白内障超声乳化摘除术联合小梁切除术治疗伴白内障的持续高眼压状态闭角型青光眼的疗效  

Curative effect of ultrasonic phacoemulsification combined with trabeculectomy in the treatment of persistent-ocular-hypertension angle-closure glaucoma with cataract

作　　者：韩光杰 黄红波 陈秋菊 HAN Guangjie;HUANG Hongbo;CHEN Qiuju(Department of Ophtalmology,Liuzhou Red Cross Hospital,Liuzhou 545001,Guangxi,China)

机构地区：[1]广西柳州市红十字会医院眼科,广西柳州545001

出　　处：《右江医学》2022年第12期921-925,共5页Chinese Youjiang Medical Journal

基　　金：广西卫生健康委员会自筹经费科研项目(Z20201425)。

摘　　要：目的探讨白内障超声乳化摘除术联合小梁切除术治疗伴有白内障的持续高眼压状态下闭角型青光眼的手术要点及治疗效果。方法回顾性分析25例(25眼)伴有白内障的持续高眼压状态下闭角型青光眼患者行白内障超声乳化摘除术+人工晶体植入术+小梁切除术的临床资料,统计分析治疗前及治疗后1周、1个月、2个月、3个月、6个月、1年的手术成功率、最佳矫正视力、眼压、滤过泡形态和并发症发生情况。结果所有患者均随访至1年。完全成功率为56.0%(14眼),部分成功率为24.0%(6眼),总成功率为80.0%。患者术后视力较术前提高,差异有统计学意义(P<0.05)。术后1周、1个月、2个月、3个月、6个月、1年的平均眼压分别为:(11.30±6.07)mmHg、(13.13±5.03)mmHg、(14.17±5.61)mmHg、(16.02±4.11)mmHg、(18.61±6.33)mmHg、(19.75±8.36)mmHg,均明显低于术前平均眼压(43.19±10.13)mmHg,差异有统计学意义(P<0.001)。术后1年复诊时,有15例表现为Ⅰ型或Ⅱ型滤过泡,其余10例表现为Ⅲ型瘢疤型滤过泡。术后2个月~1年有5例眼压失控,行睫状体光凝术后眼压控制平稳。所有患者无大泡性角膜病变、恶性青光眼及暴发性脉络膜上腔出血发生。结论对于伴有白内障的持续高眼压状态下的闭角型青光眼,做好术前准备,在手术技术娴熟规范的基础上进行白内障超声乳化摘除术+人工晶体植入术+小梁切除术是安全、有效的。Objective To investigate the surgical key points and curative effect of ultrasonic phacoemulsification combined with trabeculectomy in the treatment of persistent-ocular-hypertension angle-closure glaucoma with cataract.Methods The clinical data of 25 cases(25 eyes)of persistent-ocular-hypertension angle-closure glaucoma with cataract underwent cataract ultrasonic phacoemulsification,artificial lens implantation,and trabeculectomy were retrospectively analyzed,and the surgical success rate,best corrected visual acuity(BCVA),intraocular pressure(IOP),bleb morphology,and complications in all cases before treatment and 1 week,1 month,2 months,3 months,6 months and 1 year after treatment were also statistically analyzed.Results All patients were followed up for 1 year.The complete success rate was 56.0%(14 eyes),the partial success rate was 24.0%(6 eyes),and the total success rate was 80.0%.The postoperative visual acuity was improved compared with that before operation,and the difference was statistically significant(P<0.05).The average IOP at 1 week,1 month,2 months,3 months,6 months,and 1 year after operation were:(11.30±6.07)mmHg,(13.13±5.03)mmHg,(14.17±5.61)mmHg,(16.02±4.11)mmHg,(18.61±6.33)mmHg,(19.75±8.36)mmHg,respectively,which were all lower than the average IOP before operation(43.19±10.13)mmHg,and the differences were statistically significant(P<0.001).1 year after operation,there were 15 cases with typeⅠorⅡbleb and 10 cases with typeⅢscarred bleb.2 months to 1 year after after operation,the IOP of 5 cases was out of control,which were stabilized after the endoscopic cyclophotocoagulation.No bullous keratopathy,malignant glaucoma,and fulminant suprachoroidal hemorrhage occurred in all patients.Conclusion With good preoperative preparation,it is safe and effective to conduct cataract ultrasonic phacoemulsification+artificial lens implantation+trabeculectomy for patients with persistent-ocular-hypertension angle-closure glaucoma with cataract on the basis of skilled and standardized surgery tech

关 键 词：闭角型青光眼 白内障 超声乳化摘除术 小梁切除术 高眼压 

分 类 号：R776.1[医药卫生—眼科] R775.2[医药卫生—临床医学]