中国实用眼科杂志
中國實用眼科雜誌
중국실용안과잡지
CHINESE JOURNAL OF PRACTICAL OPHTHALMOLOGY
2010年
1期
37-39
,共3页
青光眼%白内障%小梁切除术%小切口白内障晶体摘除术%人工晶状体植入术
青光眼%白內障%小樑切除術%小切口白內障晶體摘除術%人工晶狀體植入術
청광안%백내장%소량절제술%소절구백내장정체적제술%인공정상체식입술
Glaucoma%Cataract%Trabeculectomy%NF%IOL
目的 探讨治疗青光眼合并白内障3种手术方式的适应证和临床疗效.方法 对青光眼合并白内障患者135例152只眼进行手术分组:其中30例36只眼先行抗青光眼手术,待白内障发展到一定程度再行白内障手术,即所谓的两阶段手术(A组);87例98只眼行-白联合手术-复合式小梁切除联合小切口白内障晶体吸除+人工晶状体植入术(B组);18例18只眼行单纯白内障手术+人工晶状体植入术(C组).比较不同适应证下3种手术方式的临床疗效,包括眼压控制情况、角膜内皮细胞、视力以及术后并发症等.随访时间(12±1)月.结果 均经统计学处理.结果 手术前后视力≥0.2的眼数3组比较,差异有统计学意义(x~2=16.00,P<0.01).A组与B组手术前后眼压有显著性差异(t_1=1.89,P_1=0.01:t_2=2.87,P_2=0.03),C组手术前后无显著性差异(t=0.43,P=0.78).术前术后角膜内皮细胞数量无显著性差异(P>0.05),3组均未见严重术中并发症,其个A组滤泡形成良好,眼压控制满意,B组术后角膜水肿17例,未特殊处理,1周后全部消退;有2只眼出现瞳孔区纤维膜,滤泡形成欠理想.C组术后视力均显著捉高,有2只眼轻度角膜水肿,有2只眼需加用药物控制眼压,其中1只眼最后接受抗青光眼手术.结论 青光眼合并白内障患者应根据具体情况选择适当的手术方式,以获得较好的视力和眼压控制.
目的 探討治療青光眼閤併白內障3種手術方式的適應證和臨床療效.方法 對青光眼閤併白內障患者135例152隻眼進行手術分組:其中30例36隻眼先行抗青光眼手術,待白內障髮展到一定程度再行白內障手術,即所謂的兩階段手術(A組);87例98隻眼行-白聯閤手術-複閤式小樑切除聯閤小切口白內障晶體吸除+人工晶狀體植入術(B組);18例18隻眼行單純白內障手術+人工晶狀體植入術(C組).比較不同適應證下3種手術方式的臨床療效,包括眼壓控製情況、角膜內皮細胞、視力以及術後併髮癥等.隨訪時間(12±1)月.結果 均經統計學處理.結果 手術前後視力≥0.2的眼數3組比較,差異有統計學意義(x~2=16.00,P<0.01).A組與B組手術前後眼壓有顯著性差異(t_1=1.89,P_1=0.01:t_2=2.87,P_2=0.03),C組手術前後無顯著性差異(t=0.43,P=0.78).術前術後角膜內皮細胞數量無顯著性差異(P>0.05),3組均未見嚴重術中併髮癥,其箇A組濾泡形成良好,眼壓控製滿意,B組術後角膜水腫17例,未特殊處理,1週後全部消退;有2隻眼齣現瞳孔區纖維膜,濾泡形成欠理想.C組術後視力均顯著捉高,有2隻眼輕度角膜水腫,有2隻眼需加用藥物控製眼壓,其中1隻眼最後接受抗青光眼手術.結論 青光眼閤併白內障患者應根據具體情況選擇適噹的手術方式,以穫得較好的視力和眼壓控製.
목적 탐토치료청광안합병백내장3충수술방식적괄응증화림상료효.방법 대청광안합병백내장환자135례152지안진행수술분조:기중30례36지안선행항청광안수술,대백내장발전도일정정도재행백내장수술,즉소위적량계단수술(A조);87례98지안행-백연합수술-복합식소량절제연합소절구백내장정체흡제+인공정상체식입술(B조);18례18지안행단순백내장수술+인공정상체식입술(C조).비교불동괄응증하3충수술방식적림상료효,포괄안압공제정황、각막내피세포、시력이급술후병발증등.수방시간(12±1)월.결과 균경통계학처리.결과 수술전후시력≥0.2적안수3조비교,차이유통계학의의(x~2=16.00,P<0.01).A조여B조수술전후안압유현저성차이(t_1=1.89,P_1=0.01:t_2=2.87,P_2=0.03),C조수술전후무현저성차이(t=0.43,P=0.78).술전술후각막내피세포수량무현저성차이(P>0.05),3조균미견엄중술중병발증,기개A조려포형성량호,안압공제만의,B조술후각막수종17례,미특수처리,1주후전부소퇴;유2지안출현동공구섬유막,려포형성흠이상.C조술후시력균현저착고,유2지안경도각막수종,유2지안수가용약물공제안압,기중1지안최후접수항청광안수술.결론 청광안합병백내장환자응근거구체정황선택괄당적수술방식,이획득교호적시력화안압공제.
Objective To compare three types of microsurgery on management of glaucoma com-bined with a cataract.Methods The indications of three types of microsurgery were set up for a non-random-ized comparison study on 152 eyes (135 cases) with acute or chronic glaucoma and coexisting cataracts which were performed trabeculectomy only, NF trabeculectomy plus intraocular lens implantation, NF with IOL.The eyes were categorized into three groups according to whether staged procedure, one procedure or combined procedure.Group A: 36 eyes with staged procedure, after successful trabeculectomy, underwent cataract surgery by NF techniques and intraocular lens implantation.The average time from initial trabeculectomy to cataract surgery was 24.2 mo.Group B: 98 eyes with triple procedure, cataract surgery by NF techniques and intraocular lens implantation combined with trabeculectomy with peripheral iridectomy.Mean follow-up was 12±1 mo.Group C: 18 eyes with one procedure, cataract surgery by NF techniques and intraocular lens im-plantation only.The postoperative visual acuity, intraocular pressure (IOP) and corneal endothelial cell among the three groups were analyzed and compared.Results Of the three groups, the patients with VA better than 0.2 improved statistically after operation (x~2=16.00, P<0.01).Mean intraocular pressure was lowered signifi-cantly in Group A and Group B (t_1=1.89, P_1=0.01; t_2=2.87, P_2=0.03).In Group C, there was no significantly difference with post-operation and pre-operation (t=0.43, P=0.78).As to corneal endothelial cell, there was no statistically significant difference among the three groups (P≥0.05).No severe intra-operative complications happened in three groups.Two eyes with mildest postoperative inflammatory response were seen in Group B.There were 17 eyes happened low-grade to moderate corneal edema in Group B and 5 eyes in Group C.Con-clusions Various surgery techniques for glaucoma with a cataract should be chosen depending on the dif-ferent conditions.Only if we recognize correctly the type of glaucoma and know accurately the stage and cause of cataract, can we select the most effective therapy with lowest complications and optimal surgery outcome.