中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2013年
5期
370-372
,共3页
青光眼%白内障%超声乳化%巩膜隧道瓣%小梁切除
青光眼%白內障%超聲乳化%鞏膜隧道瓣%小樑切除
청광안%백내장%초성유화%공막수도판%소량절제
Glaucoma%Cataract%Phacoemusification%Cleral tunnel%Trabeculectomy
目的 探讨无缝线巩膜隧道瓣小梁切除联合白内障超声乳化人工晶体植入术治疗青光眼合并白内障的临床疗效.方法 选择深州市医院眼科2009年2月至2012年6月49例(52只眼)视力在0.3以下,眼压控制不理想或需要多种降眼压药物的青光眼合并白内障患者,采用Phaco隧道刀做4 mm×4 mm巩膜隧道瓣,深度为1/2 ～2/3巩膜全层,超声乳化仪乳化吸除白内障,植入折叠式人工晶体,巩膜隧道瓣下行2 mm ×1.5 mm小梁切除,巩膜瓣平铺不缝合,严密缝合结膜瓣.结果 随访观察12个月,视力＞0.5者42只眼,占80.8％,眼压为11.32 mm Hg ～17.63 mm Hg(1 mm Hg=0.133 kPa),平均(13.59±4.26) mm Hg,与术前的平均眼压(24.53 ±5.71) mm Hg相比,经t检验差异具有统计学意义(t’=11.073,P＜0.01),Ⅰ～Ⅱ型滤过泡43只眼,占82.6％,中央前房深度术前平均为(1.79 ±0.31)mm,术后平均深度为(3.28 ±0.42)mm,两者比较差异有统计学意义(t’=20.486,P＜0.01),角膜散光52只眼角膜平均散光度术前为(1.13 ±0.74)D,术后为(1.01±0.62)D,两者比较差异无统计学意义(F=2.0673,P＞0.05),全部病例均未发现严重并发症.结论 该术式是对传统小梁切除术的改良和发展,也是对青光眼白内障“三联术”的更新,既降低了眼压,又提高了视力,还减少了并发症,是一种安全、合理、快速、有效地治疗青光眼合并白内障的手术方法.
目的 探討無縫線鞏膜隧道瓣小樑切除聯閤白內障超聲乳化人工晶體植入術治療青光眼閤併白內障的臨床療效.方法 選擇深州市醫院眼科2009年2月至2012年6月49例(52隻眼)視力在0.3以下,眼壓控製不理想或需要多種降眼壓藥物的青光眼閤併白內障患者,採用Phaco隧道刀做4 mm×4 mm鞏膜隧道瓣,深度為1/2 ～2/3鞏膜全層,超聲乳化儀乳化吸除白內障,植入摺疊式人工晶體,鞏膜隧道瓣下行2 mm ×1.5 mm小樑切除,鞏膜瓣平鋪不縫閤,嚴密縫閤結膜瓣.結果 隨訪觀察12箇月,視力＞0.5者42隻眼,佔80.8％,眼壓為11.32 mm Hg ～17.63 mm Hg(1 mm Hg=0.133 kPa),平均(13.59±4.26) mm Hg,與術前的平均眼壓(24.53 ±5.71) mm Hg相比,經t檢驗差異具有統計學意義(t’=11.073,P＜0.01),Ⅰ～Ⅱ型濾過泡43隻眼,佔82.6％,中央前房深度術前平均為(1.79 ±0.31)mm,術後平均深度為(3.28 ±0.42)mm,兩者比較差異有統計學意義(t’=20.486,P＜0.01),角膜散光52隻眼角膜平均散光度術前為(1.13 ±0.74)D,術後為(1.01±0.62)D,兩者比較差異無統計學意義(F=2.0673,P＞0.05),全部病例均未髮現嚴重併髮癥.結論 該術式是對傳統小樑切除術的改良和髮展,也是對青光眼白內障“三聯術”的更新,既降低瞭眼壓,又提高瞭視力,還減少瞭併髮癥,是一種安全、閤理、快速、有效地治療青光眼閤併白內障的手術方法.
목적 탐토무봉선공막수도판소량절제연합백내장초성유화인공정체식입술치료청광안합병백내장적림상료효.방법 선택심주시의원안과2009년2월지2012년6월49례(52지안)시력재0.3이하,안압공제불이상혹수요다충강안압약물적청광안합병백내장환자,채용Phaco수도도주4 mm×4 mm공막수도판,심도위1/2 ～2/3공막전층,초성유화의유화흡제백내장,식입절첩식인공정체,공막수도판하행2 mm ×1.5 mm소량절제,공막판평포불봉합,엄밀봉합결막판.결과 수방관찰12개월,시력＞0.5자42지안,점80.8％,안압위11.32 mm Hg ～17.63 mm Hg(1 mm Hg=0.133 kPa),평균(13.59±4.26) mm Hg,여술전적평균안압(24.53 ±5.71) mm Hg상비,경t검험차이구유통계학의의(t’=11.073,P＜0.01),Ⅰ～Ⅱ형려과포43지안,점82.6％,중앙전방심도술전평균위(1.79 ±0.31)mm,술후평균심도위(3.28 ±0.42)mm,량자비교차이유통계학의의(t’=20.486,P＜0.01),각막산광52지안각막평균산광도술전위(1.13 ±0.74)D,술후위(1.01±0.62)D,량자비교차이무통계학의의(F=2.0673,P＞0.05),전부병례균미발현엄중병발증.결론 해술식시대전통소량절제술적개량화발전,야시대청광안백내장“삼련술”적경신,기강저료안압,우제고료시력,환감소료병발증,시일충안전、합리、쾌속、유효지치료청광안합병백내장적수술방법.
Objection To explore the clinical efficacies of scleral tunnel sutureless trabeculectomy plus phacoemulsification and intraocular lens implantation in the treatment of glaucoma and cataract.Methods A total of 49 cataract patients with glaucoma (52 eyes) from our hospital during the period of February 2009 to June 2012.Their visual acuities were ＜ 0.3 and intraocular pressure was not desirable or in need of various ocular hypotensive drugs.A phaco tunnel knife was employed to prepare a 4 mm × 4 mm scleral tunnel flap with 1/2-2/3 whole layer of sclera depth.Phacoemulsification instrument was used to emulsify cataracts.Foldable intraocular lens was implanted.A trabecular cut of 2 mm x 1.5 mm was made under the scleral tunnel.Tile scleral flap was not sutured and conjunctival flap tightly closed.Results After a 12-month follow-up,＞ 0.5 in 42 eyes (80.8％).The intraocular pressure was 11.32-17.63 mm Hg (1 mm Hg =0.133 kPa) and the mean intraocular pressure (13.59 ±4.26) mm Hg.There was a mean pressure reduction of 11.2 mm Hg from (24.53 ± 5.71) mm Hg pre-operation.Statistical significance existed (t' =11.073,P ＜0.01).The filtering blebs of type Ⅰ-Ⅱ was 43 eyes (82.6％) and the mean central anterior chamber 3.28 mm ± 0.42 mm.There was statistical difference (t' =20.486,P ＜ 0.01) with (1.79 ± 0.31) mm at pre-operation.On 52 eyes,the mean postoperative astigmatism was (1.01 ±0.62) D versus (1.13 ± 0.74) D at pre-operation.There was no statistical significance (F =2.0673,P ＞0.05).No severe complication occurred in all cases.Conclusion Compared with traditional trabeculectomy and triple procedure,this improved and updated procedure lowers intraocular pressure,improves visual acuity and decreases the occurrences of complications.It is a safe,reasonable,quick and effective treatment for cataract patients with glaucoma.
