青光眼白内障联合手术中改良小梁切除与经典小梁切除对比研究  

Comparision between modified phacotrabeculectomyand routine phacotrabeculectomyinangle close glaucoma with cataract

作　　者：何莲[1] 陈茂盛[1] 

机构地区：[1]重庆爱尔眼科医院,重庆400020

出　　处：《中国实用眼科杂志》2013年第4期438-440,共3页Chinese Journal of Practical Ophthalmology

摘　　要：目的探讨带三角形深巩膜床切除的改良小梁切除术治疗晚期闭角型青光眼合并白内障的可行性、有效性和安全性。方法临床回顾性研究。晚期闭角型青光眼合并白内障136例（142只眼），80例（86只眼）行带三角形深巩膜床切除的改良小梁切除联合超声乳化人工晶状体植入术（改良组），56例（56只眼）行经典小梁切除联合超声乳化人工晶状体植入术（常规组），比较术前及术后视力变化、眼压、滤过泡情况及术后并发症。结果两组患者均安全实施手术。随访6～18个月，平均（12±1．5）个月。两组术前及术后视力比较，差异无统计学意义（P〉0．05）。两组术前眼压比较，差异无统计学意义（P〉0．05）。术后平均眼压和下降幅度比较，改良组较术前降低（16．5±4．9）mmHg，降压幅度55．9％，对照组较术前降低（11．5±5．1）mmHg，降压幅度（40．0％），两者比较差异有统计学意义（t=0．03，P〈0．05）。术后功能性滤过泡（I型和Ⅱ型），两组比较差异无统计学意义（P〉0．05）。两组术后最常见并发症为一过性低眼压。结论带三角形深巩膜床切除的改良小梁切除联合白内障超声乳化人工晶状体植入术较常规方法能更低的降低眼内压，未增加术中风险和术后并发症，是一种安全、有效、可供选择的手术方法之一。Objective To compare the feasibility, effective and security ofphacotrabeculectomy with the resection of triangular deep scleral bed to routine phacotrabeculectomy in treatment of the advanced angle-closure glaucoma and coexisting cataract. Methods Clinical retrospective study. 136 patients（142 eyes） of advanced angle-closure glaucoma with cataract were analyzed. 86 eyes （modi- fied group） were treated with modified phacotrabeculectomy with the resection of triangular deep scleral bed and 56 eyes were treated with routine phacotrabeculectomy（control group） . The visual acuity, intraocular pressure （IOP）, type of filtering bleb and postoperative complications were blind method observed after operation. Results The patients were followed up for 6 to 18 months（average 12q-1.5 months）. Both groups were performed the operation safely. Best corrected visual acuity were increased in both groups after surgery , there was no statistical difference between two groups（P 〉 0.05）. The IOP was no statistical difference （P 〉0.05） between the two groups before operation. The mean IOP and decreased IOP range were statistically significant （t =0.03,P 〈0.05）between two groups at 12 months post operation. Decreased IOP in the modified group was 16.5~4.9mmHg （lmmHg=0.133kPa）and decreased extent was 55.9% compare to ll.5~5.1mmHg and 40.0% in con- trol. The functional filtering bleb（I and lltype）in the modified groups was 73 eyes （84.9%）,and 48 eyes（85.7%） in the control group, which was no significant difference （P 〉0.05）. There was tran- sient hypotony in two groups after operation.Conclusions The modified phacotrabeculectomy can re- duce lOP more effectively than routinephacotrabeculectomy and induce no more postoperative compli- cations .It is one of safe , effective and optional method in advanced angle-closure glaucoma with co- existing cataract patients.

关 键 词：闭角型青光眼 白内障 小梁切除超声乳化联合手术深巩膜床切除 

分 类 号：R775[医药卫生—眼科]