超声乳化白内障吸除联合青光眼黏弹剂小管扩张术的临床疗效观察  

Clinical observation of combined surgery for cataract and glaucoma:phacoemulsification and viscocanalostomy

作　　者：姚克[1] 申屠形超[1] 徐雯[1] 陈佩卿[1] 章征[1] 

机构地区：[1]浙江大学医学院附属第二医院眼科中心,杭州310009

出　　处：《中华眼科杂志》2004年第5期291-294,共4页Chinese Journal of 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)植入联合黏弹剂小管扩张术(V P术 )的安全性和有效性。方法　收集 2 8例 (30只眼 )因白内障合并原发性开角型青光眼行V P术患者 (V P组 )的临床资料 ,总结和分析患者的视力、眼压及手术并发症的发生情况 ,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 2 7例 (2 8只眼 )白内障合并青光眼患者 (T P组 )进行比较。术后随访时间 6个月。结果　术后 6个月 ,V P组平均眼压为 (14 6 5± 2 70 )mmHg(1mmHg=0 133kPa) ,较术前降低 10 33mmHg ,差异有显著意义 (P =0 0 0 0 ) ;术后 1周、1个月、6个月两组降眼压效果比较 ,差异均无显著意义 (P =0 6 6 1,0 381,0 5 2 6 )。V P组术后 1周、1个月、6个月最佳矫正视力≥ 0 5的眼数占随访眼数的百分比分别为 6 2 1% (18/ 2 9)、71 4 % (2 0 / 2 8)及 80 0 % (2 4 /30 ) ,与T P组比较 ,差异均无显著意义 (P =0 6 2 1,0 70 2 ,0 893)。V P组术中并发症包括小梁网Descemet膜穿破和Schlemm管刺破 (各 2只眼 ) ,术后 2 4h一过性眼压升高 (4只眼 ) ,无其他严重并发症。T P组术后并发症包括前房明显炎性反应 (6只眼 ) ,少量前房出血和脉络膜脱离 (各 1只眼 )。结论　V P术疗效好。Objective To evaluate the therapeutic effects and safety of phacoemulsification-intraocular lens (IOL) implantation combined with viscocanalostomy (V-P) and compared the outcomes of phacoemulsification-IOL implantation combined with trabeculectomy (T-P). Methods Combined phacoemulsification with corneal incision,foldable intraocular lens implantation and viscocanalostomy was performed in 30 eyes of 28 cataract patients with primary open-angle glaucoma. Results Follow-up was performed up to 6 months after surgery. The mean intraocular pressure (IOP) of V-P group was (14.65±2.70) mm Hg (1 mm Hg=0.133 kPa) with a mean pressure reduction of 10.33 mm Hg compared with IOP before the operation ( P =0.000). There were no statistical differences of the IOP within two groups during postoperative 1 week,1 and 6 month ( P =0.661,0.381,0.526). Postoperatively,the best corrected visual acuities of V-P group were ≥ 0.5 in 18 eyes (follow-up 29 eyes,62.1%),20 eyes (28 eyes,71.4%),24 eyes (30 eyes,80.0%) at 1 week,1 month and 6 months,but no statistical difference with T-P group,( P =0.621,0.702,0.893). Complications of V-P group included: Descemet′s membrane puncture 2 eyes (6.7%),Schlemm′s tube puncture 2 eyes (6.7%) and IOP spikes 4 eyes (13.3% at 24 hours postoperatively). The V-P group showed a significantly less inflammation,hyphema and choroidal detachment than that in the T-P group. Conclusions Phacoemulsification-IOL implantation combined with viscocanalostomy is a safe and efficacious surgery with lower complications.

关 键 词：超声乳化吸除术 联合手术 青光眼 黏弹剂 小管扩张术 白内障 小梁切除术 

分 类 号：R779.6[医药卫生—眼科]