超声乳化白内障吸除术对功能性滤过泡形态和功能的影响

目的 评价超声乳化白内障吸除术对小梁切除术后有功能性滤过泡的患者的眼压及滤过泡形态的影响,并分析可能造成手术后眼压升高的危险因素.方法 前瞻性系列病例研究.选择2005年11月到2006年10月于我院就诊,需要行超声乳化白内障吸除术的具有功能性滤过泡的全部患者,完成2年随访的共20人(共25只眼).记录超声乳化白内障吸除术前及术后1、3、6、12、24个月的眼压和抗青光眼药物的使用情况;手术前、术后1个月及术后2年进行超声活体显微镜(UBM)检查.Kaplan-Meier法计算生存率,并结合UBM形态学测最结果分析造成超声乳化白内障吸除术后眼压升高的危险因素.对于患者手术前后的眼压及UBM的相关测量值进行配对t检验.声乳化白内障吸除术前后患者的眼压及抗青光眼的药物种类进行配对t检验.结果 超声乳化白内障吸除术前及术后各随访时间点的眼压分别为(15.8±5.1)、(13.7±3.6)、(13.6±3.3)、(14.4±4.1)、(14.2±3.6)、(13.8±3.5)mm Hg(1 mm Hg=0.133 kPa)(t=2.933,3.186,2.275,2.262,3.173;P=0.007,0.004,0.021,0.033,0.004).超声乳化白内障吸除术前后使用的抗青光眼药物数量分别为每眼(0.2±0.6)和(0.3±0.7)种,差异无统计学意义(t=-1.440,P=0.265).Log-rank分析超声乳化白内障吸除术后眼压升高的危险因素有手术前眼压高于15 mm Hg(P=0.042),手术后短期内出现滤过泡的高度下降大于10%和滤过泡的内反射增强.结论 对曾经进行过小梁切除术并有功能性滤过泡的患者进行超声乳化白内障吸除术,长期随访发现眼压控制良好,超声乳化白内障吸除术对外滤过功能无影响.超声乳化白内障吸除术前眼压高于15 mm Hg,术后短期出现滤过泡的明显变小和内反射增强是眼压升高的危险因素.

The effect of phacoemulsification on eyes with preexisting functional filtering blebs

Objective To investigate the effect of clear corneal phacoemulsification on filtering bleb morphology and filtering function in glaucoma eyes with functional filtering blebs.Analysis the risk factors of intraocular pressure (IOP) increasement after phacoemulsification.Method It was a prospective series case study.Twenty-five eyes of 20 Chinese patients who had undergone clear corneal phacoemulsification after trabeculectomy were enrolled, lOP and the numbers of antiglaucoma medicine before and 1 month,3 months, 6 months, 12 months and 24 months after phacoemulsification were recorded.Ultrasound Biomicroscopy was conducted preoperatively, 1 month and 24 months postoperatively.Compare the IOP and the numbers of antiglaucoma medicines before and after phacoemulsification by student t test.Risk factors were evaluated for association with loss of IOP control requiring additional medications or further glaucoma surgery, using Kaplan-Meier survival analysis.Results The IOP was (15.8±5.1)mm Hg(1 mm Hg=0.133 kPa), (13.7±3.6)mm Hg, (13.6±3.3)mm Hg, (14.4±4.1)mm Hg, (14.2±3.6)mm Hg,(13.8±3.5) mm Hg (P=0.007, 0.004, 0.021,0.033, 0.004) before and at 1,3,6,12,24 months after phacoemulsification.The numbers of antiglaucoma medicine were 0.2±0.6 and 0.3±0.7 before and after phacoemulsification (P=0.265).Log-rank analysis the risk factors include IOP higher than 15 mm Hg before phacoemulification (P=0.042), bleb height decreased more than 10% 1 month after phacoemulification (P=0.037) and the intrableb reflectivity increase (P=0.001).Conclusions Phacoemulsification on eyes with functional filtering bleb did not affect the filtering function.Risk factors of loss of IOP control include IOP higher than 15 mm Hg before phacoemulification,bleb height decreased more than 10% and the intrableb reflectivity increase in a short term after phacoemulification.