超声乳化联合复合式小梁切除术治疗青光眼合并白内障临床探究.docVIP

超声乳化联合复合式小梁切除术治疗青光眼合并白内障临床探究【摘要】 目的 观察超声乳化联合小梁切除术,术中应用丝裂霉素(MMC)及经角膜的调整缝线治疗青光眼合并白内障的临床效果。方法 69例(72眼)术中做以角膜缘为基底的结膜瓣,再以角膜缘为基底做5 mm×4 mm 1/2板层厚巩膜瓣,0.2~0.4 mg/ml MMC棉片置于结膜和巩膜瓣下3~5 min,再以大量BSS冲洗,继之进行超声乳化及人工晶体植入术,切除小梁2 mm×2.5 mm,剪除周边虹膜少许。巩膜瓣顶端间断缝合2针,侧面缝经角膜的调整缝线。间断缝合Tenons囊,结膜连续缝合。结果 平均随访(7.36±4.64)个月,术后视力提高者46眼(63.89%),不变19眼(26.39%),下降7眼(9.27%)。术前平均眼压(28.67±10.69)mm Hg(1 mm Hg=0.133 KPa)。术后随访期末眼压21 mm Hg以下66眼(91.67%),功能性滤过泡91.67%,非功能滤过泡6眼(8.33%)。并发症包括角膜水肿,浅前房、前房渗出等。结论 超声乳化联合小梁切除及术中应用丝裂霉素、调整缝线是治疗青光眼合并白内障的有效方法。 【关键词】 白内障超声乳化术;小梁切除术;可调节缝线;丝裂霉素 Clinical effect of phacoemulsification combined with trabeculectomy in glancoma patients LI Shu-zhen.Departoent of ophthalmology,the First Peoples Hospital of Shangqiu,Shangqiu 476100,China 【Abstract】 Objective To observe the clinical effects of phacomulsification. IOL implantation combined with trabeculectomy,MMC and transcornea adjustable suture in glaucoma. Methods 69 patients (72 eyes ) were treated,mading conjunctive petal base in fornix madng scleral flap 5 mm×4 mm,base in limbus corneae,setting 0.2~0.4 mg/ml MMC cotton disk under conjunctive petal and sclera petal,stopping 3~5 min,washing with normal saline then phacoemulsification . IOL trabeculectomy implantation trabeculectomy and transcornea adiustale suture. Results The mean follow up time was 7.36±4.64 months. Best corrected visual acuity improved in 46 eyes(63.89%) of the patients,fixed in 9 eyes(26.39%),dropped in 7 eyes (9.72%). Preoperative IOP was 28.67±10.69 mm Hg. Final IOP of 66 eyes(91.67%) were controlled ( 0.06~0.09 1520.83 912.50 0.1~0.3 4258.331216.67 0.4~0.50 03244.44 0.6~001419.44 2 结果 术后第1天角膜水肿24眼(33.33%),均在术后10 d内恢复透明。随访期末最佳矫正视力较术前提高者46眼(63.8%),视力不变者19眼(26.39%),视力下降7眼(9.72%)。眼压:术前平均眼压(28.67±10.96)mmH g,随访期末66眼(91.61%)眼压在21 mm Hg以下,眼压21 mm Hg者6眼(8.33%)。术后第3天平均眼压(10.65±5.26)mm Hg;术后1周眼压:(10.09±6.36)mm Hg,术后2周眼压(11.36±4.78)mm Hg,术后3周眼压(14.26±4.96)mm Hg,术后1月眼压(14.36±4.96)mm Hg,术后2月眼压(14.36±5.64)mm Hg术后3月眼压(14.89±4.96)mm Hg,