微创小梁切除联合晶状体超声乳化术治疗急性闭角型青光眼合并白内障的6个月效果  

Six-months result of minimally invasive phacotrabeculectomy in the treatment of patients with acute angle-closure glaucoma and coexisting cataract

作　　者：侯旭[1] 胡丹[1] 崔志利[1] 周健[1] 蔡莉[1] 王雨生[1] 

机构地区：[1]第四军医大学西京医院眼科全军眼科研究所,西安710032

出　　处：《眼科》2015年第1期31-34,共4页Ophthalmology in China

基　　金：陕西省自然科学基金(2013JM4018)

摘　　要：目的探讨急性闭角型青光眼眼压难于控制的条件下微创小梁切除联合晶状体超声乳化术的效果。设计回顾性病例系列。研究对象2011-2013年西京医院急性闭角型青光眼合并白内障的患者15例15眼。方法术前局部滴糖皮质激素眼液,给予甘露醇、醋甲唑胺和前房穿刺等措施降眼压。采取角膜缘后2.5 mm以穹窿为基底的小结膜瓣(5 mm)和小巩膜瓣(3 mm)小梁切除术联合晶状体超声乳化术。主要指标手术前后视力、眼压、前房深度、炎症反应、滤过泡情况。结果术前平均眼压(53.13±8.82)mm Hg;术后1周、3个月、6个月眼压分别为(13.41±3.42)、(14.65±4.21)、(15.35±5.48)mm Hg。术后2周前房闪辉和炎性渗出吸收。术后2周前房深度(2.72±0.38)mm。所有患眼术后6个月滤过泡为扁平弥散型或微小囊泡型。术后6个月视力为(0.92±0.48)。随访期间未见严重并发症。结论微创小梁切除术可减少组织损伤,提高手术安全性,与晶状体超声乳化术联合应用是治疗急性闭角型青光眼眼压失控的一种有效方法。Objective To study the effect of the application of minimally invasive phacotrabeculectomy in patients with unresponsive acute angle-closure glaucoma. Design Retrospective case series. Participants 15 cases（ 15 eyes）with acute angle-closure glaucoma and coexisting cataract in Xijing Hospital between March 2011 to March 2013. Methods Preoperative topical corticosteroids, mannitol, methazolamide and paracentesis were applied to reduce intraocular pressure （IOP）. A standard phaeoemulsification was performed, followed by minimally invasive trabeculectomy with a fornix-based conjunctival flap （5 ram） and small sclera flap （3 mm）. Main Outcome Measures Visual acuity, IOP, anterior chamber depth, inflammatory reaction, and bleb-related complications. Results Pre-operative average lOP was （53.13±8.82） mmHg. One week after surgery the visual acuity of all patients was improved significantly, and the lOP was （13.41 ± 3.42） mmHg. 3 and 6 months after surgery lOP was （14.65±4.21） and （15.35±5.48） mmHg, respectively. Inflammation in the anterior chamber subsided postoperatively at one week, inflammatory exudate was almost absorbed, and anterior chamber depth was sig- nificantly deeper at two weeks, with an average of （2.72 ± 0.38） ram. All 15 eyes had diffuse blebs or elevated blebs with mierocystic changes in the conjunctiva between 3 months to 6 months postoperatively. Postoperative vision acuity was （0.92±0.48） at 6 months. No serious adverse complications were encountered during follow-up. Conclusion Minimally invasive trabeculectomy could reduce tissue injury and improve the safety of surgery, which is an effective method when combined with phacoemulsification in the treatment of pa- tients with unresponsive acute angle-closure glaucoma and coexisting cataract.

关 键 词：急性闭角型青光眼/外科学 小梁切除术 超声乳化白内障吸除术 

分 类 号：R779.6[医药卫生—眼科]