小梁切除术后白内障超声乳化手术分析

目的:探讨分析抗青光眼小梁切除术后白内障超声乳化摘除联合人工晶状体植入术的手术方法、技巧及效果分析。方法:我院2007-01/2010-12对87例87眼抗青光眼小梁切除术后发生白内障的病例行白内障超声乳化摘除联合人工晶状体植入术,随访6mo,分析术后视力、眼压、并发症等情况。结果:术后随访6mo,87眼术后视力均有不同程度的提高,其中78眼（90％）视力≥0.3;术后眼压均较术前下降;术后并发症主要有角膜水肿（15眼,17％）、虹膜反应（11眼,13％）、前房出血（5眼,6％）、后囊膜混浊（10眼,11％）。结论:对抗青光眼小梁切除术后出现的白内障,行透明角膜切口的白内障超声乳化摘除联合人工晶状体植入术可显著提高视力,保持滤过泡和眼压的稳定,恢复眼前节的组织结构。     

白内障超声乳化术治疗原发性闭角型青光眼临床观察

目的:观察白内障超声乳化术治疗闭角型青光眼术后中央前房深度和眼压的变化及手术疗效.方法:前瞻性病例对照研究.入选病例为原发性急、慢性闭角型青光眼37例49眼,对26眼临床前期或房角检查动态下房角关闭粘连范围≤180°的患者采取白内障超声乳化+后房型折叠式人工晶状体植入术;对23眼动态下房角关闭粘连范围≥180°的患者行白内障超声乳化+人工晶状体植入术+小梁切除术;对有青光眼发作史的所有患眼联合行房角粘连分离术.术后观察视力、眼压、前房深度和房角.随访3mo~2a.结果:术后47眼视力提高,2眼无变化,≥0.5者35眼(71%).术后所有患者眼压明显降低(P<0.01)、前房明显加深(P<0.01),房角增宽.47眼眼压得到长期良好控制.2眼术后1mo眼压再次升高,为慢性闭角型青光眼晚期高眼压下手术的患者.结论:白内障超声乳化人工晶状体植入术可有效治疗原发性闭角型青光眼,可使前房加深、眼压降低、房角增宽;但对房角关闭粘连范围≥180°的患者应同时行小梁切除术.     

超声乳化联合房角分离术治疗闭角型青光眼术后合并白内障

目的观察超声乳化白内障吸出后房型人工晶状体植入术联合房角分离术治疗原发性闭角型青光眼患者小梁切除术后合并白内障患者的临床疗效。方法前瞻性研究方法。纳入符合条件的手术患者35例（38只眼）,行透明角膜切口白内障超声乳化吸除联合后房型人工晶状体植入术并房角分离术,随访6个月至1年,比较观察手术前后视力、眼压情况、中央前房变化情况和房角开放情况。结果所有患者术后视力均有提高。患者术前平均眼压（16．91±3．44）mmHg,术后平均（11．82±2．52）mmHg,差异有统计学意义（P〈0．05）;术前中央前房深度平均（2．10±0．19）mm,术后平均（3．31±0．28）mm,差异有统计学意义（P〈0．05）。术前周边前房深度〈1／2 CT者29只眼,术后28只眼周边前房深度≥1CT。术后房角关闭所在象限均有不同程度的开放,周边虹膜粘连范围明显缩小。2只眼前房出血,3只眼前房渗出,1只眼发生后囊膜破裂,无恶性青光眼、角膜失代偿等并发症。结论超声乳化自内障吸出人工晶状体植入术联合房角分离术治疗青光眼合并白内障患者可有效的降低眼压。     

超声乳化与小梁切除治疗闭角型青光眼的对比

目的 对比研究超声乳化人工晶状体植入术与小梁切除术对初次发作的原发性急性闭角型青光眼的疗效。方法 将58例（58眼）初次发作的原发性急性闭角型青光眼合并白内障者随机分为两组，每组29例（29眼），A组行超声乳化吸出人工晶状体植入术，B组行穿透性小梁切除术。术后随访3～6月。结果 术后随访期间两组视力均有提高，以A组提高明显。A组术后前房深度增加；B组术后前房深度减少，并且有5例术后早期发生了浅前房。术后两组眼压均比术前明显降低，早期以B组下降明显，A组有6例术后1天眼压高于21mmHg（1mmHg=0．133kPa），经局部用药后降至正常。结论 初次发作的合并有白内障的原发性急性闭角型青光眼，若无明显前房角粘连，经药物治疗眼压控制不佳者，采用晶状体超声乳化吸出人工晶状体植入术可以有效地降低眼压恢复视功能，且术后并发症较传统的小梁切除术为少。     

YAG激光虹膜周切术治疗药物难控制性急性闭角型青光眼

目的:探讨YAG激光周边虹膜切除术在药物难控制急性闭角型青光眼治疗中的作用。方法:回顾分析我院住院患者共124例124眼,其中男51例,女73例,入院诊断符合急性闭角型青光眼发作期临床特征,且药物治疗24h后眼压仍>21mmHg的急性闭角型青光眼患者,其中控制眼压为21~35mmHg者51眼(41.1%),眼压36~50mmHg者37眼(29.8%),50mmHg以上者36眼(29.1%)。视力范围为光感~0.3。所有患者均在表面麻醉下行YAG激光周边虹膜切除术治疗,术后继续观察眼压、视力、前房深度变化,眼压控制稳定后分别进行小梁切除术、青光眼白内障联合人工晶状体植入术,或单纯白内障超声乳化吸出联合人工晶状体植入术。结果:患者124例124眼急性闭角性青光眼患者行YAG激光虹膜周切术后,第2d检测眼压≤21mmHg者28眼(22.6%),眼压为22~35mmHg者60眼(48.4%),眼压36~50mmHg者25眼(20.2%),眼压>50mmHg者11眼(8.9%);激光术后视力增加3行者33眼（26.6%）,2行者31眼(25.0%),视力增加1行者44眼(35.5%),视力不增加者16眼(12.9%);119眼前房深度增加(96.0%); YAG激光虹膜周切术后并发前房出血98眼(79.0%)。眼压控制稳定后分别进行小梁切除术37眼,青光眼白内障联合人工晶状体植入术43眼,白内障超声乳化吸出联合人工晶状体植入术44眼。观察随访3~9mo,眼压控制≤18mmHg者95眼,眼压≤25mmHg者24眼,眼压为26~35mmHg者5眼,未见前房积血、黄斑囊样水肿等并发症。结论:YAG激光虹膜周切术在药物难控制性急性闭角型青光眼治疗中能明显降低眼压,为各种青光眼手术的治疗提供安全可靠的条件,有助于视功能保护和恢复,提高疗效。     

超声乳化白内障吸除联合小梁切除术治疗闭角型青光眼合并白内障

目的:观察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闭角型青光眼合并白内障的临床效果。方法:对闭角型青光眼并白内障36例46眼行超声乳化白内障吸除折叠式人工晶状体植入联合小梁切除手术治疗。术前、术后分别详细记录患者视力、眼压、滤过泡、前房深度、房角及眼底情况。结果:术后随访3mo～2a,43眼(93.5%)视力较术前明显提高,44眼(95.7%)眼压保持在正常范围,术后眼压<21mmHg。35例46眼患者前房深度术前平均为2.1±0.3mm,术后平均3.8±0.4mm,术后所有患者前房深度均加深,术前关闭的前房角也有不同程度的开放。6眼(13.0%)角膜水肿,无角膜内皮失代偿。结论:合并白内障的闭角型青光眼患者行超声乳化白内障吸除联合小梁切除术安全有效,能够有效降低眼压、加深前房、开放房角,提高视力。     

闭角型青光眼合并白内障联合手术的疗效观察

目的了解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白内障的疗效。方法选取原发性闭角型青光眼合并白内障患者40例行超声乳化白内障吸除人工晶状体植入联合小梁切除术,记录术后三个月患者的视力、眼压、滤过泡。采用配对t检验,与术前眼压进行比较。结果术后三个月视力0.1-0.3共8只眼,0.4～0.5共22只眼,0.6～1.0共10只眼;眼压在8.7～20.3mmHg范围,平均15.5 mmHg,同术前比较,眼压下降有统计学意义(P<0.05)。未发生严重术中及术后并发症。结论联合手术是有效的安全的治疗青光眼合并白内障的方法。     

小切口小梁切除联合超声乳化白内障吸除术治疗青光眼合并白内障

目的　探讨 3 5mm小切口小梁切除联合超声乳化白内障吸除后房型人工晶状体植入术 (三联手术 )治疗青光眼合并白内障患者的效果。方法　应用小切口三联手术对 2 0例 (2 6只眼 )青光眼合并白内障患者进行手术治疗。术后随访 3～ 41个月 ,平均 16 1个月。结果　术前平均眼压(2 3 0 1± 2 6 3)mmHg(1mmHg =0 133kPa) ,术后随访最终平均眼压降至 (13 93± 1 85 )mmHg(P <0 0 0 1)。术后随访最终矫正视力范围 0 0 5～ 1 0 ,其中≥ 0 6者 17只眼 (6 5 % ) ,术后平均散光度0 81D ,其中 4只眼无散光度。术后早期 2只眼使用降眼压药物 ,随访后期无使用者。术后早期并发症角膜水肿 5只眼 (19% ) ,浅前房 3只眼 (12 % ) ;晚期并发症后发性白内障 6只眼 (2 3% )。结论　小切口三联手术治疗青光眼合并白内障患者 ,具有恢复有用视力、稳定眼压、减少术后用药、并发症少等理想效果。     

Phacotrabeculectomy

The outcome of combined same-site phacoemulsification, posterior chamber lens implantation and trabeculectomy was retrospectively studied in patients with cataract and moderately controlled glaucoma, with a follow-up of at least 6 months. Primary phacotrabeculectomy without antimetabolites was performed in 74 patients. Mean IOP decreased from 22.8 to 14.3 mm Hg (35.3%). A maximum IOP of 19 mm Hg without glaucoma medication was reached in 66.2%. Mean logMAR visual acuity increased from 0.58 to 0.30. Primary phacotrabeculectomy has been shown to be a safe and effective procedure with good IOP control and rapid visual rehabilitation.     

三联术治疗青光眼合并白内障的疗效观察

目的:探讨三联术(白内障超声乳化吸除、后房型人工晶状体植入联合小梁切除术)治疗青光眼合并白内障患者的临床疗效。方法:青光眼合并白内障患者72例72眼行小梁切除联合白内障超声乳化吸除联合后房型人工晶状体植入术,观察术后视力、眼压、滤过泡及并发症等情况。结果:术后72例72眼患者视力均有不同程度的提高;术后眼压控制良好,术后3,18mo平均眼压分别为15.30±2.64mmHg和16.72±2.30mmHg,术后均无严重并发症。结论:小梁切除联合白内障超声乳化吸除联合后房型人工晶状体植入术具有切口小,眼压控制良好,能获得较满意的视力。     

小切口手法非超乳三联术治疗青光眼合并白内障在基层医院的应用

目的探讨小切口白内障囊外摘除联合人工晶状体植入及小梁切除术治疗急性闭角型青光眼合并白内障的临床疗效。方法选择41例41只眼青光眼合并老年性白内障患者作为研究对象,均接受小切口白内障囊外摘除联合人工晶状体植入及小梁切除术治疗,观察手术前后视力、眼压、术后并发症。结果术后随访6个月,平均眼压由术前的31.5±6.5mm Hg降至11.2±3.5mm Hg,差异有统计学意义（P〈0.05）;视力均有不同程度提高,差异有统计学意义（P〈0.05）。所有患者无严重并发症发生。结论白内障囊外摘除联合人工晶状体植入及小梁切除术治疗急性闭角型青光眼合并老年性白内障不仅安全有效、而且术后并发症轻微,值得临床推广应用。     

超声乳化白内障吸除术或联合房角分离术治疗原发性闭角型青光眼

目的:观察超声乳化白内障吸除人工晶状体植入术或同时联合房角分离术治疗原发性闭角型青光眼(Primary angle closure glaucoma,PACG)的临床疗效,探讨手术适应证.方法:PACG患者29例(43眼),均合并不同程度晶状体混浊.根据术前房角粘连关闭的范围不同分为3组:A组16眼,术前房角粘连关闭≤180°,行超声乳化白内障吸除人工晶状体植入术.B组15眼,180°＜术前房角粘连关闭≤270°,C组12眼,术前房角粘连关闭＞270°,B组和C组行超声乳化白内障吸除人工品状体植入联合房角分离术.术后随访9～24(平均12.7±5.4)mo.观察眼压、房角和视力等的变化.结果:A组16眼(100%)、B组14眼(93%)、C组2眼(17%),术后不用任何降眼压药物眼压正常.B组另1眼(7%)局部用药眼压控制正常.C组其余的10眼中,2眼(17%)局部用药眼压＞21mmHg(＜25 mmHg),8眼(67%)行滤过性手术治疗.所有眼术后房角均增宽,术前房角关闭所在象限大部分重新开放.38眼(88%)术后最佳矫正视力提高.结论:超声乳化白内障吸除人工晶状体植入术可有效降低术前房角粘连关闭≤180°,合并有白内障的PACG的眼压,并可改善其视功能.对于180°＜术前房角粘连关闭≤270°的患者,联合房角分离术可获得基本相同的治疗效果.如果术前房角粘连关闭＞270°,则有必要联合小梁切除术.     

原发性闭角型青光眼行超声乳化联合房角分离术后房角改变

目的:观察白内障超声乳化吸除并人工晶状体植入联合房角分离术治疗合并有白内障的原发性闭角型青光眼术前术后房角的改变。方法:回顾性分析合并有白内障的闭角型青光眼患者35例(37眼),其中前房角关闭范围≤180°者16眼,>180°者21眼,均在表面麻醉下行角巩膜隧道切口行白内障超声乳化吸除折叠式人工晶状体植入联合房角分离术,对其手术前后的房角状态,眼压,中央前房深度,视力进行对照观察。结果:随访3～24mo术后房角状态与术前比有3眼大部分开放,余房角均开放,随访期内未见房角关闭及粘连范围扩大,末次随访平均眼压(14.3±4.1)mmHg,较术前用药后平均眼压(26.4±3.2)mmHg明显降低,差异具有统计学意义(t=5.86,P<0.01),中央前房深度由术前的(2.0±0.3)mm,增加到术后的(3.2±0.4)mm,视力除2眼有视神经萎缩外,余均有不同程度提高。结论:对于合并有白内障的闭角型青光眼的治疗,行白内障超声乳化吸除折叠式人工晶状体植入联合房角分离术治疗能有效地降低眼压,开放房角,加深前房,提高视力,与滤过性手术相比,手术并发症少,是有效且安全的手术方法。     

透明角膜切口白内障超声乳化联合青光眼手术的疗效分析

目的:观察透明角膜切口白内障超声乳化人工晶状体植入联合小梁切除术(以下简称超声乳化三联术)治疗青光眼合并白内障的临床疗效和安全性。方法:回顾性分析使用透明角膜切口超声乳化三联术治疗各种类型的青光眼合并白内障患者127例(128眼)手术前、后的视力和眼压,手术并发症和滤过泡情况。结果:术后视力迅速恢复,矫正视力较术前明显提高,随访6mo～2a,113眼≥0.5(88.3%);眼压较术前明显降低,11眼术后眼压<20mmHg,16眼加滴1～2种降压药后眼压控制满意且稳定。术后并发症少,功能性滤过泡83.6%。结论:透明角膜切口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青光眼合并白内障,不但能良好地控制眼压,迅速恢复视力。而且并发症少,手术适应证广,在白内障青光眼并存情况下采用超声乳化三联手术是安全、有效、可靠的治疗方法。     

高度近视白内障超声乳化摘除及负低度数后房型人工晶状体植入术疗效观察

目的:研究超声乳化联合植入负低度数后房型人工晶状体治疗高度近视眼合并白内障的临床效果。方法:对试验组80例100眼高度近视并发白内障实行巩膜隧道切口超声乳化吸除,同时通过5.5mm切口植入PMMA硬性人工晶状体。其中男45例56眼,女35例44眼,年龄44～76(平均61)岁;眼轴长为27.00～35.42(平均30.55)mm。取同期来我院治疗的94例100眼正常眼轴老年性白内障患者作为对照组。观察术中、术后并发症及手术效果。术后随访3～12mo。结果:试验组术后3mo矫正视力≥0.5者为51眼(51.0%),0.1～者43眼(43.0%),<0.1者6眼(6.0%)。术中并发症:后囊膜破裂2眼;晶状体脱位2眼。术后并发症:角膜水肿9眼;视网膜脱离1眼;后发性白内障2眼。对照组术中并发症:晶状体脱位1眼。术后并发症:角膜水肿4眼;后发性白内障2眼。结论:巩膜隧道切口超声乳化联合硬质后房型人工晶状体植入术治疗高度近视并发白内障,具有视力恢复快、屈光状态稳定等优点,是安全有效的方法。     

New Management of Angle—closure Glaucoma by Phacoemulsification with Foldable Posterior Chamber Intraocular Lens Implantation

Objective: To investigate the management oi angle-closure glaucoma byphacoemulsification with foldable posterior chamber intraocular lens (PC-IOL)implantation.Design: Retrospective, noncontrolled interventional case series.Participants: In 36 eyes with angle-closure glaucoma (ACG) , there were 18 eyes withprimary acute angle-closure glaucoma (PACG) , 14 eyes with primary chronicangle-closure glaucoma (PCCG) , 3 eyes with secondary acute angle-closure glaucoma(SACG) and 1 eye with secondary chronic angle-closure glaucoma (SCCG).Intervention: Phacoemulsification with posterior chamber intraocular lens implantation.Main Outcome Measures: Postoperative visual acuity, IOP, axial anterior chamberdepth.Results: After a mean postoperative follow-up time of 8. 81±7. 45 months, intraocularpressure was reduced from a preoperative mean of 23. 81 ±17. 84 mmHg to apostoperative mean of 12. 54 4. 73 mmHg ( P =0. 001). Mean anterior chamber depthwas 1. 75 ± 0. 48 mm preoperatively and 2. 29 ?0. 38 mm postoperatively     

抗青光眼滤过术后白内障摘除术对眼内压长期影响的临床观察

目的探讨抗青光眼滤过术后白内障摘除术对眼内压的长期影响。方法对抗青光眼滤过术后白内障患者69例69眼随机分为三组,分别采用颞侧角巩膜缘切口白内障囊外摘除及人工晶状体植入术(简称ECCE组)(18例18眼)、颞侧角巩膜缘隧道切口超声乳化白内障吸除及人工晶体植入术(简称角巩膜缘超声乳化组)(25例25眼)和上方透明角膜切口超声乳化白内障吸除及折叠式人工晶体植入术(简称透明角膜超声乳化组)(26例26眼),术后平均随访26个月,分别观察眼压和视力并进行比较。结果ECCE组、角巩膜缘超声乳化组、透明角膜超声乳化组术后最后一次随访时平均眼压升高分别为2.75mmHg,1.82mmHg和1.68mmHg,与术前比较,差异均无统计学意义(>0.05);视力改善分别为12眼(70.6%)、23眼(92.0%)和24眼(92.3%);ECCE组与角巩膜缘超声乳化组和透明角膜超声乳化组比较,术后效果低于两种超声乳化组,差异有统计学意义(<0.05),两种超声乳化组间比较,差异无统计学意义(>O.05)。结论抗青光眼滤过术后三种白内障摘除术术后眼压均可有效控制,视力改善,超声乳化白内障吸除术尤其是经透明角膜切口折叠式人工晶体植入术术后长期对眼压影响小,视力恢复快,是目前此类白内障手术的最佳术式。     

Comparison of trabeculectomy with mitomycin C with or without phacoemulsification and lens implantation

PURPOSE: To compare the results of combined trabeculectomy with phacoemulsification and posterior chamber intraocular lens (IOL) implantation to those of trabeculectomy alone using mitomycin C (MMC) application intraoperatively in all cases. PATIENTS AND METHODS: A retrospective comparative study of consecutive patients was conducted on two groups: 102 eyes of 90 patients studied in the combined procedure group, and 33 eyes of 30 patients in the trabeculectomy alone group. RESULTS: Both groups showed a significant decrease in IOP. The combined group had a change from 21.5+/-5.8 mm HG preoperative to 14.73+/-3.44 mm HG postoperative, P=0.0001; the trabeculectomy group changed from 24.2+/-7.5 mm HG preoperative to 12.46+/-3.86 mm HG postoperative, P=0.0001. This represents a 31.5% reduction in IOP in the combined group versus a 48.5% reduction in the trabeculectomy alone group (P=0.0001). The follow-up time was longer in the trabeculectomy group (trabeculectomy group, 22.6+/-13.3 months; combined group, 14.2+/-8.0 months), P=0.0014. There were 97 eyes in the combined group (95%) and 32 eyes (97%) in the trabeculectomy group that had an IOP of less than 20 mm HG at the end of follow up. Postoperatively, the two groups showed similar significant reductions in the number of antiglaucomatous medications used (combined group, 0.82+/-1.0 compared with 2.65+/-0.84 preoperatively, P=0.0001; trabeculectomy group, 0.76+/-1.2 compared with 2.7+/-0.95 preoperatively, P=0.0001). There were no cases of bleb leakage in the combined group and two cases (6%) in the trabeculectomy group. CONCLUSION: The reduction of IOP is significantly larger after trabeculectomy alone than after the combined procedure; however, the functional and anatomical results of the combined procedure of phacoemulsification, posterior chamber IOL implantation, and trabeculectomy with MMC application were as good as those of trabeculectomy alone with MMC.     

Clinical outcomes of 25-gauge vitrectomy surgery for vitreoretinal diseases: comparison of vitrectomy alone and phaco-vitrectomy

AIM: To compare the clinical outcomes of combined 25-gauge pars plana vitrectomy (PPV) and phacoemulsification/posterior chamber intraocular lens (PC-IOL) implantation with vitrectomy alone surgery in patients with various vitreoretinal diseases. METHODS: A total of 306 eyes (145 with PPV alone and 161 with phaco-vitrectomy) were enrolled in this retrospective analysis. The surgical approach was 25-gauge PPV combined with phacoemulsification and PC-IOL implantation at the same time in eyes in phaco-vitrectomy group and only PPV in eyes in vitrectomy alone surgery group. The main outcome measures were postoperative clinical outcomes included anterior chamber inflammation, changes in intraocular pressure (IOP) and best corrected visual acuity (BCVA). RESULTS: The most common postoperative complication was anterior chamber reaction which has higher incidence in phaco-vitrectomy group (P<0.001). The mean postoperative 1st day IOP of vitrectomy alone group was significantly lower than that of phaco-vitrectomy group (16.3±5.8 mm Hg vs 17.8±8.1 mm Hg, respectively, P=0.02). Hypotony (IOP(8 mm Hg) was not different between groups in the postoperative 1st day (P>0.05). The mean preoperative visual acuity was not different between groups (1.6±0.9 logMAR vs 1.8±0.9 logMAR, respectively, P>0.05). However, the mean visual acuity was decreased in vitrectomy alone group at the final visit compared to phaco-vitrectomy group (1.2±0.8 logMAR, 0.9±0.7 logMAR, respectively P<0.05). CONCLUSION: Twenty-five gauge PPV combined with phacoemulsification surgery is a safe and efficient procedure, which can be preferred in phacic patients with a variety of vitreoretinal diseases compared to vitrectomy alone. Despite improved outcomes, this approach is not free of limitations as anterior chamber complications especially with combined surgery.     

白内障超声乳化在闭角型青光眼中的应用

目的探讨白内障超声乳化吸除合并人工晶状体（intraocular lens，IOL）植入术对伴有白内障的闭角型青光眼的手术效果。方法对31例（33眼）闭角型青光眼伴白内障患者行白内障超声乳化吸除合并IOL植入术。观察手术前后前房角、前房深度、眼压及视力变化。术后随访1.5-3年。结果术后所有术眼眼压下降，平均（14.99±0.65）mmHg（1mmHg=0.133kPa），比术前用药后平均眼压（24.43±1.61）mmHg明显降低。手术前后眼压差异有显著性（t=5.28，P=0.000）。UBM检查中央前房深度，由术前的（1.60±0.25）mm增加到术后的（3.30±0.35）mm，两者差异有显著性（t=6.24，P=0.000）；术后前房角宽度均增加,房角开放。前房角镜检查前房角均增宽，睫状体带易于看见。术后视力明显提高（X^2=63.47，P〈0.01）。结论对由晶状体因素引起的瞳孔阻滞型闭角型青光眼合并白内障患者，白内障超声乳化吸除合并IOL植入术是可供选择的治疗方法之一。