超声乳化白内障吸除联合非穿透性小梁手术并羊膜植入物的临床疗效观察  

Clinical observation of combined surgery for cataract and glaucoma: phacoemulsification and non-penetrating trabecular surgery with amniotic membrane implant

作　　者：刘兆荣[1] 

机构地区：[1]山东省日照市人民医院眼科,日照276800

出　　处：《中国实用眼科杂志》2006年第8期816-819,共4页Chinese Journal of Practical Ophthalmology

摘　　要：目的评价超声乳化白内障吸除折叠式人工晶状体(IOL)植入联合非穿透性小梁手术并滤过道内植入羊膜组织(N-P术)的临床效果。方法对29例35眼因白内障合并原发性开角型青光眼患者行N-P术治疗,总结和分析患者术后最佳矫正视力、眼压、滤过泡及手术并发症情况,并与行超声乳化白内障吸除折叠式IOL植入联合小梁切除术(T-P术)的26例30眼进行比较。患者术后平均随访时间为(9.2±3.5)m。结果①N-P组29例35眼术后1w、1m、6m及12m平均眼压分别为(13.75±3.56)mmHg、(14.12±3.21)mmHg、(13.95±2.32)mmHg和(14.28±3.12)mmHg明显低于术前(29.46±4.48)mmHg(P均<0.01),差异均有显著性意义;术后相同时期与T-P组眼压下降量比较差异均无显著性意义(P均>0.05)。②全部患者术后视力均有不同程度提高。N-P组术后1w、1m、6m及12m最佳矫正视力≥0.5的眼数占随访眼数的百分比分别为65.7%(23/35)、76.5%(26/34)、81.2%(26/32)及84.8%(28/33),与T-P组比较,差异均无显著性意义(χ2值分别为0.427,0.348,0.285,0.256;P均>0.05)。③N-P组患者术后均无明显前房炎性反应、前房变浅,脉络膜脱离等并发症发生。T-P组术后有2眼浅前房,经加压包扎24h后恢复正常。术后房角检查N-P组可见术区后弹力膜及残存小梁网变薄,有3眼可见小梁网处有微穿孔。④两组患者术后均形成滤过泡。随访12m时N-P组33眼中25眼(75.8%)存在功能性滤过泡;T-P组27眼中有21眼(70.4%)存在功能性滤过泡。两组比较无显著性差异(χ2=0.257,P>0.05)。结论N-P术能有效降低眼压、减少抗青光眼药物的应用,疗效好、并发症少,是治疗白内障合并原发性开角型青光眼的有效方法。Objective To evaluate the clinical effect of phacoemulsification-intraocular lens（IOL） implantation combined non-penetrating trabecular surgery （NPTS） with amniotic membrane implant. Methods Combined phacoemulsification-intraocular lens（IOL） implantation with NPTS and amniotic membrame implant （N-P） was performed on 35 eyes of 29 compared the outcomes of phacoemulsification-IOL combined with trabeculectomy（T-P） on 30 eyes of 26 cataract patients with primary open-angle glaucoma.Best-corrected visual acuity,pre-and post-operation intraocular pressure（IOP）, postoperative bleb formation and postoperative complications were summarized and analyzed between the two groups. The mean follow-up was （9.2 ± 3.5） months. Results ①The mean lOP of 29 cases（35eyes） in one week and 1,6, 12 months postoperatively were （13.75 ± 3.56） mmHg, （14.12 ±3.21 ）mmHg, （13.95± 2.32）mmHg and （14.28 ± 3.12）mmHg, which were distinctly lower than that of preoperatively[（29.46± 4.48） mmHg, （P〈0.01）].There was no significant difference between the N-P and T-P group at the same time （P〉0.05）. ② The best-corrected visual acuity of all cases was improved than that of preoperation to some degrees. Postoperatively, the best-corrected visual acuities of N-P group were ≥ 0.5 in 23 eyes（follow-up 35 eyes,65.7%）,26 eyes（follow-up 34 eyes,76.5%）,26 eyes（follow-up 32 eyes,81.2%）,28 eyes（follow-up 33 eyes, 84.8%）. There was no significant difference compared with the T-P group （ x^ 2=0.427, 0.348, 0.285, 0.256; P〉0.05）. ③ The complications of the N-P group such as flat chamber, inflammation and choroidal detachment were not observed. The gonioscopy showed that the remnant trabecular meshwork and Descemet membrane were thinner at the surgical site, and in 3 eyes microperforation occurred in the trabecular meshwork. ④The bleb were formed in the two groups postoperatively.There were 25 eyes in 35 eyes of the N-P （75.8%） and 21 eyes in 27 eyes of the T-P gro

关 键 词：超声乳化白内障吸除术 青光眼 晶体 人工 羊膜 

分 类 号：R775[医药卫生—眼科] R743.33[医药卫生—临床医学]