摘要
目的应用超声生物显微镜（UBM）观察白内障超声乳化吸除联合小梁切除术前后的眼前节结构变化及临床效果。方法对合并有白内障的24例（31只眼）青光眼患者行白内障超声乳化吸除联合小梁切除术。记录术前术后最佳矫正视力（BCVA）、眼压、角膜内皮数目、抗青光眼药物数目以及术后并发症。并分别于术前及术后6个月进行UBM检查，测量前房深度（ACD）、房角开放距离500（AOD500）、小梁虹膜夹角（TIA）、房角隐窝面积（ARA）以及小梁睫状体距离（TCPD），并观察术后滤过泡形态。采用重复测量资料的方差分析、Wilcoxon秩和检验以及配对设计t检验对数据进行统计分析。结果31只眼术后1周、1个月、3个月及6个月的BCVA（0．62±0．39、0．68±0．29、0．64±0．36、0．60±0．36）分别与术前（0．19±0．17）相比，差异均有统计学意义（P〈0．01）；术后1周、1个月、3个月及6个月平均眼压（13．48±5．02）mmHg、（13．85±4．17）mmHg、（13．95±4．41）mmHg、（14．51±4．26mmHg均低于术前（19．38±4．43）mmHg，其差异均有统计学意义（P〈0．01）；术后6个月平均ACD、AOD500、TIA及ARA分别（3．49±0．58、0．35±0．20、29．96±11．94和0．23±0．17）与术前（1．80±0．72、0．14±0．15、13．60±15．40和0．07±0．08）相比，差异均有统计学意义（P〈0．01）；平均TCPD（0．94±0．19）与术前（0．78±0．28）相比，差异无统计学意义（P〉0．05）；滤过泡的成功率为9．68％（3／31只眼），其中2只眼为L型滤过泡，1只眼为H滤过泡，28只眼为F型滤过泡。术前及术后6个月平均角膜内皮计数分别为（2366．90±652．73）个／mm：、（2077．07±528．10）个／mm。，二者相比，差异有统计学意义（P〈0．01），平均抗青光眼药物数目由术前的（2．35±0．66）种降至术后的（0．83±1．00）种，差异有统计学意义（P〈0．01）。术后早期有14只眼出现轻、中度角膜水肿、4只眼瞳孔区纤维渗出膜形成、2只眼前房积血及3只眼脉络膜脱离。结论合并白内障的青光眼患者行超声乳化人工晶体植入联合小梁切除术，术后前房深度明显增加，瞳孔阻滞解除，房角解剖结构得到改善，房水内、外引流功能增强，眼压能够得到有效控制，但存在一定的手术风险。
Objective To evaluate the ultrasound biomicroscopic （UBM） changes of the anterior chamber and the clinical outcome after phacoemulsification combined with trabeculectomy in patients with glaucoma and cataract. Methods Phacoemulsiftcation and intraocular lens implantation combined with trabeculectomy were performed on 24 patients （31eyes） with glaucoma and cataract. Best-corrected visual acuity （BCVA）, intraocular pressure （lOP）, corneal endothelial cell density, and the number of the antiglaucomatous mediation were documented preoperatively and postoperatively respectively, as well as the main complications in the early period after surgery. UBM was performed preoperatively and 6 months after surgery, and anterior chamber distance （ACD）, angle opening distance （AOD500）, trabecular iris angle （TIA）, angle recess area （ARA） and trabecular ciliary processes distance （TCPD） were compared respectively, and filtration blebs were observed after surgery. Variance analysis of repeated measured data, Wilcoxon rank sum test and paired t test were used to analyze the data. Resuits In 31 eyes, the mean BCVA improved at 1 week （0.62±0.39）, 1 month （0.68± 0.29）, 3 months （0.64±0.36） and 6 months （0.60± 0.36） postoperatively than preoperatively （0.19±0.17）（P 〈0.01）. The mean lOP at 1 week,1 month, 3 months and 6 months postoperatively were 13.48±5.02 mmHg, 13.85±4.17 mmHg, 13.95± 4.41 mmHg and 14.51± 4.26 mmHg respectively, which were significant lower than preoperatively （19.38± 4.43mmHg） （P 〈0.01）. The mean ACD, AOD500, TIA and ARA at 6 months postoperatively were 3.49±0.58, 0.35＋ 0.20, 29.96±11.94 and 0.23±0.17 respectively, which were significantly different from preoperatively （1.80±0.72, 0.14± 0.15, 13.60±15.40 and 0.07±0.08）（P 〈0.01）, while the mean TCPD （0.94± 0.19） had no significant difference from preoperatively （0.78± 0.28）（P 〉0.05）. Six months after surgery, 2 eyes had ＂L＂ type filtration blebs, 1 eye ＂H＂ type filtration bleb, and 28 eyes ＂F＂ type filtration blebs, the formation ratio of the filtration bleb was 9.68%. The mean corneal endothelial cell density at 6 months postoperatively was 2077.07± 528.10 cells/mm2, which was significant lower than preoperatively （2366.90± 652.73 cells/mm2）（P 〈0. 01）, and the mean number of antiglaucomatous medication decreased from （2.35± 0.66） preoperatively to （0.83±1.00） 6 months postoperatively （P 〈0.01）. The main complications in the early period after surgery were found that 14 eyes had mild and moderate corneal edema, 4 eyes exudative membrane in pupil, 2 eyes anterior chamber hemorrhage and 3 eyes choroid detachment. Conclusions Phacoemulsification and intraocular lens implantation combined with trabeculectomy performed on the pa- tients with glaucoma and cataract can effectively deepen the anterior chamber, eliminate the papillary block, remand the configuration of the anterior chamber angle, and increase the faculty of the inner and outer drainage of the aqueous outflow, as well, the lOP is well controlled postoperatively.
出处
《中国实用眼科杂志》
CSCD
北大核心
2011年第12期1240-1244,共5页
Chinese Journal of Practical Ophthalmology
