超声乳化术对小梁切除术患者眼压及滤过泡功能的影响

目的：观察使用丝裂霉素C小梁切除术成功/合格史的患者超声乳化术后眼压(IOP)控制及滤过泡功能。

方法：回顾性队列研究。收集2013-01-01/2015-12-31期间接受小梁切除术并随后进行白内障手术患者的数据。所有患者都曾成功/合格地进行过小梁切除术。他们通过透明角膜切口进行了简单的超声乳化手术。用Goldmann眼压计进行术后眼压随访，复查滤过泡情况。观察术后IOP控制、视力改善、抗青光眼药物的数量以及从小梁切除术到超声乳化术的时间，并与对照组进行比较。

结果：共13例15眼患者满足了研究标准，并且在小梁切除术后进行了简单的超声乳化术。其中2眼为继发性青光眼，13眼为原发性青光眼。所有的超声乳化术均在小梁切除术后至少6mo进行(平均14.7±4.3mo)。白内障术前仅1眼(6.7%)需要抗青光眼药物治疗，超声乳化术1a后，增加到4眼(26.7%)，超声乳化术2a后，进一步增加到8眼(53.3%)。术后2a所需抗青光眼药水的数量在2～4种之间。在15眼中，白内障术前(平均13.4±2.9 mmHg)与超声乳化术后1a(平均14.1±3.2 mmHg，P=0.357)和2a(平均15.1±3.3 mmHg，P=0.212)的IOP控制无显著性差异。然而，术前平均LogMAR视力为1.52±1.00， 术后平均视力为0.53±0.54，超声乳化术后的视力改善是显著的(P=0.000)。

结论：结果显示，在不影响眼压控制的情况下，小梁切除术后白内障患者的视力明显改善。然而，手术后，特别是白内障手术后2a，抗青光眼眼药水的使用数量增加，证明了术后滤过泡功能的降低。白内障超声乳化手术后，患者应该被告知重新开始服用抗青光眼药物的可能性。白内障和青光眼手术的时机和顺序应优化，以获得最佳的手术效果。

Effect of phacoemulsification on intraocular pressure and bleb function in eyes with previous trabeculectomy

AIM: To observe the intraocular pressure(IOP)control and bleb function after phacoemulsification in patients with previous history of successful/qualified success mitomycin-C augmented trabeculectomy.

METHODS: This was a retrospective cohort study. Data of patients who had undergone trabeculectomy between 1^st January 2013 to 31^st Dec 2015 with subsequent cataract surgery were extracted from server. All patients had previous either success/qualified success trabeculectomy done. They went through uncomplicated phacoemulsification via clear corneal incision. Postoperative follow-up, review of bleb and IOP readings using Goldmann tonometer were taken. Details that were investigated include postoperative IOP control, visual improvement, number of anti-glaucoma medications, as well as the timing from trabeculectomy to phacoemulsification. Comparison with control group was made.

RESULTS: Fifteen eyes from thirteen patients fulfilled the criteria for study and had undergone uncomplicated phacoemulsification on a post-trabeculectomy eye. Two of the eyes had secondary glaucoma while the other thirteen had primary glaucoma. All phacoemulsifications were done at least 6mo after trabeculectomy(mean 14.7±4.3mo). There was only 1 eye(6.7%)requiring anti-glaucoma medications before the cataract surgery. This number increased to 4(26.7%)at 1-year post-phacoemulsification. The number further increased to eight(53.3%)at 2y post-phacoemulsification. The number of anti-glaucoma drops needed after surgery at 2y ranged from 2-4. In all the 15 eyes, there was no statistically significant change in IOP control between pre-cataract surgery(mean 13.4±2.9 mmHg)compared to 1y(mean 14.1±3.2 mmHg, P=0.357)and 2y(mean 15.1±3.3 mmHg, P=0.212)post-phacoemulsification. Visual improvement after phacoemulsification however is significant, from a preoperative average visual acuity of LogMAR 1.52±1.00 to a postoperative average visual acuity of 0.53±0.54(P=0.000, paired t-test).

CONCLUSION: This analysis shows significant visual improvement following cataract surgery in post-trabeculectomy patients without compromising IOP control. However, a reduced bleb function is noted following the surgery evidenced by the increase in number of anti-glaucoma drops used after surgery especially two years after the cataract surgery. Patients should be counselled regarding the possibility of restarting on anti-glaucoma medications post-phacoemulsification. The timing and sequence of cataract and glaucoma surgery should be optimized for best outcome.