超声乳化白内障吸出人工晶状体植入术联合房角分离术治疗闭角型青光眼合并年龄相关性白内障的疗效观察

目的　对比观察超声乳化白内障吸出人工晶状体植入术联合及不联合房角分离术治疗闭角型青光眼合并年龄相关性白内障的疗效。方法　选取８９例（９８眼）闭角型青光眼合并年龄相关性白内障患眼分为两组,Ａ组４９眼采用超声乳化白内障吸出人工晶状体植入术联合房角分离术治疗,Ｂ组４９眼行超声乳化白内障吸出人工晶状体植入术,对比观察两组患者手术前后的眼压、中央前房深度、房角结构等。结果　Ａ组术后１ａ眼压为（１４．３４±３．６４）ｍｍＨｇ（１ｋＰａ＝７．５ｍｍＨｇ）,比术前眼压（３４．６５±６．５３）ｍｍＨｇ明显降低,差异有统计学意义（ｔ＝１９．２８,Ｐ＜０．０５）。Ｂ组术后１ａ眼压为（１６．２６±４．９１）ｍｍＨｇ,比术前（３５．１５±６．２７）ｍｍＨｇ亦明显降低,差异有统计学意义（ｔ＝１６．５５,Ｐ＜０．０５）。术后１ａ两组间眼压对比差异有统计学意义（ｔ＝２．１９,Ｐ＜０．０５）。Ａ组绝对成功３０眼（６１．２２％）,相对成功９眼（１８．３７％）,总成功率７９．５９％。Ｂ组绝对成功２７眼（５５．１０％）,相对成功７眼（１４．２９％）,总成功率６９．３９％。两组间的总成功率差异无统计学意义（Ｚ＝０．８８６,Ｐ＞０．０５）。Ａ组术后１个月中央前房深度（３．２４±０．３８）ｍｍ较术前（２．０４±０．３１）ｍｍ加深,差异有统计学意义（ｔ＝３．１４１,Ｐ＜０．０５）。Ｂ组术后１个月中央前房深度（３．０５±０．３６）ｍｍ较术前（２．０１±０．２９）ｍｍ亦加深,差异有统计学意义（ｔ＝３．０７８,Ｐ＜０．０５）。术后１个月两组比较差异无统计学意义（ｔ＝０．１７５,Ｐ＞０．０５）。术后１个月行房角检查:Ａ组４０眼前房角全部开放,９眼残留小于４５°的锥状或堤坝状粘连。Ｂ组１０眼３个象限残留房角粘连,１９眼２个象限残留房角粘连,２０眼有小于１个象限的房角粘连。两组视力改善率及术后并发症发生率差异均无统计学意义（均为Ｐ＞０．０５）。结论　超声乳化白内障吸出人工晶状体植入术联合房角分离术是治疗闭角型青光眼合并白内障的安全、有效的方法,对眼压、中央前房深度和房角结构都有明显改善。     

小切口白内障手术联合小梁切除术与常规三联手术的临床对比分析

为了评价小切口白内障手术小梁切除术的效果,我们回顾性地对比分析了５２例青光眼合并白内障患者的临床资料。其中２２例（３０眼）行超声乳化白内障摘除联合人工晶体植入术（小切口组）,３０例（４４眼）行白内障滞商除联合人工晶体植入及小梁切除术（常规组）。结果显示：术后６周内,小切口组角膜散光度明显小于常规组,且视力提高较大（Ｐ〈０．０１）;术后１２个月时,两组的眼压控制成功率相似,但小切口组需加用抗青光眼药     

葡萄膜炎并发白内障超声乳化摘除及人工晶体植入术

目的 探讨葡萄膜炎并发白内障超声乳化摘除及人工晶体植入术的疗效。方法 对２６例２６只眼患者行５．５ｍｍ的巩膜隧道切口,超声乳化白内障摘除,植入后房型人工晶体。结果 ２６只眼中有２只眼轻度炎症反应,全部瞳孔恢复圆瞳孔,术后１个月裸眼视力≥０．５者２２只眼（８４．６％）;≥０．３者３只眼（１１．５％）;〈０．０５者１只眼（３．９％）。结论 超声乳化白内障摘除术治疗葡萄膜炎并发白内障,术后炎症反应轻,视     

现代白内障囊外摘除术后早期眼压的观察

目的探讨白内障囊外摘除术后早期眼压的变化情况。方法将５８只眼随机分为三组，对术后早期不同时间的眼压进行观察和对照。结果术后１小时眼压均低者不能测出；３小时平均眼压高于术前水平；６～１２小时达高峰，３１只眼（５３．４５％）眼压＞２．８０ｋＰａ（１ｋＰａ＝７．５ｍｍＨｇ），４只眼（６．９０％）眼压≥４．００ｋＰａ，最高眼压为４．４０ｋＰａ；２４小时后眼压自然下降；术后７２小时内，５只眼（８．６２％）眼压低于正常水平（＜１．３３ｋＰａ）。术前应用醋氮酰胺组，术后平均眼压低于应用甘露醇组和未用降眼压药组（Ｐ＜０．０５），且术后正常眼压者所占比例较高。结论术前预防性服用醋氮酰胺，对降低白内障摘除术后早期的眼压有一定作用。     

白内障超声乳化摘除及后房型人工晶体植入术

目的评价超声乳化白内障摘除术的疗效。方法对６７例（７４只眼）老年性、并发性和先天性白内障施行超声乳化摘除及后房型人工晶体植入术。结果术后１周裸眼或矫正视力≥０．５者占８０．５％，３个月者占９７．６％。术后１周平均散光为１．９０±１．１５Ｄ，术后３个月为０．９３±０．５５Ｄ。分别小于１０～１２ｍｍ大切口对照组（Ｐ＜０．００１），但与手法切核小切口组比较差异无显著性（Ｐ＞０．０５）。本组并发症为术中瞳孔领虹膜咬伤６只眼，后囊膜碰破２只眼，术后无菌性前房积脓１只眼，其余未见明显并发症。并讨论超声乳化病例及方法的选择以及术中意外的处理方法。结论提示超声乳化术具有推广的价值，但不能忽视对初学者有更多和更危险的并发症。     

小切口囊外白内障摘除与人工晶体植入临床分析

报道８０例（８２眼）老年性和并发性白内障６ｍｍ切口囊外摘除及人工晶体植入术，随机选择 常规切口白内障囊外摘除及人工晶体植入术作为对照组。术后３月矫正视力＞０．５以上小切口组７９ 眼，占９６．３％，大切口组有６１眼，占７５．２％（Ｐ＜０．０５），有显著性差异。术后３月小切口组散光为１．０２± ０．６５，大切口组２．０３±１．５１（Ｐ＜０．０５）。提出用手法小切口技术适应发展中国家的国情。     

小切口植入折叠式人工晶体的临床观察

目的探讨能够在术后早期迅速恢复视力的白内障术式。方法对三组１３１例老年性白内障分别采用３．５、６．５ｍｍ巩膜隧道和１１ｍｍ角巩缘切口，施行白内障超声乳化摘除及折叠式人工晶体植入术、超声乳化摘除及一体型人工晶体植入术和囊外摘除及一体型人工晶体植入术。结果术后第３天的平均裸眼视力分别为１．０４、０．５１和０．４６，达到正常视力的比例分别为６２．７５％、１２．５０％和８．９３％，前者与后两者比较，差异均有显著性（ｔ检验，Ｐ＜０．０５）。结论采用３．５ｍｍ无缝线切口施行白内障超声乳化摘除及折叠式人工晶体植入术可使术后视力早期恢复     

白内障超声乳化人工晶体植入术临床报告

目的 探讨白内障超声乳化人工晶体植入术的特点、手术技巧、并发症及防治措施。方法 对１６８只眼白内障施行超声乳化人工晶体植入术,并与同期施行常规白内障囊外摘除人工晶体植入术的病例对照组相比较。结果 裸眼平均视力,术后第１天明显优于对照组（Ｐ〈０．０１）,术后第１周和第１个月时差异仍有显著性。角膜散光术后第１周,两组差异非常显著（Ｐ〈０．００１）,术后第３个月两组差异仍显著（Ｐ〈０．０１）。结论 白内     

白内障超声乳化摘除及无缝线小切口折叠式人工晶体植入术

目的评价超声乳化白内障摘除及无缝线小切口折叠式人工晶体植入手术的疗效。方法对６５例（７２只眼）老年性、并发性、先天性和外伤性白内障行超声乳化摘除，通过３．２ｍｍ切口植入硅胶折叠式人工晶体。结果术后１天裸眼或矫正视力≥０．５者占９４．４％；术后１周，１个月和３个月视力≥１．０者分别占７０．８％，７５．８％和７６．５％。术后１周和１个月平均散光分别为０．８９±０．８３Ｄ和０．７３±０．７６Ｄ，分别小于６．５ｍｍ切口对照组（Ｐ＜０．００１），但３个月时无统计学差异（Ｐ＞０．０５）。结论提示无缝线小切口折叠式人工晶体植入术具有早期恢复和稳定眼屈光状态和视力的优点。     

巩膜眉状小切口人工晶体植入术

对４８例（５６只眼）老年性和并发性白内障施行６ｍｍ巩膜眉状小切口手法碎核白内障囊外摘除及后房型人工晶体植入术。术后１０天矫正视力≥０．５者占７６．９％，３个月以上则为９５．９％，术后１０天平均散光度为１．９８±１．０６Ｄ，术后３个月为０．９８±０．６８Ｄ，分别小于同期内施行的２４例（３０只眼）１２ｍｍ大切口对照组（Ｐ＜０．００１）。文中详细介绍了手术体会及该手术方法的优点。     

超声乳化人工晶状体植入术后眼压的观察

目的探讨晶状体超声乳化人工晶状体植入术后早期的眼压变化及术中、术后用药对术后早期的眼压变化影响。方法本组病例均为我院行晶状体超声乳化白内障吸出人工晶状体植入术的住院患者,60例,分4组进行研究。对4组病例于术前、术后2h、4h6、h、8h、10h、12h1、4h2、4h及36h进行眼压测量,并进行组间对比。结果晶状体超声乳化白内障吸出人工晶状体植入术后早期眼压有不同程度升高,术中用缩瞳剂可使术后眼压下降,但仍明显高于术前;术后用醋氮酰胺也可使眼压下降。但在用缩瞳剂后,醋氮酰胺降眼压作用被缩瞳剂的作用所掩盖。术后早期(2小时后)眼压升高,于12小时达高峰,以后眼压逐渐下降,24~36小时已降至术前水平。结论晶状体超声乳化的白内障吸出人工晶状体植入术时术中应使用小量缩瞳剂,术后口服醋氮酰胺,这样可以有效的控制术后眼压。     

白内障超声乳化人工晶状体植入术后高眼压危险因素分析

目的:探讨白内障超声乳化工晶状体植入术后高眼压的相关危险因素、发生的原因及防治。方法:对我院2006-01/2012-10完成的白内障超声乳化工晶状体植入术1258例1318眼临床资料进行回顾分析。结果:术后发生高眼压共54眼,发生率为4.10%。术后眼压升高的幅度为22～60mmHg,大多数患者出现高眼压的时间为术后2～24h。54眼中先天性白内障1眼,外伤性白内障2眼,合并糖尿病15眼,合并高血压病12眼,陈旧性色素膜炎2眼,玻璃体切割术后1眼,合并高度近视11眼,未合并全身疾病的白内障10眼。裂隙灯观察高眼压患者可见部分皮质残留以及黏弹剂残留或晶状体后囊膜破裂玻璃体溢入前房或严重的炎症反应。结论:黏弹剂残留和炎症反应是引起术后高眼压的主要原因,合并有糖尿病、高度近视、陈旧性色素膜炎、眼外伤等疾病的白内障患者更容易出现术后高眼压。     

Intraocular pressure after phacoemulsification and implantation of silicone plate haptic intraocular lenses without viscoelastics

BACKGROUND: A rise in intraocular pressure (IOP) after cataract operation is a well known problem. Avoidance of the use of viscoelastics seems to solve the problem. PATIENTS AND METHODS: The IOP was measured in a group of 33 eyes of 33 patients one day before, as well as 6 hours, 24 hours, and 7 days after phacoemulsification and implantation of a foldable silicone plate haptic intraocular lens without viscoelastics and by means of an injector and of the anterior chamber maintainer. RESULTS: Mean preoperative IOP was 16.1 +/- 3.9 mm Hg (range 10 to 28 mm Hg). Postoperatively mean IOP was 12.3 +/- 3.3 mm Hg (range 5 to 18 mm Hg) after 6 hours (p < 0.0001), 13.8 +/- 2.8 mm Hg (range 7 to 19 mm Hg) after 24 hours (p = 0.032), and 15.5 +/- 3.4 (range 10 to 24) after one week (p = 0.39). In none of the eyes was the pressure in the first 24 hours higher than 18 mm Hg. When excluding the 4 patients with glaucoma and PEX or when taking them as a separate group, the results were similar. CONCLUSIONS: Pressure elevation after cataract operation without the use of viscoelastic substances can be avoided, thus contributing not only to lower costs but also to a higher safety.     

周边虹膜切除术与超声乳化人工晶状体植入术治疗早期原发性闭角型青光眼的疗效比较

目的比较周边虹膜切除术与超声乳化联合人工晶状体植入术治疗早期原发性闭角型青光眼的临床效果。方法选择仅局部用药即可控制眼压在正常范围内的早期闭角型青光眼合并白内障患者48例(54眼),应用周边虹膜切除术对28例(32眼)早期闭角型青光眼进行手术治疗,其结果与同类病人(20例22眼)的超声乳化联合人工晶状体植入术治疗结果进行比较。术前,术后一个月内每周一次,半年内每月一次,半年后三个月一次做眼压、裂隙灯检查直至1年。比较两者在术后眼压控制、视力恢复及前房情况,并作统计学分析。结果应用周边虹膜切除术治疗组术后平均眼内压为15.2±3.1mmHg,而同类病人经超声乳化联合人工晶状体植入术治疗后平均眼内压为14.9±2.6mmHg。分别经周边虹膜切除术和超声乳化联合人工晶状体植入术治疗,两类病人眼内压在术后早期无明显差异(P>0.05)。经超声乳化联合人工晶状体植入术治疗,18眼(81.8%)最佳矫正视力提高,0.4者占63.6%,经周边虹膜切除术治疗术后最佳矫正视力无明显提高,其中8眼视力不增反降,最佳矫正视力0.4者占18.8%,两者差异有显著性(P<0.05)。经周边虹膜切除术治疗术后中央前房深度无明显变化,而经超声乳化联合人工晶状体植入术治疗术后中央前房深度显著加深,两者差异性明显(P<0.05)。结论原发性闭角型青光眼早期患者施行超声乳化联合人工晶状体植入术,术后房角显著加宽,中央前房深度显著加深,矫正视力也不同程度提高,且并发症少。     

Preoperative latanoprost to prevent ocular hypertension after phacoemulsification and intraocular lens implantation.

PURPOSE: To evaluate the efficacy of latanoprost given 2 hours preoperatively to prevent ocular hypertension in the early period after phacoemulsification and posterior chamber intraocular lens (PC IOL) implantation. SETTING: Departments of Ophthalmology, United Christian Hospital and Prince of Wales Hospital, Hong Kong, China. METHODS: Sixty-four eyes of 64 patients with uncomplicated cataract having phacoemulsification with PC IOL implantation were included in this prospective randomized double-masked clinical trial. The eyes were randomly assigned to 1 of 2 groups: application of latanoprost 0.005% 2 hours before surgery or no latanoprost (control). Intraocular pressure (IOP) was measured 3 and 24 hours postoperatively. The anterior chamber was examined for the level of cells and flare using a slitlamp biomicroscope. The level of significance was 5%. RESULTS: The decrease in the mean IOP was not statistically significantly different between eyes receiving latanoprost 2 hours preoperatively and control eyes 3 hours (P =.843) and 24 hours (P =.721) postoperatively. CONCLUSION: A single application of latanoprost given 2 hours before phacoemulsification and PC IOL implantation did not produce a statistically significant IOP-lowering effect when compared with a control group in the first 24 hours after surgery.     

超声乳化白内障摘除术中后囊破裂的Ⅰ期后房型人工晶体植入术

目的评价超声乳化白内障摘除术中后囊破裂的Ⅰ期后房型人工晶体植入术的疗效。方法对１８４例（２００只眼）施行超声乳化白内障摘除术中后囊破裂者２９例（２９只眼）行Ⅰ期后房型人工晶体植入术。结果１０例囊袋内植入,１９例睫状沟植入。术后３个月随访,裸眼视力１．０以上者１７例（５８．６２％）,０．５～０．９者１０例（３４．４８％）;矫正视力１．０以上者２２例（７５．８６％）,０．５～０．９者５例（１７．２４％）。本组并发症主要为角膜水肿,瞳孔缘虹膜咬伤,前段玻璃体炎症等。结论对于后囊破裂及玻璃体脱出的患者,适当利用残留的前、后囊作为支撑,清除前段玻璃体,仍可植入后房型人工晶体。     

白内障超声乳化联合房角分离术治疗闭角型青光眼

目的：分析白内障超声乳化吸出+人工晶状体植入联合房角分离术治疗闭角型青光眼的临床效果。

方法：回顾性分析合并有白内障的闭角型青光眼患者,且房角关闭粘连范围≤180°的患者46例56眼,行白内障超声乳化吸出+人工晶状体植入联合房角分离手术,观察分析术前和术后眼压、视力、前房深度、前房角的变化。

结果：术后眼压全部控制在21mmHg(1mmHg=0.133kPa)以下,最佳矫正视力均有不同程度的提高,前房深度明显增加,房角均有不同程度开放。术中、术后无严重手术并发症。术前和术后眼压、前房深度、最佳矫正视力差异有统计学意义(P<0.05)。

结论：选择对合适的闭角型青光眼合并白内障的患者施行白内障超声乳化联合房角分离手术能够获得满意的临床效果。     

激光虹膜切除联合超声乳化吸除术治疗急性闭角型青光眼合并白内障临床观察

目的 探讨急性闭角型青光眼初次发作后,采用激光周边虹膜切除,再行晶状体超声乳化吸出联合人工晶体植入术治疗的疗效.方法 分析2005年9月至2007年3月收治急性闭角型青光眼合并白内障患者16例,16只眼,应用激光周边虹膜切除术后,行晶状体超声乳化吸出联合人工晶体植入,观察术前及术后视力、周边前房深度、前房角、眼压情况.术后随诊4～12个月,平均9.4个月.结果 16只眼术后视力、周边前房深度较术前明显改善,前房角完全开放,眼压非药物控制于正常范围,平均眼压14.24mmHg.术后早期并发角膜水肿3只眼,前房纤维样渗出2只眼,无浅前房和后发障发生.结论 应用激光周边虹膜切除后,行晶状体超声乳化吸出人工晶体植入可有效治疗急性闭角型青光眼合并白内障,且术后视力恢复快、眼压控制好、并发症少.     

Circumferential viscodilation and tensioning of Schlemm canal (canaloplasty) with temporal clear corneal phacoemulsification cataract surgery for open-angle glaucoma and visually significant cataract: one-year results

PURPOSE: To evaluate the safety and efficacy of circumferential viscodilation and tensioning of the inner wall of Schlemm canal, a new nonpenetrating surgical procedure (canaloplasty) to treat open-angle glaucoma (OAG), combined with clear corneal phacoemulsification and posterior chamber intraocular lens (IOL) implantation. SETTING: Multicenter surgical sites. METHODS: This international multicenter prospective study comprised adult patients with OAG having combined glaucoma and cataract surgery. Patients with qualifying treated preoperative intraocular pressure (IOP) of at least 21 mm Hg or higher and open angles were eligible. Evaluation was performed at baseline and 1 day, 1 week, and 1, 3, 6, and 12 months postoperatively. Intraoperative and postoperative high-resolution ultrasound imaging was used to assess Schlemm canal and anterior segment angle morphology, including distension of the trabecular meshwork due to the tensioning suture. RESULTS: Data from 54 eyes that had combined glaucoma and cataract surgery performed by 11 surgeons at 9 study sites were analyzed for this interim analysis. The mean baseline IOP was 24.4 mm Hg+/-6.1 (SD) with a mean of 1.5+/-1.0 medications per eye. In all eyes, the mean postoperative IOP was 13.6+/-3.8 mm Hg at 1 month, 14.2+/-3.6 mm Hg at 3 months, 13.0+/-2.9 mm Hg at 6 months, and 13.7+/-4.4 mm Hg at 12 months. Medication use dropped to a mean of 0.2+/-0.4 per patient at 12 months. Surgical complications were reported in 5 eyes (9.3%) and included hyphema (n=3, 5.6%), Descemet tear (n=1, 1.9%), and iris prolapse (n=1, 1.9%). Transient IOP elevation of more than 30 mm Hg was observed in 4 eyes (7.3%) 1 day postoperatively. CONCLUSION: Circumferential viscodilation and tensioning of Schlemm canal combined with clear corneal phacoemulsification and posterior chamber IOL implantation was a safe and effective procedure to reduce IOP in adult patients with OAG.