超聲乳化術(shù)治療膨脹期白內(nèi)障繼發(fā)青光眼34例(1)

1、超聲乳化術(shù)治療膨脹期白內(nèi)障繼發(fā)青光眼34例(1)【摘要】 評(píng)價(jià)透明角膜切口超聲乳化白內(nèi)障吸除聯(lián)合人工晶體植入術(shù)，治療膨脹期白內(nèi)障繼發(fā)青光眼的臨床療效。方法 回顧分析34例(41眼)膨脹期白內(nèi)障繼發(fā)青光眼患者臨床資料，其中用藥后眼壓控制良好擇期手術(shù)34眼、高眼壓條件下急診手術(shù)7眼，均采用透明角膜切口白內(nèi)障超聲乳化聯(lián)合后房折疊型人工晶體植入術(shù)。術(shù)后隨訪2個(gè)月3年，對(duì)比術(shù)前術(shù)后視力、眼壓、前房深度和房角開放范圍。結(jié)果 術(shù)中、術(shù)后所有患者均未發(fā)生嚴(yán)重手術(shù)并發(fā)癥。術(shù)后最佳矯正視力明顯好于術(shù)前(P0.01)；眼壓比入院接診時(shí)明顯下降(P0.001)；前房深度加深，術(shù)前術(shù)后差異有統(tǒng)計(jì)學(xué)意義（P0.001）。

2、41眼中有2眼術(shù)后半年加用抗青光眼藥物。所有患者原狹窄房角增寬，關(guān)閉的房角部分開放。結(jié)論 白內(nèi)障超聲乳化摘除聯(lián)合人工晶體植入術(shù)是治療膨脹期白內(nèi)障繼發(fā)青光眼的一種有效手段。 【關(guān)鍵詞】 青光眼 白內(nèi)障 超聲乳化白內(nèi)障吸除術(shù) To explore the clinical effect of phacoemulsification with foldable lens implantation through a clear corneal incision in treatment of secondary glaucoma due to intumescent cataract.Methods

3、 The clinical data of 34 cases (41 eyes) of secondary glaucoma due to intumescent cataract admitted to our hospital from June 2003 to March 2007 were retrospectively analyzed. Of them, 34 eyes whose intraocular pressure (IOP) was controlled by drugs underwent delayed phacoemulsifications with foldab

4、le IOL implantations through clear corneal incisions, and 7 eyes whose high IOP was not controlled underwent emergent operations. The IOP, best corrected eye vision (BCVA), depth of the anterior chamber (AC) and width of the AC were determined before and after the operations. Patients were followed

5、up from 2 months to 3 years. Results All patients were successfully operated on without severe complications, the mean BCVA was significantly increased after the operations,0.400.21 vs 0.150.09(P0 01), the mean IOP was significantly decreased after the operations (14.24.03)mmHg vs （32.366.83)mmHg (P

6、0.01), the depth of AC significantly increased after the operations (2.480.37)mm vs (1.140.38)mm (P0.01), and the angles of AC became wider after the operations. 2 eyes were given antiglaucoma drugs to decrease the IOP six months after the operations. Conclusion Phacoemulsification with foldable len

7、s implantation through a clear corneal incision is an effective means for secondary glaucoma due to intumescent cataract. Key words:Glaucoma; Cataract; Phacoemulsification Shingleton等于1999年提出以單純白內(nèi)障摘除聯(lián)合人工晶體植入術(shù)來(lái)治療膨脹期白內(nèi)障繼發(fā)青光眼的新方案，由此指導(dǎo)，我們?cè)趯?duì)既往白內(nèi)障手術(shù)患者術(shù)后復(fù)查時(shí)特別注意了眼壓和前房的變化，發(fā)現(xiàn)白內(nèi)障患者術(shù)后的前房普遍加深，眼壓較穩(wěn)定，尤其對(duì)一些術(shù)前曾有過眼壓高

8、、眼脹不適的患者，白內(nèi)障術(shù)后眼壓控制均較理想。2003年6月2007年5月，我科對(duì)患有膨脹期白內(nèi)障繼發(fā)青光眼的34例患者實(shí)施單純白內(nèi)障摘除加人工晶體植入手術(shù)，療效良好。 1 資料與方法 1.1 一般資料 34例(41眼) 中男14例，女20例，5776歲，平均67歲，用藥后眼壓控制良好擇期手術(shù)患者34眼，高眼壓條件下急診手術(shù)7眼。所有患者術(shù)前均接受了視力、最佳矯正視力、Goldmann眼壓、裂隙燈、房角鏡以及眼球A/B超檢查，排除視網(wǎng)膜脫離、眼底出血等其他后節(jié)疾患。 1.2 方法 1.2.1 術(shù)前檢查 41眼中視力低于0.1者11眼，0.10.3者25眼,0.40.6者5眼。眼壓平均為(32.

9、366.83)mmHg，其中34眼經(jīng)局部或全身降眼壓藥物治療，眼壓控制于24?mmHg以下，眼壓穩(wěn)定23?d后行手術(shù)治療；7眼給與各項(xiàng)降眼壓治療12周后眼壓依然波動(dòng)在在2842?mmHg，在高眼壓條件下行急診手術(shù)。34例中，青光眼首次發(fā)作15例、有慢性閉角型青光眼病史19例；裂隙燈檢查均有淺前房、虹膜膨隆、晶體膨脹、房角狹窄情況，根據(jù)A超（STOZE公司）檢查結(jié)果，術(shù)前中央前房深度平均值為（1.140.38）mm；房角鏡檢查均存在不同程度的房角粘連或關(guān)閉，其中房角關(guān)閉7眼，狹窄超過2個(gè)象限的24眼，狹窄小于2個(gè)象限的10眼；晶狀體核與皮質(zhì)均存在不同程度混濁，按照LOCS分級(jí)法：級(jí)核12眼，級(jí)核

10、24眼，級(jí)核5眼。 1.2.2 手術(shù)方法 所有患者均采用超聲乳化聯(lián)合人工晶體植入術(shù)，球后麻醉方式。于12：00方位透明角膜緣內(nèi)0.5?mm處，做寬度為3.5?mm的隧道式透明角膜切口，前房?jī)?nèi)注入粘彈劑(Healon，GV)支撐前房，以15前房穿刺刀于角膜緣3：00和9：00方位做輔助切口，以撕囊鑷進(jìn)行連續(xù)環(huán)形撕囊，水分離和水分層完成后，連續(xù)環(huán)形撕囊，進(jìn)行充分水分離和水分層，應(yīng)用超聲乳化儀（Protg，STORZ公司）采用劈核法粉碎吸除晶狀體核，雙手IA清除殘留皮質(zhì)，囊袋內(nèi)植入丙烯酸折疊人工晶體（ACRYSOL NARUTAL）。手術(shù)過程順利，術(shù)中均未發(fā)生后囊破裂、玻璃體脫出等并發(fā)癥。 1.2.

11、3 術(shù)后處理及隨訪 所有患者，術(shù)后第1天常規(guī)全身給予抗生素、甘露醇和地塞米松，局部給予“典必舒”等滴眼液，出現(xiàn)角膜水腫及/或前房滲出者，球旁注射“妥布霉素20.0?mg+地塞米松2.5?mg”治療；分別于術(shù)后1天、1周、1個(gè)月、3個(gè)月復(fù)查視力、最佳矯正視力、眼壓；1個(gè)月后增加前房角檢查和A超測(cè)量；除2眼術(shù)后半年加用抗青光眼藥物外，其余患者無(wú)。隨訪1個(gè)月3年。 1.3 統(tǒng)計(jì)學(xué)處理 應(yīng)用SPSS10.0統(tǒng)計(jì)軟件，對(duì)手術(shù)前后最佳矯正視力、眼壓、前房深度、房角進(jìn)行配對(duì)t檢驗(yàn)，P0.05為差異有統(tǒng)計(jì)學(xué)意義。 1 （version 9.00）.Variance analysis of the 22 fac

12、toral design was conducted for: ages; height; weight; anesthetic effect ratings; the period from anesthesia to operation, and Apgar scores of 1 minute after the fetus was taken out; SBP, DBP, HR, and SBPHR prior to and after anesthesia. t Test was conducted for intra-group comparison. 0.05. 1.8 Medical Ethics It met the requirements of law and ethics to supplement with an intravenous drug in case of no or poor anesthetic effects, and was agreed by the Scientific & Technological Committee of our hospital. 2 Result 2.1 General Data Variance analysis of the 22 factoral design was conducted f