四环单结瞳孔成形术在青光眼白内障联合手术中的应用
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摘要
目的:观察四环单结瞳孔成形术在青光眼白内障联合手术中的应用效果。方法:收集2015-08/2018-03我院青光眼急性发作后大瞳孔且合并有白内障的患者28例30眼。所有患者均行白内障超声乳化吸除与人工晶状体植入,联合房角分离或小梁切除术及四环单结瞳孔成形术治疗。观察术前及术后7d的矫正视力、瞳孔直径、术中及术后并发症,并进行术前和术后3mo的视觉质量调查。结果:术后7d矫正视力较术前有明显提高,且术后无复视、眩光等视觉不良反应。术前瞳孔直径5.9±0.25mm,术后7d为4.1±0.13mm(P<0.05)。术后3mo视觉质量较术前有较大提高(P<0.05)。术中并发症:有5例5眼缝合出现虹膜分层撕脱,1例1眼成形瞳孔旁出现小裂孔,3例3眼虹膜根部少量渗血,经相应处理后均恢复良好。术后早期并发症以前房炎症反应常见,抗炎治疗后炎症吸收。长期观察未见瞳孔区线结松动、脱落。结论:四环单结瞳孔成形术操作简单、安全、有效,能明显消除因青光眼急性发作后由大瞳孔引起的复视、眩光等视觉障碍。
·AIM: To observe the application effect of single-pass four-throw pupilloplasty in combined surgery of cataract and glaucoma.·METHODS: Twenty eight patients(30 eyes) suffered from acute attack of glaucoma with large pupil and cataract, received cataract phacoemulsification and intraocular lens implantation combined with angle separation or trabeculectomy and single-pass four-throw pupilloplasty in apllication. Preoperative and postoperative visual acuity, pupil diameter and complications were observed, and postoperative visual quality were measured.·RESULTS: The visual acuity of 7 d after operation was significantly improved without double vision and glare. The preoperative pupil diameter was 5.9+0.25 mm, and the postoperative was 4.1±0.13 mm(P<0.05). Postoperative visual quality was significantly improved(P<0.05). Among the intraoperative complications, there were 5 cases 5 eyes of iridodelamination avulsion after suture, 1 case 1 eye of small holes near the formed pupil and 3 cases 3 eyes of small blood seepage at the iris root, which recovered well after the corresponding treatment. The inflammation of anterior chamber were common at the early postoperative period, and inflammatory absorption after anti-inflammatory treatment. Long-term observation showed no loosening or shedding of the line knot in the pupil area.·CONCLUSION: Single-pass four-throw pupilloplasty is simple, safe and effective. It can obviously eliminate the visual impairment caused by the large pupil after acute glaucoma attack.
·AIM: To observe the application effect of single-pass four-throw pupilloplasty in combined surgery of cataract and glaucoma.·METHODS: Twenty eight patients(30 eyes) suffered from acute attack of glaucoma with large pupil and cataract, received cataract phacoemulsification and intraocular lens implantation combined with angle separation or trabeculectomy and single-pass four-throw pupilloplasty in apllication. Preoperative and postoperative visual acuity, pupil diameter and complications were observed, and postoperative visual quality were measured.·RESULTS: The visual acuity of 7 d after operation was significantly improved without double vision and glare. The preoperative pupil diameter was 5.9+0.25 mm, and the postoperative was 4.1±0.13 mm(P<0.05). Postoperative visual quality was significantly improved(P<0.05). Among the intraoperative complications, there were 5 cases 5 eyes of iridodelamination avulsion after suture, 1 case 1 eye of small holes near the formed pupil and 3 cases 3 eyes of small blood seepage at the iris root, which recovered well after the corresponding treatment. The inflammation of anterior chamber were common at the early postoperative period, and inflammatory absorption after anti-inflammatory treatment. Long-term observation showed no loosening or shedding of the line knot in the pupil area.·CONCLUSION: Single-pass four-throw pupilloplasty is simple, safe and effective. It can obviously eliminate the visual impairment caused by the large pupil after acute glaucoma attack.
引文
1 Mangione CM, Lee PP, Gutierrez PR, et al. Development of the 25-item National Eye Institute Visual Function Question-naireJ3. Arch Ophthalmol 2001;119(7):1050-1058
2吴仲新, 仲明, 朱萍, 等.改良瞳孔成形术在青光眼性瞳孔散大合并白内障手术中的应用.中国眼耳鼻喉科杂志2017;17(6):395-398
3杨鑫, 张凤妍, 方梦圆.瞳孔成形术的临床观察.中华眼外伤职业眼病杂志2012;34(6):438-440
4冯其高, 赖铭莹, 田汝银, 等.白内障超声乳化联合瞳孔成形术治疗闭角型青光眼.中国实用眼科杂志2011;29(12):1269-1271
5何守志.眼科显微手术.北京:人民军医出版社1994:104-124
6党光福, 郑秀云, 郑秀华, 等.虹膜缝合瞳孔成型术治疗病理性瞳孔散大的临床研究.中国实用眼科杂志2007;25(1):66-68
7肖博文, 曹维, 李俊岭.人工晶状体睫状沟缝线固定联合瞳孔成形术.中华眼外伤职业眼病杂志2014;36(7):511-514
8刘奕志.白内障手术学.第3版.北京:人民军医出版社2012:364-366
9 Narang P, Agarwal A, Kumar DA. Single-pass four-throw pupilloplasty for angle-closure glaucoma. Indian J Ophthalmol 2018;66(1):120-124
10郭海科, 崔颖, 张洪洋, 等.瞳孔成形联合人工晶状体植入术的临床研究.眼科新进展2010;30(5):466-468
11 Guyatt GH, Ferrans CE, Halyard MY, et al. Exploration of the value of health-related quality-of-life information from clinical research and into clinical practice. Mayo Clin Proc 2000;82(10):1229-1239
12何吕福, 余相均, 赵士鑫, 等.后发性白内障患者行后囊膜切开术后视觉相关生活质量的评价.中华实验眼科杂志2014;32(4):346-349
13 Brody BL, Gamst AC, Williams RA, et al. Depression, visual acuity, comorbidity, and disability associated with age-related macular degeneration. Ophthalmology 2001;108(10):1893-1900
2吴仲新, 仲明, 朱萍, 等.改良瞳孔成形术在青光眼性瞳孔散大合并白内障手术中的应用.中国眼耳鼻喉科杂志2017;17(6):395-398
3杨鑫, 张凤妍, 方梦圆.瞳孔成形术的临床观察.中华眼外伤职业眼病杂志2012;34(6):438-440
4冯其高, 赖铭莹, 田汝银, 等.白内障超声乳化联合瞳孔成形术治疗闭角型青光眼.中国实用眼科杂志2011;29(12):1269-1271
5何守志.眼科显微手术.北京:人民军医出版社1994:104-124
6党光福, 郑秀云, 郑秀华, 等.虹膜缝合瞳孔成型术治疗病理性瞳孔散大的临床研究.中国实用眼科杂志2007;25(1):66-68
7肖博文, 曹维, 李俊岭.人工晶状体睫状沟缝线固定联合瞳孔成形术.中华眼外伤职业眼病杂志2014;36(7):511-514
8刘奕志.白内障手术学.第3版.北京:人民军医出版社2012:364-366
9 Narang P, Agarwal A, Kumar DA. Single-pass four-throw pupilloplasty for angle-closure glaucoma. Indian J Ophthalmol 2018;66(1):120-124
10郭海科, 崔颖, 张洪洋, 等.瞳孔成形联合人工晶状体植入术的临床研究.眼科新进展2010;30(5):466-468
11 Guyatt GH, Ferrans CE, Halyard MY, et al. Exploration of the value of health-related quality-of-life information from clinical research and into clinical practice. Mayo Clin Proc 2000;82(10):1229-1239
12何吕福, 余相均, 赵士鑫, 等.后发性白内障患者行后囊膜切开术后视觉相关生活质量的评价.中华实验眼科杂志2014;32(4):346-349
13 Brody BL, Gamst AC, Williams RA, et al. Depression, visual acuity, comorbidity, and disability associated with age-related macular degeneration. Ophthalmology 2001;108(10):1893-1900