双切口小梁切除联合超声乳化人工晶状体植入术治疗青光眼合并白内障
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摘要
目的:探讨双切口小梁切除联合超声乳化人工晶状体植入三联手术治疗青光眼合并白内障的效果。方法:选取我院2014-06/2016-01期间收治的急慢性闭角型青光眼合并白内障患者36例40眼,所有患者均采用双切口小梁切除联合超声乳化人工晶状体植入三联手术进行治疗。术后对所有患者均进行1mo随访,比较患者手术前后的视力、前房深度、前房角开放范围、眼压,同时观察患者的术后滤过泡情况以及术中、术后的并发症发生情况。结果:所有患者术前的眼压19~36(平均26.02±2.42)mmH g,术后1mo眼压11~22(平均13.62±4.38)mmH g,手术前后眼压比较差异有统计学意义(t=33.273,P<0.05)。术前视力<0.3者34眼(85.0%),术后视力>0.3者21眼(53%)。所有患者患眼在术后均形成良好滤过泡。36例患者术后的房角开放程度、前房角开放距离以及中央前房深度等均较术前有明显增加,差异具有统计学意义(t=5.832、5.924、33.293,P<0.05)。术后7眼出现角膜轻度水肿,均在术后3d内消失;1眼在虹膜切除时出血,2d后被吸收;4眼出现人工晶状体表面及前房纤维素渗出,术后6d内吸收,无其他严重并发症情况出现。结论:双切口小梁切除联合超声乳化人工晶状体植入三联手术治疗青光眼合并白内障能够有效改善患者的视力,并且能够较好地控制患者术后的眼压。
AIM:To investigate the effect of double incision trabeculectomy combined with phacoemulsification and intraocular lens implantation for the treatment of glaucoma complicated with cataract.METHODS:Selected 36 patients(40 eyes) with acute or chronic angle-closure glaucoma and cataract in our hospital from June 2014 to January 2016 were treated with double incision trabeculectomy combined phacoemulsification and intraocular lens implantation.All patients were followed up for 1mo to observe preoperative and postoperative visual acuity,anterior chamber depth,scope of anterior chamber angle open and intraocular pressure.At the same time,we observed the patients' postoperative filtering bleb and intraoperative and postoperative complications.RESULTS:Intraocular pressure before treatment were between 19-36 mmHg,the average was 26.02 ± 2.42 mmHg,and after the treatment intraocular pressure was patients between 11-22 mmHg,the average was 13.62±4.38 mmHg,preoperative and postoperative intraocular pressure had the obvious difference(t=33.273,P<0.05).Preoperatively 85.0%(32 cases,34 eyes) was with vision less than 0.3,and 53%(19 cases,21 eyes) after surgery with eyesight over 0.3.All of the eyes formed good filtering bleb after surgery.Scope of anterior chamber angle open,anterior chamber angle open distance and central anterior chamber depth after operation increased in 36 cases compared with preoperative(t = 5.832,5.924,33.293,P<0.05).There were 7 eyes with mild edema of the cornea,all disappear within 3d after surgery;one eye with bleeding when the iris was cut and absorbed after2d;4 eyes with fibrin effusion on lens surface and anterior chamber and absorbed with 6d.There were not any other severe complication in this study.CONCLUSION:Double incision trabeculectomy combined with phacoemulsification and intraocular lens implantation for glaucoma with cataract can effectively improve the patient's vision,and can better control the intraocular pressure after surgery.
AIM:To investigate the effect of double incision trabeculectomy combined with phacoemulsification and intraocular lens implantation for the treatment of glaucoma complicated with cataract.METHODS:Selected 36 patients(40 eyes) with acute or chronic angle-closure glaucoma and cataract in our hospital from June 2014 to January 2016 were treated with double incision trabeculectomy combined phacoemulsification and intraocular lens implantation.All patients were followed up for 1mo to observe preoperative and postoperative visual acuity,anterior chamber depth,scope of anterior chamber angle open and intraocular pressure.At the same time,we observed the patients' postoperative filtering bleb and intraoperative and postoperative complications.RESULTS:Intraocular pressure before treatment were between 19-36 mmHg,the average was 26.02 ± 2.42 mmHg,and after the treatment intraocular pressure was patients between 11-22 mmHg,the average was 13.62±4.38 mmHg,preoperative and postoperative intraocular pressure had the obvious difference(t=33.273,P<0.05).Preoperatively 85.0%(32 cases,34 eyes) was with vision less than 0.3,and 53%(19 cases,21 eyes) after surgery with eyesight over 0.3.All of the eyes formed good filtering bleb after surgery.Scope of anterior chamber angle open,anterior chamber angle open distance and central anterior chamber depth after operation increased in 36 cases compared with preoperative(t = 5.832,5.924,33.293,P<0.05).There were 7 eyes with mild edema of the cornea,all disappear within 3d after surgery;one eye with bleeding when the iris was cut and absorbed after2d;4 eyes with fibrin effusion on lens surface and anterior chamber and absorbed with 6d.There were not any other severe complication in this study.CONCLUSION:Double incision trabeculectomy combined with phacoemulsification and intraocular lens implantation for glaucoma with cataract can effectively improve the patient's vision,and can better control the intraocular pressure after surgery.
引文
1唐建明,赵婕,熊毅,等.青光眼伴白内障双切口三联手术的效果观察.中华眼外伤职业眼病杂志2014;36(1):31-33
2潘丽梅,王朝瑜,刘正聪,等.两种术式对白内障合并青光眼患者的眼压、视力以及浅前房影响的比较.医学综述2016;22(13):2699-2701,2702
3陈美玲.超声乳化联合小梁切除术治疗老年青光眼合并白内障65例.陕西医学杂志2014;43(11):1520-1520,1552
4胡丰平,张燕,董立红,等.不同手术方式治疗青光眼合并白内障患者的疗效比较.安徽医学2016;37(2):175-177
5 Lee TH,Heo H,Park SW.Clinical usefulness of spectral-domain optical coherence tomography in glaucoma and NAION.Chonnam Med J2016;52(1):194-200
6李春玲.白内障超声乳化吸除治疗原发性闭角型青光眼合并白内障观察.中国实用眼科杂志2012;30(2):156-159
7 Sabur H,Baykara M,Can B.Laser intervention on trabeculoDescemet's membrane after resistant viscocanalostomy:selective 532nm gonioreconditioning or conventional 1064nm neodymiumdoped yttrium aluminum garnet laser goniopuncture.Indian J Ophthalmol 2016;64(2):568-571
8孔庆健.超声乳化联合小梁切除术治疗青光眼合并白内障临床疗效观察.国际眼科杂志2011;11(2):324-325
9 Paul C,Sengupta S,Choudhury S,et al.Prevalence of glaucoma in Eastern India:the hooghly river glaucoma study.Indian J Ophthalmol2016;64(2):578-583
10吴燕,肖建江,沈秋杰,等.同期实施小梁切除与超声乳化术治疗青光眼合并白内障的疗效.中国老年学杂志2012;32(24):5584-5585
11 Venugopal N,Kummararaj S.Comment on:Childhood optic atrophy in biotinidase deficiency.Indian J Ophthalmol 2016;64(2):614
12陈宾,马坚.两种术式联合治疗白内障合并青光眼的疗效分析.国际眼科杂志2013;13(2):363-364
13 Stahon KE,Bastian C,Auid O,et al.Age-related changes in axonal and mitochondrial ultrastructure and function in white matter.J Neurosci2016;36(39):9990-10001
2潘丽梅,王朝瑜,刘正聪,等.两种术式对白内障合并青光眼患者的眼压、视力以及浅前房影响的比较.医学综述2016;22(13):2699-2701,2702
3陈美玲.超声乳化联合小梁切除术治疗老年青光眼合并白内障65例.陕西医学杂志2014;43(11):1520-1520,1552
4胡丰平,张燕,董立红,等.不同手术方式治疗青光眼合并白内障患者的疗效比较.安徽医学2016;37(2):175-177
5 Lee TH,Heo H,Park SW.Clinical usefulness of spectral-domain optical coherence tomography in glaucoma and NAION.Chonnam Med J2016;52(1):194-200
6李春玲.白内障超声乳化吸除治疗原发性闭角型青光眼合并白内障观察.中国实用眼科杂志2012;30(2):156-159
7 Sabur H,Baykara M,Can B.Laser intervention on trabeculoDescemet's membrane after resistant viscocanalostomy:selective 532nm gonioreconditioning or conventional 1064nm neodymiumdoped yttrium aluminum garnet laser goniopuncture.Indian J Ophthalmol 2016;64(2):568-571
8孔庆健.超声乳化联合小梁切除术治疗青光眼合并白内障临床疗效观察.国际眼科杂志2011;11(2):324-325
9 Paul C,Sengupta S,Choudhury S,et al.Prevalence of glaucoma in Eastern India:the hooghly river glaucoma study.Indian J Ophthalmol2016;64(2):578-583
10吴燕,肖建江,沈秋杰,等.同期实施小梁切除与超声乳化术治疗青光眼合并白内障的疗效.中国老年学杂志2012;32(24):5584-5585
11 Venugopal N,Kummararaj S.Comment on:Childhood optic atrophy in biotinidase deficiency.Indian J Ophthalmol 2016;64(2):614
12陈宾,马坚.两种术式联合治疗白内障合并青光眼的疗效分析.国际眼科杂志2013;13(2):363-364
13 Stahon KE,Bastian C,Auid O,et al.Age-related changes in axonal and mitochondrial ultrastructure and function in white matter.J Neurosci2016;36(39):9990-10001