隧道式巩膜瓣白内障青光眼联合手术的新方法

目的探讨小切口白内障摘出联合隧道式巩膜瓣小梁切除术治疗青光眼合并白内障的效果.方法应用小切口白内障摘出联合隧道式巩膜瓣小梁切除术对46例47眼青光眼合并白内障进行手术治疗.术后随访观察视力、眼压、滤过泡及并发症等.结果术前眼压平均(24.35±3.64)mmHg(1mmHg=0.133 kPa),术后眼压平均为(14.70±2.49)mmHg,较术前平均降低9.65 mmHg,差异有显著性意义(P＜0.001),仅两例眼压高于正常,药物可控制.术前视力全部低于0.3,术后视力大于0.5者61.7%.结论小切口白内障摘出联合隧道式巩膜瓣小梁切除术具有降压疗效好、恢复快、并发症少等优点,效果较为理想.     

白内障小切口囊外摘除联合小梁切除治疗PACG合并白内障

目的：观察白内障小切口囊外摘除联合小梁切除术治疗原发性急性、慢性闭角型青光眼的疗效。

方法：急性闭角型青光眼合并白内障23例24眼,慢性闭角型青光眼合并白内障11例12眼,进行白内障小切口囊外摘除联合小梁切除术,均一期植入人工晶状体。

结果：术后随访1mo,急性闭角型青光眼组术前平均眼压30.68±7.60mmHg,术后17.83±5.95mmHg,差异有统计学意义(P<0.05); 慢性闭角型青光眼组术前平均眼压29.27±5.55mmHg,术后18.12±1.88mmHg,差异有统计学意义(P<0.05)。术前、术后两组间平均眼压差异无统计学意义。术后眼压控制良好者(6～21mmHg)者26眼(72%),局部使用抗青光眼药物后眼压控制良好者8眼(22%),总体有效控制率94%,眼压不能控制者(22～30mmHg)2眼(6%); 术后视力提高者32眼(89%),没有发生严重并发症。

结论：白内障小切口囊外摘除联合小梁切除术对于原发性闭角型青光眼(PACG)合并白内障的治疗可以有效控制眼压、提高视力,并发症少; 其在控制眼压方面对于原发性急/慢性闭角型青光眼无差异。     

小切口白内障囊外摘出隧道内小梁切除术

目的探讨小切口隧道式非超声乳化白内障囊外摘出联合隧道切口内小梁切除术的可行性.方法青光眼合并白内障24例(26眼)行小切口隧道式非超声乳化囊外摘出联合隧道内的小梁切除术,观察术后视力及眼压变化情况.结果24例(26 眼)术后均形成弥散扁平型滤过泡,术后在不用降眼压药物的情况下眼压正常,平均眼压由术前的(26.86±9.46)mmHg(1 mmHg=0.133kPa)降至术后的(12.89±2.15)mmHg.视力亦均有不同程度提高,术中术后未见严重并发症.结论该联合手术术后眼压控制满意,视力恢复良好,操作简便,且无需缝合.     

双切口三联手术治疗青光眼合并白内障的研究

目的探讨双切口三联手术治疗青光眼合并白内障的手术效果.方法对比分析了56例(60眼)青光眼合并白内障的临床资料,其中30眼行巩膜隧道式小切口白内障囊外摘出联合人工晶状体植入术,另作一切口行小梁切除术(双切口组);另30眼行白内障囊外摘出联合人工晶状体植入及小梁切除术(对照组).结果术后1月内,双切口组视力提高明显优于对照组(t=2.12287,P＜0.05);术后8月两组的眼压控制程度相似,但对照组需加用抗青光眼药物;功能性滤过泡的形成率两组间的差异有显著意义.结论提示巩膜隧道式小切口白内障手术联合另外切口小梁切除术组(双切口组)的临床效果良好.     

超声乳化人工晶状体植入联合小梁切除术

目的　评价白内障超声乳化折叠式人工晶状体植入联合小梁切除术治疗白内障合并青光眼的效果。方法　 2 4例2 4眼随机分成A、B两组 ,A组行颞侧透明角膜隧道切口超声乳化折叠式人工晶状体植入联合上方巩膜瓣小梁切除。B组行上方巩膜隧道切口原位小梁切除手术步骤同A组。结果　随访 3～ 6月 ,A组术前眼压为 ( 2 4.3 8± 6.2 1)mmHg ,术后 3～ 6月眼压为 ( 15 .3 7± 3 .75 )mmHg。B组术前眼压为 ( 2 4.78± 5 .62 )mmHg ,术后 3～ 6月眼压为 ( 15 .46± 3 .80 )mmHg( 1mmHg =0 .13 3kPa)。术后视力≥ 0 .5者A组 10眼 ( 83 .3 % ) ,B组 9眼 ( 75 0 % )。两种方法术后眼压、视力、角膜平均散光度、滤过泡形成情况差异均无显著意义 (P >0 .0 5 )。结论　本手术能在稳定控制眼压的同时改善患者视力 ,两种方法的效果无明显差别。     

超声乳化白内障吸除联合小梁切除治疗青光眼合并白内障分析

目的 探讨双切口超声乳化白内障吸除人工晶状体植入联合复合式小梁切除术治疗青光眼合并白内障的临床疗效.方法 回顾分析32例35只眼青光眼合并白内障患者进行联合手术后的临床效果,在术后随访的12～48个月中,分析手术前后视力、眼压、滤过泡形态和并发症的情况.结果 35眼中32只眼眼压控制在21mmHg以下,其中20只眼在15mmHg以下,眼压由术前平均(28.16±2.63)mmHg降低至术后(16.32±3.45)mmHg,t=21.60,P＜0.05;所使用的抗青光眼药物由术前平均(2.59±0.49)种减少至术后仅3只眼需1种.30只眼(85.7%)术后视力提高.并发症主要是短暂角膜水肿及虹膜睫状体炎.结论 超声乳化白内障吸除人工晶状体植入联合复合式小梁切除术在治疗青光眼合并白内障的患者时,能够有效降低眼压、提高视力.     

白内障超声乳化人工晶状体植入联合小梁切除术

目的评价白内障超声乳化摘出、折叠式人工晶状体植入联合隧道内小梁切除术(三联手术)治疗青光眼合并白内障的疗效.方法采用隧道式巩膜瓣切口对24例(28眼)青光眼合并白内障施行三联手术.结果术后随访末期,最终矫正视力为0.1～1.0,其中0.1～0.5者15眼(53.6%),0.6～0.8者10眼(35.7%),1.0者3眼(10.7%).术后眼压全部降至正常范围,平均眼压(14.3±6.5)mmHg(1mmHg=0.133kPa).术后有角膜水肿8眼(28.6%),浅前房2眼(7.1%),后发性白内障2眼(7.1%).结论白内障超声乳化吸出折叠人工晶状体植入联合隧道内小梁切除术治疗青光眼合并白内障是一种安全、有效的手术方法.     

超声乳化白内障吸除联合小梁切除术不同手术切口选择的临床分析

目的 比较超声乳化白内障吸除人工晶状体植入联合小梁切除术采用单切口术式和双切口术式的临床疗效。方法 对开角型或慢性闭角型青光眼合并白内障患者37例（42只眼）,分别以单切口术式（单切口组,23只眼）或双切口术式（双切口组,19只眼）,行超声乳化白内障吸除人工晶状体植人联合小梁切除术,比较两种术式的手术前、后眼压和视力,观察术后滤过泡的形成和并发症情况。术后随访6个月。结果 术后两组平均眼压较术前均有明显降低,差异有显著性意义（P〈0．001）;两组平均眼压下降差异无显著意义（P〉0．05）;术后两组视力、滤过泡比较,差异均无显著意义（P〉0．05）;术后无严重并发症发生。结论 超声乳化白内障吸除人工晶状体植入联合小梁切除术治疗青光眼合并白内障安全、有效,单切口和双切口术式手术成功率无明显差别。     

白内障超声乳化人工晶状体植入联合小梁切除术

目的:探讨局部麻醉下行小梁切除术联合透明角膜切口白内障超声乳化吸除联合折叠人工晶状体植入术(三联术)的临床效果方法:对43例合并有白内障的患者在局部麻醉下采用分切口小梁切除术和透明角膜切口白内障原位超声乳化折叠人工晶状体植入手术,结果:术后视力>0.5者26眼(60%),0.1～0.5者17眼(40%)。43眼术后视力均较术前提高。术后1wk平均眼压15.4±3.8mmHg,较术前眼压降低10～30mmHg,与术前相比有显著性差异(P<0.01)。42眼(98%)形成功能性滤过泡。结论:分切口的青光眼小梁切除术联合透明切口白内障超声乳化折叠人工晶状体植入术可以有效地控制眼压同时提高患者的视力,效果较好,并发症少。     

白内障青光眼联合手术表面麻醉的效果评价

目的评价白内障超声乳化吸出人工晶状体植入联合小梁切除术表面麻醉的临床效果.方法对34例(40眼)青光眼合并白内障在2%利多卡因表面麻醉下行白内障超声乳化吸出人工晶状体植入联合小梁切除术,观察术中反应及术后效果.结果所有患者术中均能很好配合;术后24眼(60%)视力≥0.5,影响术后视力的原因主要是眼底病变.随访3～24月,31眼术后眼压在正常范围,平均(15.89±3.02)mmHg,8眼加用β-本阻滞剂后眼压控制,视野无进行性损害.结论表面麻醉下行白内障超声乳化吸出人工晶状体植入联合小梁切除术安全、快速、经济、有效.     

Longterm results of one-site phacotrabeculectomy

PURPOSE: To evaluate results of one-site phacotrabeculectomy and intraocular lens (IOL) implantation. METHODS: A retrospective study of a consecutive series of 62 eyes with cataract and glaucoma, which underwent primary one-site phacotrabeculectomy with IOL implantation. Mean follow-up time was 28 +/- 12.3 months (range 12-46 months). RESULTS: Preoperative mean intraocular pressure (IOP) (25.1 +/- 8.6 mmHg) dropped significantly, to 16.4 +/- 1.3 mmHg 1 year after surgery (p < 0.01). Mean logMAR best corrected visual acuity (VA) improved significantly from 0.74 +/- 0.49 to 0.22 +/- 0.28 (p < 0.01). The most common complications were fibrinous exudation (10%) and choroidal detachment (6%). In two eyes (3%) we successfully performed scleral flap revision to achieve IOP control. CONCLUSION: One-site combined surgery was a safe and effective procedure with good IOP control and visual rehabilitation.     

不同切口闭角型青光眼白内障三联手术近期疗效比较

目的:探讨单切口与双切口超声乳化白内障吸除折叠式人工晶状体植入联合青光眼小梁切除术治疗闭角型青光眼并发白内障的疗效比较。方法:回顾性分析70例98眼青光眼小梁切除联合白内障超声乳化摘除人工晶状体植入术病例。其中单切口术式的病例有34例50眼,双切口的有36例48眼。分析比较两组患者的术后眼压控制、滤过泡情况,术前和术后1mo的角膜内皮细胞密度和面积及并发症情况。随访12~24(平均18.2)mo。结果:术后平均眼压单切口组10.16±4.31mmHg、双切口组11.38±3.55mmHg,两组术式平均眼压下降差异无统计学意义(P>0.05)。术后滤过泡形成两组比较差异无统计学意义(P>0.05)。两组患者角膜内皮细胞密度和面积术前没有明显差异(P>0.05),术后1mo双切口组明显高于单切口组(P<0.01)。结论:单切口和双切口不同术式的联合手术均具有较好的降眼压的作用,同时能维持良好的滤过泡功能。两组术式的降低眼压功能基本相同。双切口青光眼白内障三联手术在损失角膜内皮细胞方面比单切口术式更有优势。     

不同切口超声乳化白内障吸除术联合小梁切除术的疗效和耐受性的荟萃分析

目的:评价并比较一切口和二切口超声乳化白内障吸除术联合小梁切除术治疗白内障合并青光眼的疗效和耐受性。方法:按照Cochrane协作网方法全面检索符合纳入标准的比较一切口和二切口超声乳化白内障吸除术联合小梁切除术的临床对照研究,将其进行荟萃分析。临床疗效的评估包括:眼压下降百分比采用标准化均差(SMD),术后最佳矫正视力≥0.5的患者百分比采用比值比(OR),手术成功率采用相对危险度(RR)。临床耐受性的评估采用RR。所有结果均以95%可信区间表示。数据分析采用Stata10.1。结果:降低眼压的临床疗效二切口术式明显优于一切口术式,差异具有统计学意义(SMD,-0.19;95%CI,-0.33到-0.04;P=0.01);术后最佳矫正视力≥0.5的患者百分比二切口术式大于一切口术式,但差异不具有统计学意义(OR,0.65;95%CI,0.30到1.39;P=0.26);术后不加用抗青光眼药物达到靶眼压的患者百分比二切口术式大于一切口术式,但差异不具有统计学意义(RR,0.94;95%CI,0.84到1.04;P=0.22);两种术式在术后并发症方面差别无统计学意义。结论:二切口超声乳化白内障吸除术联合小梁切除术临床疗效优于一切口术式。两种术式的术后并发症没有明显差异。     

Efficacy and tolerability of one-site versus two-site phacotrabeculectomy: a meta-analysis

AIM: To evaluate the efficacy and tolerability of one-site versus two-site phacotrabeculectomy in the treatment of patients with coexisting cataract and glaucoma. METHODS: A comprehensive literature meta-analysis was performed according to the Cochrane Collaboration methodology to identify controlled clinical trials comparing one-site with two-site phacotrabeculectomy. The studies meeting the predefined criteria were reviewed systematically by meta-analysis. Efficacy estimates were measured by standardised mean difference (SMD) for the percentage intraocular pressure (IOP) reduction from baseline to end point, odds ratio (OR) for the percentage having a best-corrected visual acuity (BCVA) of 0.5 or better after surgery and relative risk (RR) for complete success rates. Tolerability estimates were measured by RR for adverse events. All of outcomes were reported with 95% confidence interval (CI). Data were synthesised by Stata 10.1 for Windows. RESULTS: Two-site phacotrabeculectomy was associated with numerically greater, and significant efficacy than one-site in lowering IOP (SMD, -0.19; 95% CI, -0.33 to -0.04; P=0.01). Numerically greater, but nonsignificant proportions of two-site patients than one-site patients had a BCVA of 0.5 or better (OR, 0.65; 95% CI, 0.30 to 1.39; P=0.26).Numerically greater, but nonsignificant proportions of two-site patients than one-site patients achieved the target IOP without anti-glaucoma medication at the end point (RR, 0.94; 95% CI, 0.84 to 1.04; P=0.22). Furthermore, there was nonsignificant difference in adverse events between two surgical procedures. CONCLUSION: The efficacy of two-site phacotrabecu- lectomy appears to be superior to one-site phacotrabecul- ectomy. One-site and two-site phacotrabeculectomy are similarly tolerable in postoperative adverse events.     

不同切口超声乳化白内障吸除术联合小梁切除术的疗效和耐受性的荟萃分析

目的：评价并比较一切口和二切口超声乳化白内障吸除术联合小梁切除术治疗白内障合并青光眼的疗效和耐受性。 方法：按照Cochrane协作网方法全面检索符合纳入标准的比较一切口和二切口超声乳化白内障吸除术联合小梁切除术的临床对照研究,将其进行荟萃分析。临床疗效的评估包括：眼压下降百分比采用标准化均差（SMD）,术后最佳矫正视力≥0.5的患者百分比采用比值比（OR）,手术成功率采用相对危险度（RR）。临床耐受性的评估采用RR。所有结果均以95%可信区间表示。数据分析采用Stata 10.1。 结果：降低眼压的临床疗效二切口术式明显优于一切口术式,差异具有统计学意义（SMD,-0.19 95% CI,-0.33到 -0.04 P=0.01） 术后最佳矫正视力≥ 0.5的患者百分比二切口术式大于一切口术式,但差异不具有统计学意义（OR,0.65 95% CI,0.30到1.39 P=0.26） 术后不加用抗青光眼药物达到靶眼压的患者百分比二切口术式大于一切口术式,但差异不具有统计学意义（RR, 0.94; 95% CI, 0.84到1.04; P=0.22） 两种术式在术后并发症方面差别无统计学意义。 结论：二切口超声乳化白内障吸除术联合小梁切除术临床疗效优于一切口术式。两种术式的术后并发症没有明显差异。     

The evaluation of the usefulness of phacotrabeculectomy as the only surgery for glaucoma and cataract patients

PURPOSE: To evaluate IOP changes after phacotrabeculectomy. MATERIAL AND METHODS: 24 glaucoma patients (27 eyes) with coexistence of cataract. Age: 56-79 years. Mean IOP level before surgery: 23.2 +/- 2.4 mm Hg. In all cases phacotrabeculectomy was performed. Follow-up ranged from 3 to 12 months. RESULTS: IOP decrease after surgery was achieved: mean decrease 7.1 +/- 2.3 mm Hg after 3 months and 5.5 +/- 2.4 mm Hg, and 4.1 +/- 2.1 mm Hg after 6 and 12 months, respectively. CONCLUSION: Phacotrabeculectomy combines all advantages of phacoemulsification and creates perspective for IOP normalization.     

Molteno implants in children

We report our experience with Molteno implants in 27 eyes of 20 children with glaucoma. Associated ocular findings included Sturge Weber syndrome (one patient), aniridia and retinoschisis (one patient), aphakia (seven patients, eight eyes), rubella syndrome (two patients), Peters anomaly (one patient), and Treacher Collins syndrome (one patient). Fifteen eyes received a single-plate implant, and 12 eyes received a double-plate implant in two stages. The patients' ages ranged from 2 months to 13 years (mean 47 +/- 55 months). The average number of previous glaucoma procedures was four per eye (range two to 10). The follow-up period ranged from 6 to 36 months (mean 20 +/- 9 months). The mean intraocular pressure before surgery was 34 +/- 4 mm Hg. The mean postoperative intraocular pressure was 19 +/- 11 mm Hg at 1 month and 19 +/- 6 mm Hg at 1 year (p < 0.001 at both times). After surgery nine eyes (33.3%) required no medication for control of intraocular pressure. Additional surgery was required in 12 eyes (44.4%). We believe the Molteno implant is a useful approach for children with glaucoma who fail to respond to standard medical and surgical treatments.     

Preliminary Observation of One-site Combined Trabeculectomy and Phacoemulsification in the Management of Cataract Patients with Drug-controllable Glaucoma

Purpose: To evaluate the effect of one-site combined phacoemulsification and trabeculectomy in the management of cataract patients with drug-controllable glaucoma. Methods : Twenty-four cases (25 eyes) of cataract patients with glaucoma whose intraocular pressure could be controlled by drugs were observed. All had undergone one-site combined phacoemulsification and trabeculectomy. Intraocular pressure and visual acuity were observed.Results: The follow-up was 1-21 months. Postoperative visual acuity was 0.4-0.6 in 9 eyes, 0.7-0.9 in 7 eyes and 1.0 or better in 9 eyes. Postoperative intraocular pressure was 2.17±0.764kPa (16.28±5.73mmHg), 1.83±0.90kPa (13.74 ± 6. 77mmHg) lower than that before surgery (t= 11.89, P<0.01). Only one eye needed one drug to control intraocular pressure after surgery.Conclusions:One-site combined phacoemulsification and trabeculectomy is a safe, effective and convenient technique for the management of cataract patients with drug-controllable glaucoma. . Eye Science 1999 ;     

两种切口青光眼白内障三联手术近期疗效的对比研究

目的：评价并比较单切口和双切口超声乳化白内障摘除、人工晶状体植入联合小梁切除术治疗青光眼合并白内障的近期疗效。

方法：采用前瞻性随机对照临床试验研究,青光眼合并白内障的患者60例78眼。31例40眼行单切口超声乳化白内障摘除、人工晶状体植入联合小梁切除术,29例 38眼行双切口手术。术后2wk; 1mo观察视力、眼压、术后滤过泡、散光及术后并发症。

结果：术后全部患者都感到视力较术前提高,不同切口组间视力在术后2wk; 1mo比较无显著差异(P>0.05); 术后2wk; 1mo两组患者的眼压较术前均降低,有显著性差异(P<0.05),两组间比较无显著性差异(P>0.05); 单切口组及双切口组功能滤过泡的眼数在术后2wk; 1mo比较均无显著意义(P>0.05); 术后2wk时,单切口组散光较术前增大,与同期的双切口组相比散光大,均有显著差异(P<0.05); 术后1mo时,两组与术前相比、两组间比较均无显著差异(P>0.05); 3眼术后出现少量前房积血,12眼术后早期出现角膜内皮水肿、后弹力层皱褶,6眼出现前房纤维素性渗出。

结论：双切口超声乳化白内障摘除、人工晶状体植入联合小梁切除术治疗青光眼白内障,手术操作简便、疗效佳,是一种理想的手术方式。     

Shunt revision versus additional tube shunt implantation after failed tube shunt surgery in refractory glaucoma

PURPOSE: To compare tube shunt revision with additional tube shunt after failed tube shunt surgery. METHODS: We identified 281 patients who underwent a primary tube shunt procedure from 1985 to 1998 at Indiana University and reviewed 33 eyes of 33 patients that had failed and required further surgery. Shunt revision was performed in 12, whereas an additional shunt was placed in 21 eyes. Intraocular pressure, antiglaucoma medications, visual acuity, and complications were noted. Success was defined as at least a 25% reduction in intraocular pressure that was deemed clinically adequate. Qualified success was defined as a 25% intraocular pressure reduction but with additional medications or a significant reduction in medications with stable intraocular pressure for preoperative intraocular pressure less than 21 mm Hg. RESULTS: Preoperative intraocular pressures (mean +/- 95% confidence interval) for the revision and additional tube groups were 28.8 +/- 5.8 mm Hg and 29.8 +/- 2.7 mm Hg (P =.73), with an average follow-up period of 25.2 months (range, 3 to 108 months) and 34.8 months (range, 6 to 84 months), respectively. Final mean intraocular pressure was 25.3 +/- 6.7 mm Hg for the revision group and 17.7 +/- 3.4 mm Hg for the additional tube group (P =.037). Forty-two percent in the revision group versus 62% in the additional tube group achieved at least a qualified success (P =.30, Fisher exact test). Corneal edema was a common complication, especially in the additional tube group. Limitations of this study include the small sample sizes and the uneven distribution of neovascular glaucoma between the two groups (six of 12 in the revision group vs two of 21 in the additional tube group; P =.015, Fisher exact test). CONCLUSIONS: Our series showed that after failed tube shunt surgery, an additional tube shunt offers better intraocular pressure control than revision by excision of an encapsulated bleb.