果是否有所不同,目前国内外报道较少. 目的 对比观察P50型与P200型Ex-PRESS引流器植入术治疗开角型青光眼的早期临床疗效和安全性. 方法 采用随机对照临床研究设计,纳入2012年3月至2013年4月在广州军区武汉总医院行Ex-PRESS引流器植入术的开角型青光眼患者69例80眼,采用随机数字表法将患者分为基线特征匹配的2个组,分别实施P50型Ex-PRESS引流器植入术（35例40眼）和Ex-PRESS引流器植入术（34例40眼）,比较2个组患者的病种构成比、最佳矫正视力恢复时间、理论住院天数、手术前后的眼压变化及并发症的发生情况.结果 P50组和P200组术眼手术前后眼压平均下降幅度分别为（21.19±11.22）和（24.35±12.27）mmHg（1 mmHg=0.133 kPa）,差异无统计学意义（t=-1.201,P＞0.05）.P50组患者的理论住院天数和最佳矫正视力恢复时间分别为（3.65±0.92）d和（2.85±0.95）d,明显少于P200组的（4.90±0.81）d和（3.40±0.96）d,差异均有统计学意义（t=-6.444,P＜0.01;t=-2.584,P＜0.05）.P50组和P200组术眼术后并发症发生率分别为6.06％和25.00％,差异有统计学意义（x2=9.800,P＜0.05）,P50组术眼发生低眼压和浅前房的跟数少于P200组.结论 P50型和P200型Ex-PRESS引流器植入术对开角性青光眼的降眼压作用接近,与P200型Ex-PRESS引流器植入术比较,P50型Ex-PRESS引流器植入后早期患者的视力恢复快,并发症的发生率低.

EX-PRESS青光眼引流器植入术治疗开角型青光眼

目的：EX-PRESS青光眼引流器植入术治疗开角型青光眼的临床疗效和安全性。方法：回顾经视力、眼压、房角镜、眼底、视野等检查确诊为开角型青光眼患者40例47眼。患者年龄6～73（平均39.9±16.5）岁，最佳矫正视力0.01～0.60，眼压18～65mmHg。给予3种以上降眼压药物控制不理想，行EX-PRESS青光眼引流器植入术。术后1，3d； 1wk进行眼压、裂隙灯检查。比较治疗前后最佳矫正视力、眼压的临床资料，观察其疗效及安全性。结果：术前平均视力0.26±0.29，术后1wk平均视力0.24±0.22，平均视力稍有下降，但无统计学意义（t=1.56，P=0.13）。术前平均眼压36.62±14.01mmHg，术后1，3d； 1wk平均眼压分别为10.04±5.77，9.59±4.93，9.47±3.06mmHg。EX-PRESS青光眼引流器植入术后1，3d； 1wk的眼压均较治疗前明显降低（F=157.20，P〈0.05）。除5眼术后1d眼压〈5mmHg，所有患者在治疗过程中及术后1wk均未见明显眼部或全身不良反应。结论：EX-PRESS青光眼引流器植入术治疗开角型青光眼是安全有效的，术中及术后风险低、并发症少。

在中国Ex-PRESS青光眼微型引流器植入术是否可以取代小梁切除术？

Ex-PRESS青光眼微型引流器植入术的开展,为青光眼的手术治疗提供了新的选择.与小梁切除术相比,Ex-PRESS青光眼微型引流器植入术具有操作简单、疗效相当、术后并发症少的优点.研究表明,Ex-PRESS青光眼微型引流器植入术在小梁切除术高风险病例中具有相对安全的优势,但在小梁切除术容易失败的病例中却并没有突出的优势,术后瘢痕化仍然是影响手术成功率的关键问题.这种微型青光眼引流器植入术须满足前房角有足够空间的条件,以避免伤及角膜内皮、虹膜或晶状体,因此Ex-PRESS青光眼微型引流器植入术不适用于闭角型青光眼,这是欧美国家较少考虑的问题,此外,这种手术成本效应比相对较低的缺点在中国患者中也是值得考虑的问题.因此,Ex-PRESS青光眼微型引流器植入术在中国尚不能取代小梁切除术,其优缺点有待中国研究者总结的中长期临床观察和循证医学依据来评估.

Combined phacoemulsification and goniosynechialysis with or without endoscopic cyclophotocoagulation in the treatment of PACG with cataract

AIM:To investigate the efficacy and safety of combined phacoemulsification and goniosynechialysis with or without endoscopic cyclophotocoagulation(PGE group and PG group)for the treatment of patients with coexisting primary angle-closure glaucoma(PACG)and cataracts.METHODS:The clinical data of patients with PACG and cataract were retrospectively reviewed.There was a total of 88 eyes in the study and were divided into two groups,42 eyes in PGE group and 46 eyes in PG group.Surgery success cumulative survival,preoperative and postoperative intraocular pressure(IOP),number of IOPlowering medications,best corrected visual acuity(BCVA)in the two groups were observed for more than 12 mo and compared within each group and between two groups.RESULTS:The mean IOP in PGE group declined from24.9 mm Hg preoperatively to 14.1 mm Hg at the first month after operation(P<0.001)and at the last visit 16.2 mm Hg(P<0.001).Meanwhile PG group also showed significant decrease,from 24.1 mm Hg preoperatively to 13.0 mm Hg at Imo after operation(P<0.001)and 15.3 mm Hg at the last visit(P=0.004).The mean medications reliance reduced in both groups,in PGE group was reduced from 1.62 preoperatively to 0.13 at the last visit(P<0.001),in PG group from 0.87 to 0.10(P<0.001).At the last visit,BCVA increased from 0.21 to 0.60 in PGE group(P<0.001)and from 0.24 to 0.67 in PG group(P<0.001).The success rate of PGE group at 1 mo was95.2%,then decreased to 70.7%at the last visit,whereas in PG group,the success rate at 1 mo was 100%,at the last visit was 73.4%.CONCLUSION:PGE shows promise for PACG patients with cataracts to reduce IOP,lighten the medication burden and improve visual acuity,and PG still has its value in specific patients.

Ex-PRESS implantation with phacoemulsification in POAG versus CPACG

AIM： To compare the long-term outcomes of the Ex-PRESS miniature glaucoma device implanted under a scleral flap in combination of phacoemulsification with intraocular lens implantation in primary open angle glaucoma （POAG） and chronic primary angle-closure glaucoma （CPACG）.METHODS： Retrospective, comparative study. A total of 60 eyes （60 patients） receiving the Ex-PRESS miniature glaucoma device implantation combined with phacoemulsification were reviewed. Thirty eyes （30 patients） had the combined procedures for POAG, and the other 30 eyes （30 patients） for CPACG. RESULTS： The follow-up was 39.37±7.09mo （range 3 to 49mo） in patients with POAG and 37.10±9.26mo （range 9 to 49mo） in patients with CPACG （P=0.29）. The mean change in best corrected visual acuity was 0.41 logMAR for POAG and 0.38 logMAR for CPACG at the last follow-up （P=0.22）. The postoperative intraocular pressure （IOP） of the POAG group was significantly lower than the CPACG group at 1, 3, 12, and 18mo after surgery （P=0.02, 0.00, 0.04, 0.01） with similar glaucoma medications after surgery （P〉0.16）. At 3y after surgery, the cumulative complete and qualified success rates were 63.3% （POAG） and 53.3% （CPACG）, 83.3% （POAG） and 73.3% （CPACG） （P=0.41, 0.49）, respectively. The POAG group had more hypotony than the CPACG group （P=0.04）.CONCLUSION： The long-term outcomes show the Ex-PRESS implantation combined with phacoemulcification can effectively lower the IOP in both the POAG and CPACG groups. The POAG group seems to have lower postoperative IOP and a higher risk of hypotony.

EX-PRESS植入联合超声乳化治疗原发性慢性闭角型青光眼合并白内障

目的:探讨EX-PRESS引流器植入术联合超声乳化术治疗原发性慢性闭角型青光眼(CPACG)合并白内障的临床疗效,并与小梁切除术联合超声乳化术进行比较。方法:回顾性病例对照研究。收集2017-01-01/2019-01-01在我院眼科确诊并住院治疗的CPACG合并白内障患者(29例36眼)作为研究对象,按手术方式不同分为两组,研究组(13例16眼)采用EX-PRESS引流器植入术联合超声乳化白内障摘除人工晶状体植入术,对照组(16例20眼)采用小梁切除术联合超声乳化白内障摘除人工晶状体植入术。记录两组术前,术后1wk,1、3、6mo最佳矫正视力(BCVA)、眼压,术前,术后1、6mo的中央前房深度(ACD)、中央角膜内皮细胞数、手术时间、手术至出院时间、术中术后并发症、术后随访情况等。结果:两组患者的人口基线特征无差异(均P>0.05)。研究组术后6mo与术前相比视力改善眼数增多(Z=-2.066,P=0.039),术后6mo时两组的视力无差异(Z=-0.319,P=0.765)。研究组术后1wk,1、3、6mo的眼压与术前相比均下降(均P<0.001),两组的眼压无差异(F=0.003,P=0.956)。两组术后1、6mo ACD均较术前加深(均P<0.001),两组的ACD、中央角膜内皮细胞数均无差异(P>0.05)。手术时间研究组26.1±4.5min,对照组31.5±5.1min,两组有差异(t=-3.307,P=0.002)。手术至出院时间研究组7.2±1.6d,对照组7.7±1.5d,两组无差异(t=-0.880,P=0.388)。研究组1眼EX-PRESS触及虹膜,因眼压正常未做处理。对照组2眼术后2度浅前房,采用散瞳及加压包扎1wk后恢复。术后6mo时两组各有1眼用1种降眼压滴眼液维持眼压正常。对照组1眼12mo后因眼压升高行EX-PRESS引流器植入术,1眼8mo后行睫状体光凝术。结论:EX-PRESS引流器植入术联合超声乳化术治疗CPACG可以提高视力、降低眼压,取得良好疗效,手术时间短于小梁切除术联合超声乳化术。

Ex-press青光眼引流钉植入术治疗不同类型青光眼的长期临床观察

目的评价Ex-press青光眼引流钉植入术治疗不同类型青光眼的有效性和安全性。方法回顾分析于我院行P50型Ex-press青光眼引流钉植入术的不同类型青光眼患者209例(283眼),包括原发性开角型青光眼(POAG)组135眼、原发性闭角型青光眼(PACG)组12眼、发育性青光眼(DG)组94眼、继发性青光眼(SG)组42眼,比较了手术成功率,术后眼压、视力,抗青光眼药物使用数量及并发症。结果术后平均随访(26.7±10.7)个月。术后36个月,POAG组的完全成功率(68.8%)明显高于PACG组(40.0%)和SG组(47.6%),DG组的完全成功率(65.1%)明显高于SG组(47.6%),以上P值均<0.05。各组青光眼术后眼压较术前均明显下降(P<0.05),术后不同随访时间各组间平均眼压差异无统计学意义(P>0.05)。各组视力均在术后1周明显下降(P<0.05),术后1个月恢复至术前水平。SG组术后抗青光眼药物使用数量(1.05±1.13)明显高于POAG组(0.51±1.22)、PACG组(0.83±0.84)及DG组(0.63±0.90),P值均<0.05。SG组术后并发症总发生率(40.48%)高于POAG组(15.56%)和DG组(21.28%),P值均<0.05。结论Ex-press青光眼引流钉植入术治疗POAG和DG有较好的有效性和安全性,对于PACG和SG的治疗则需根据临床情况谨慎选择。

分析不同手术切口对青光眼白内障联合手术患者角膜内皮的影响

目的评价青光眼白内障联合手术患者采用不同手术切口治疗对于角膜内皮产生的影响。方法选取2021年6月—2022年6月临沂市人民医院收治的72例行小梁切除联合超声乳化术的青光眼合并白内障患者为研究对象,根据随机数表法分为对照组和观察组,每组36例,对照组采用双切口治疗,观察组采用单切口治疗,对比两组患者的疗效。结果观察组术后不同观察阶段的角膜内皮细胞计数高于对照组,差异有统计学意义(P<0.05)。观察组术后1年的膜内皮细胞密度(1655.62±287.87)个/mm^(2)、膜内皮细胞面积(598.38±72.37)μm^(2)高于对照组(1402.72±287.82)个/mm^(2)、(536.56±70.98)μm^(2),差异有统计学意义(t=3.727、3.659,P<0.001)。结论青光眼白内障患者采用小梁切除联合超声乳化手术治疗中,采用单切口治疗的效果更佳,有利于降低对角膜内皮的损伤。

青光眼患者白内障手术人工晶状体计算公式的选择

青光眼与白内障是导致失明的主要原因,手术是重要的治疗方式。青光眼患者具有高眼压、浅前房及短眼轴等临床特征,小梁切除术等抗青光眼术后眼部结构常发生改变。这些变化也导致了抗青光眼术后行白内障手术或青白联合手术与单纯白内障手术在人工晶状体(intraocular lens,IOL)屈光度计算准确性方面存在差异。同时青光眼患者自身的临床特征与抗青光眼手术造成的结构改变对于IOL屈光度预测准确性、屈光漂移的类型等方面的影响也表现出差异。本文就青光眼或抗青光眼术后患者行白内障手术或青白联合手术时屈光误差(refractive error,RE)产生的原因、屈光漂移特征及选择最合适IOL计算公式的最新研究进展进行综述。

晶状体悬韧带与原发性闭角型青光眼之已知与未知

晶状体悬韧带异常(包括松弛和断裂)可引起晶状体虹膜隔前移、前房变浅、房角关闭和眼压升高,即闭角型青光眼(angle closure glaucoma,ACG)的发生。特发性悬韧带异常多发生于原发性闭角型青光眼(primary angle closure glaucoma,PACG),可能是PACG的发病机制之一,但仍需前瞻性队列研究进一步证实。此类患者双眼前房深度不等,虹膜/晶状体震颤等体征及超声生物显微镜(ultrasound biomicroscopy,UBM)检查能够诊断的悬韧带异常比例较低,通常在青光眼白内障联合手术前未能被诊断而在术中被发现,故被称为隐匿性晶状体悬韧带异常。目前根据术中表现如充分散瞳可见晶状体赤道部,连续环形撕囊破囊时可见前囊放射状皱褶,超声乳化时囊袋赤道部移位或卷曲,灌注抽吸时囊袋异常飘动,囊袋口不规则等可明确诊断。根据悬韧带异常的程度、范围,选择超声乳化晶状体吸除联合人工晶体植入,联合或不联合囊袋张力环植入或人工晶体缝合固定术。PACG患者术前和术中应关注是否存在悬韧带异常,制定个体化治疗方案,以保证手术安全和疗效。

全程护理在急性闭角型青光眼慢性期行青光眼白内障联合术治疗中的应用研究

目的:针对急性闭角型青光眼慢性期行青光眼白内障联合术治疗期间使用全程护理的临床价值展开分析与探讨。方法:选取2020年10月—2022年10月阳江市阳春市爱尔新希望眼科医院行青光眼白内障联合术治疗的急性闭角型青光眼慢性期患者80例为研究对象,按随机法分为对照组与观察组,各40例。对照组应用常规护理,观察组应用全程护理,比较两组患者护理效果。结果:护理前,两组患者定期复诊、规律用药、生活习惯、社会活动评分比较,差异无统计学意义(P>0.05);护理后,观察组患者定期复诊、规律用药、生活习惯、社会活动评分高于对照组,差异有统计学意义(P<0.05);护理前,两组患者视功能损害与症状、躯体机能、社会功能、精神心理评分比较,差异无统计学意义(P>0.05);护理后,观察组患者视功能损害与症状、躯体机能、社会功能、精神心理评分高于对照组,差异有统计学意义(P<0.05)。结论:通过将全程护理应用在急性闭角型青光眼的慢性期行青光眼白内障联合术治疗工作中,能够显著提升患者遵医行为,优化生存质量,值得普及使用。

Phaco或ECCE联合小梁切除术治疗白内障合并青光眼的对照研究

背景 白内障超声乳化（Phaco）联合小梁切除术和白内障囊外摘出术（ECCE）联合小梁切除术均为治疗白内障合并青光眼的主要方法,二者的疗效比较研究对治疗的选择有重要意义. 目的 比较Phaco联合小梁切除术与ECCE联合小梁切除术治疗白内障合并青光眼的临床疗效及安全性.方法 采用随机对照研究方法,纳入2013年1月至2014年2月在新疆医科大学附属自治区中医医院收治的白内障合并青光眼患者63例63眼,按照随机数字表法将患者分为2个组,组间基线资料均匹配.ECCE三联术组患者33例33眼接受ECCE＋人工晶状体（IOL）植入联合小梁切除术,Phaco三联术组患者30例30眼接受Phaco＋IOL植入联合小梁切除术,术后均随访6个月,比较2个组间术眼术后视力、眼压、术后散光及并发症情况.结果 术后2个组术眼的视力均明显改善,2个组间在不同等级视力范围的眼数分布差异有统计学意义（H=0.125,P=0.032）.术后6个月Phaco三联术组和ECCE三联术组的眼压分别为（14.13±5.19） mmHg和（15.18±6.04） mmHg,2个组间眼压值差异无统计学意义（F分组=3.762,P＞0.05）但术后眼压均低于术前（F时间=14.991,P＜0.05）.术后Phaco三联术组术眼散光度为（1.02±0.44）D,明显低于ECCE三联术组的（3.76±1.53）D,差异有统计学意义（t=3.089,P=0.034）.Phaco三联术组和ECCE三联术组的术后并发症发生率分别为6.67％和18.18％,差异有统计学意义（x2=6.112,P＜0.05）. 结论 与ECCE三联术比较,Phaco三联术对白内障合并青光眼进行治疗的手术创伤小,并发症少,术后散光度低。

白内障合并青光眼的联合手术治疗

白内障超声乳化人工晶状体植入联合小梁切除术在手术并发症,眼内压以及视敏度等方面比其他联合手术取得了更大的成功。一切口式与二切口式联合手术有相同的手术效果。白内障超声乳化联合小梁切除术并配合使用MMC比单纯白内障超声乳化联合小梁切除术能更好的降低眼压,但带来更多的手术并发症;5-FU没有MMC的效果,而且还对手术结果有不同的影响。近年来联合手术中的小梁切除术有一定的进展,但还没有进行长期的术后随访研究。国内外有关白内障合并青光眼的联合手术治疗的报道很多,本文主要对这些报道进行客观的总结评价和总结。

超声乳化白内障吸除联合小梁切除术治疗闭角型青光眼合并白内障

目的：探讨双切口白内障超声乳化吸除人工晶状体植入联合小梁切除术治疗闭角型青光眼合并白内障的临床疗效。方法：回顾分析双切口白内障超声乳化吸除人工晶状体植入联合小梁切除术治疗闭角型青光眼合并白内障患者65例70眼,术后随访3-12mo,观察视力、眼压及并发症的发生。 结果：术后患者视力≤0.1者2眼,〉0.1-0.3者6眼,0.4-0.8者60眼,≥1.0者2眼,术后眼压在正常范围内（〈21mmHg）者69眼,1眼术后出现浅前房,经治疗改善。 结论：双切口白内障超声乳化吸除人工晶状体植入联合小梁切除术治疗闭角型青光眼合并白内障手术成功率高,疗效佳,是一种理想的手术方式。

260例青光眼白内障联合手术临床分析

目的:分析评价青光眼白内障联合手术的疗效。方法:对260例(279眼)行青光眼白内障联合手术的病例作回顾性分析,并将病人分为3组。Ⅰ组:白内障囊外摘除联合小梁切除术;Ⅱ组:白内障囊外摘除、人工晶体植入联合小梁切除术;Ⅲ组:超声乳化白内障吸出、人工晶体植入联合小梁切除术;并分析比较3组的术后视力、眼压和并发症。结果:3组病例术后视力≥0.3者分别为16.2％、32.4％和43.5％,术后视力改善率分别为46.6％、70.4％和78.3％;3组术后平均眼压分别为12.72±6.66mmHg(1mmHg=0.133kPa)、13.01±5.26mmHg、12.63±4.66mmHg,与术前相比有显著性差异(P<0.01);Ⅲ组的并发症较其余2组明显减少。结论:青光眼白内障联合手术可有效控制眼压,三联手术能迅速提高视力,其中采用超声乳化白内障吸出技术能大大减少并发症的发生,提高手术的成功率。眼科学报2000;16:102-105。

青光眼引流装置植入术在治疗难治性青光眼中的作用

难治性青光眼是主要的致盲眼病之一，目前青光眼引流装置植入术已成为治疗难治性青光眼的主要方法，因其具有安全、有效、并发症较少等优点，青光眼引流装置在临床已得到广泛应用。通过近几年大量临床应用与青光眼微创手术的创新发展，青光眼引流装置植入术展现出良好的治疗前景。本文总结分析了青光眼外引流装置（Molteno、Schocket、Baerveldt、国产HAD房水引流物、Krupin、Ahmed、Joseph、Whites、Optimed房水引流物）及青光眼微创手术（Ex—PRESS青光眼引流器、Xen凝胶支架、CyPass微型支架、小梁消融术、Schlemm管支架、iStent引流器、SOLX Gold Shunt等）的结构特点和临床疗效，就青光眼引流装置植入术在治疗难治性青光眼中的作用进行综述。

眼压对青光眼-白内障联合术患者人工晶状体计算公式选择的影响

目的探讨眼压对青光眼—白内障联合术患者人工晶状体计算公式选择的影响,为临床上避免屈光误差(refractive error,RE)提供参考依据。方法选取2014年5月至2017年4月在我院行白内障超声乳化吸出并人工晶状体植入联合复合式小梁切除术的原发性闭角型青光眼(primary angle-closure glaucoma,PACG)合并白内障患者72例(80眼),依术前平均眼压将测试眼分为两组:正常眼压组(10~21 mm Hg,1 k Pa=7.5 mm Hg)和高眼压组(>21 mm Hg),分别为28眼和52眼。比较各组内术后3个月验光所得实际等效球镜度与术前人工晶状体Master中4种人工晶状体计算公式(SRK/T、Holladay1、Hoffer Q及Haigis)相应预测等效球镜度的差异。定义实际等效球镜度减去预测等效球镜度即为RE,当RE<0时为屈光近视漂移,而RE>0则为屈光远视漂移,RE取绝对值为绝对屈光误差(absolute refractive error,ARE),评估眼压对各公式术后ARE及RE的影响。术后随访6个月。结果全部患者术后3个月眼压较术前下降明显,差异有统计学意义(t=9.96,P=0.000),且眼压降低幅度与术前平均眼压呈正相关(r=0.974,P=0.000)。正常眼压组SRK/T、Holladay1、Hoffer Q、Haigis公式ARE的中位数差异有统计学意义(P=0.008);高眼压组各公式ARE的中位数差异亦有统计学意义(P=0.004)。正常眼压组和高眼压组远视漂移时SRK/T、Holladay1、Hoffer Q、Haigis公式RE总体差异均无统计学意义(P=0.633、0.422)。正常眼压组近视漂移时各公式RE间总体差异有统计学意义(P=0.000),经LSD两两比较,SRK/T公式较其他公式的RE小(均为P<0.01),Haigis公式较其他公式的RE大(均为P<0.05),其他各公式RE差异均无统计学意义(均为P>0.05)。而高眼压组近视漂移时各公式RE总体差异亦有统计学意义(F=6.757,P=0.000),经LSD两两比较,Hoffer Q公式RE较其他公式的小(均为P<0.01),其他各公式RE差异均无统计学意义(均为P>0.05)。结论青光眼—白内障联合术可提高患者视力并改善眼压,术后眼压降低幅度与术前平均眼压呈明显正相关。计算青光眼—白内障联合术人工晶状体度数时,术前平均眼压正常者应选SRK/T公式较为准确,而术前平均眼压高时Hoffer Q公式更合适。