摘要
目的:比较两阶段手术和超声乳化三联手术治疗闭角型青光眼合并轻度白内障的临床疗效。方法:原发性闭角型青光眼合并轻度白内障患者68例(74眼),对象分为A组(36眼):联合手术(超声乳化白内障吸除人工晶状体植入联合小梁切除术);B组(38眼):两阶段手术(先施行小梁切除术,待白内障发展到一定程度再行超声乳化白内障吸除人工晶状体植入)。结果:术后平均随访时间12.2(6～22)mo。视力:A组36眼(100%)>0.5,20眼(56%)>1.0。B组白内障术后视力28眼(74%)>0.5,7眼(18%)>1.0。两组比较差异有显著性(P<0.01,P<0.001)。两组术后平均眼压较术前均明显下降(P<0.001)。两组间术后平均眼压比较,差异无显著性(P>0.05)。无需药物眼压控制率A组为94%,B组为71%,两组比较差异有显著性(P<0.01)。A组术后中央前房深度加深,平均增加约1mm(P<0.05)。B组青光眼滤过手术后中央前房变浅,平均减少0.62mm(P<0.05)。术后发生浅前房14眼(37%)。结论:与两阶段手术相比,超声乳化白内障吸除人工晶状体植入联合小梁切除术治疗原发性闭角型青光眼合并轻度白内障,具有有效控制眼压,视力预后好,前房深度增加、手术难度较低等理想效果。
AIM： To compare the effect of staged procedure versus combined procedure for primary angle-closer glaucomatous patients with coexisting cataract and better visual acuity.
METHODS： We retrospectively evaluated the clinical course of 74 eyes from 68 patients with uncontrolled glaucoma and coexisting cataracts . The eyes were categorized into two groups according to whether stagedprocedure or combined procedure. Group A： 36 eyes with triple procedure, cataract phacoemulsification and intraocular lens implantation combined with trabeculectomy with peripheral iridectomy. Preoperative visual acuity is 0.4-0.6. Mean follow-up was 12.2mo （range, 6-22mo）. Group B： 38 eyes with staged procedure, after successful trabeculectomy, underwent cataract surgery by phacoemul-sification techniques and intraocular lens implantation. The visual acuity before trabeculectomy was 0.4-0.8, before cataract phacoemulsification, 0.01 to 0.2. The average time from initial trabeculectomy to cataract phacoemulsification was 22.8mo （range, 8-52mo）. We analyzed and compared the postoperative visual acuity （VA）, intraocular pressure （IOP） and central anterior chamber depth between the two groups.
RESULTS： In Group A, the postoperative VA of all patients improved in different degrees, with 〉 0.5 in 36 eyes （100%） and 31.0 in 20 eyes （56%）. In Group B, the VA following cataract extraction was better than 0.5 in 28 eyes （74%） and 1.0 or better in 7 eyes （18%）. There was statistically significant difference between the two groups （X^2=8.40,P〈0.01,X^2=11.00,P〈0.001）. Hean intraocular pressure was lowered significantly from 27.15± 8.44mmHg to 12.52 ± 3.25mmHg in Group A （P〈0.001）, from 26.56± 6.23mmHg to 13.9± 4.25 mmHg in Group B after trabeculectomy （P〈0.001）. In Group A, the IOP of 34 eyes （94%） wear controlled with trabeculectomy alone and 2 eyes （6%） were controlled with trabeculectomy and additional medical treatment. In Group B, the IOP of 29 eyes （76%） wear controlled with trabeculectomy alone, 5 eyes （13%） were controlled with trabeculectomy and additional medical treatment and in 4 eyes （10%）, trabeculectomy with medical treatment failed to control the intraocular pressure. Following cataract extraction, the mean IOP increased insignificantly （P〉0.05） by 1.92mmHg. The functional filtering bleb was not apparently cicatrized. The IOP wear controlled under 21mmHg in 37 eyes （97%）, 30 eyes （79%） without additional medical treatment and 7 eyes （18%） with additional medical treatment. The rate of IOP control without additional glaucoma medication was 94% in Group A, 71% in Group B at the time of the late investigation. There was statistically significant difference between the two groups （X^2=6.98, P〈0.01 ）. The central anterior chamber depth increased in all eyes in group A. The mean central anterior chamber depth deepened significantly （P〈0.05） from preoperative 1.62±0.44mm to postoperative 2.56 ± 0.38mm. After trabeculectomy in Group B, the mean central anterior chamber depth decreased significantly （P〈0.05） from preoperative 1.68±0.32mm to postoperative 1.06± 0.38mm. Shallow anterior chamber occurred in 14 eyes （37%）, with grade Ⅰ in 10 eyes （26%）, grade Ⅱ in 3 eyes （8%） and grade Ⅲ in 1 eyes（3% ）. For the cataract extraction of Group B, narrow pupil, caused by the miotic therapy, posterior synechias or changes after glaucoma surgery, made the cataract phacoemulsification difficult in most of the cases. Due to intrasurgical difficulties, application of below additional surgical procedures was necessary： loosening of adhesions, mechanical pupiUary dilation, tearing off fibrous or stained membrane, iridorrhaphy and pupil reconstruction.
CONCLUSION： The triple procedure, combined phacoemulsification, intraocular lens implantation and trabeculectomy is associated with better intraocular pressure control, better visual outcome and less intrasurgical difficulties than staged-procedure for angle-closer glaucomatous patients with coexisting cataract and better visual acuity.
出处
《国际眼科杂志》
CAS
2006年第2期373-376,共4页
International Eye Science
