小切口白内障摘除联合小梁切除术治疗开角型青光眼

Trabeculectomy combined with small incision extracapsular cataract extraction and intraocular lens implantation for primary open angle glaucoma coexisting with cataract

摘要:

目的:观察小切口白内障囊外摘除、后房型人工晶状体植入联合小梁切除术治疗合并白内障的开角型青光眼的疗效。方法:回顾分析2004-01/2010-06在我院住院行小切口白内障囊外摘除、后房型人工晶状体植入联合小梁切除术且资料完整的32例56眼开角型青光眼的疗效,根据患者年龄、眼球筋膜情况、视神经受损程度及术后要求达到的靶眼压确定术中用或不用丝裂霉素C(MMC),其中29眼术中使用MMC,27眼不使用MMC,患者均有明显的晶状体混浊。随访6～24(平均14.2±6.7)mo。结果:术中使用MMC组29眼,术前眼压(39.2±10.6)mmHg,术后眼压(13.2±5.5)mmHg,仅1眼需辅助1种局部降眼压药。不使用MMC组27眼,术前眼压(30.1±9.2)mmHg,术后眼压(17.5±8.1)mmHg,有4眼需辅助1种局部降眼压药,1眼需辅助2种局部降眼压药,1眼再手术。术后不需使用降眼压药者49眼(88%)。术后47眼(84%)最佳矫正视力提高。结论:小切口白内障囊外摘除、后房型人工晶状体植入联合小梁切除术可有效治疗合并白内障的开角型青光眼。

Abstract:

·AIM:To assess the outcome of trabeculectomy combined with small incision extracapsular cataract extraction and intraocular lens(IOL)implantation for the treatment of primary open angle glaucoma coexisting with cataract.·METHODS:A retrospective analysis of postoperative intraocular pressure(IOP)in 32 patients 56 eyes with primary open angle glaucoma between January 2004 and June 2010 were undertook.All patients had undergone simultaneous trabeculectomy,cataract extraction and posterior chamber IOL implantation.According to the age,the amount of glaucoma damage,and the target pressure,mitomycin C(MMC)was applied in 29 eyes,however 27 eyes were not applied.The mean follow-up duration was 14.2±6.7 months.·RESULTS:The mean IOP was reduced from preoperatively(39.2±10.6)mmHg to postoperatively(13.2±5.5)mmHg in the MMC group,the mean IOP was reduced from preoperatively(30.1±9.2)mmHg to postoperatively(17.5±8.1)mmHg in the cataract extraction and trabeculectomy alone group.Most subjects(88%)were able to discontinue all glaucoma medications.The best-corrected visual acuity was improved in 47 of 56 eyes(84%).·CONCLUSION:Trabeculectomy combined with small incision extracapsular cataract extraction and IOL implantation are effective as an initial surgical treatment for open angle glaucoma in glaucoma patients coexisting with cataract.·