[In Press] Effect of phacoemulsification on intraocular pressure in patients with primary open-angle glaucoma and pseudoexfoliation glaucoma

AIM: To compare the effect of phacoemulsification on intraocular pressure (IOP) in patients with primary open angle glaucoma (POAG) and pseudoexfoliation glaucoma (PXG). METHODS: A retrospective comparative case series conducted at the Glaucoma Department at the Association for Preventing Blindness in Mexico. The study enrolled consecutive patients having phacoemulsification with IOL implantation and a diagnosis of POAG or PXG. Data about IOP values and number of glaucoma medications used was collected at baseline, month 1, 3, 6 and 12 postoperatively. RESULTS: The study enrolled 88 patients (88 eyes). After phacoemulsification, there was a statistically significant reduction in IOP values and glaucoma medications use compared to baseline in both POAG and PXG patients (P<0.001). In the POAG group, a 20% decrease in IOP values was evidenced, and a 56.5% reduction in the number of medications used at the one-year follow-up. The PXG group showed a 20.39%, and a 34.46% decrease in IOP and number of medications used, respectively. A significant difference in the mean ΔIOP (postoperative changes in intraocular pressure) was evidenced between groups (P=0.005). The reduction of the postsurgical IOP mean values in both groups, the POAG group showed a greater reduction in IOP values compared to the PXG group. CONCLUSION: In both types of glaucoma, phacoemulsification cataract surgery can result in a significant IOP reduction (20%) over a 12-month follow-up period. The number of medications used is also significantly reduced up to 12mo after surgery, especially in the PXG group.     

Effect of phacoemulsification on intraocular pressure in patients with primary open angle glaucoma and pseudoexfoliation glaucoma

AIM: To compare the effect of phacoemulsification on intraocular pressure (IOP) in patients with primary open angle glaucoma (POAG) and pseudoexfoliation glaucoma (PXG). METHODS: A retrospective comparative case series conducted at the Glaucoma Department at the Association to Prevent Blindness in Mexico. The study enrolled consecutive patients having phacoemulsification with intraocular lens (IOL) implantation and a diagnosis of POAG or PXG. Data about IOP values and number of glaucoma medications used was collected at baseline, 1, 3, 6 and 12mo postoperatively. RESULTS: The study enrolled 88 patients (88 eyes). After phacoemulsification, there was a statistically significant reduction in IOP values and glaucoma medications use compared to baseline in both POAG and PXG patients (P<0.001). In the POAG group, a 20% decrease in IOP values was evidenced, and a 56.5% reduction in the number of medications used at the one-year follow-up. The PXG group showed a 20.39%, and a 34.46% decrease in IOP and number of medications used, respectively. A significant difference in the mean ΔIOP (postoperative changes in IOP) was evidenced between groups (P=0.005). The reduction of the postsurgical IOP mean values in both groups, the POAG group showed a greater reduction in IOP values compared to the PXG group. CONCLUSION: In both types of glaucoma, phacoemulsification cataract surgery can result in a significant IOP reduction (20%) over a 12mo follow-up period. The number of medications used is also significantly reduced up to 12mo after surgery, especially in the PXG group.     

Ex-PRESS implantation with phacoemulsification in POAG versus CPACG

AIM: To compare the long-term outcomes of the Ex-PRESS miniature glaucoma device implanted under a scleral flap in combination of phacoemulsification with intraocular lens implantation in primary open angle glaucoma (POAG) and chronic primary angle-closure glaucoma (CPACG). METHODS: Retrospective, comparative study. A total of 60 eyes (60 patients) receiving the Ex-PRESS miniature glaucoma device implantation combined with phacoemulsification were reviewed. Thirty eyes (30 patients) had the combined procedures for POAG, and the other 30 eyes (30 patients) for CPACG. RESULTS: The follow-up was 39.37±7.09mo (range 3 to 49mo) in patients with POAG and 37.10±9.26mo (range 9 to 49mo) in patients with CPACG (P=0.29). The mean change in best corrected visual acuity was 0.41 logMAR for POAG and 0.38 logMAR for CPACG at the last follow-up (P=0.22). The postoperative intraocular pressure (IOP) of the POAG group was significantly lower than the CPACG group at 1, 3, 12, and 18mo after surgery (P=0.02, 0.00, 0.04, 0.01) with similar glaucoma medications after surgery (P＞0.16). At 3y after surgery, the cumulative complete and qualified success rates were 63.3% (POAG) and 53.3% (CPACG), 83.3% (POAG) and 73.3% (CPACG) (P=0.41, 0.49), respectively. The POAG group had more hypotony than the CPACG group (P=0.04). CONCLUSION: The long-term outcomes show the Ex-PRESS implantation combined with phacoemulcification can effectively lower the IOP in both the POAG and CPACG groups. The POAG group seems to have lower postoperative IOP and a higher risk of hypotony.     

Comparing posture induced intraocular pressure variations in normal subjects and glaucoma patients

AIM:To compare the posture-induced variations in intraocular pressure(IOP)between the primary open angle glaucoma(POAG)and non-glaucomatous eyes.METHODS:A case-controlled age matched study was conducted in 55 successive newly diagnosed POAG and 56 non-glaucomatous patients seen in glaucoma clinic and general outpatient eye clinic in the Alex Ekwueme University Teaching Hospital,Abakaliki.The IOPs of eligible correspondents were measured with Perkin’s hand-held tonometer in the sitting,supine flat and supine with pillow positions respectively.Measurement of IOP in each position was done after 15 min of assuming such posture.RESULTS:The IOP difference between the sitting and supine flat position was significantly higher in the POAG than non-glaucoma subjects(7.68±2.08 vs 4.03±0.13 mm Hg,P<0.001).The IOP difference between the sitting and supine with pillow positions was 2.61±1.49 mm Hg for POAG and 1.44±0.70 mm Hg in non-glaucoma(P<0.001),while difference between supine flat and supine with pillow positions was 5.07±2.24 mm Hg in POAG and 2.59±0.66 mm Hg in non-glaucomatous patients(P<0.001).CONCLUSION:Greater variations in posture induced IOP occurred in POAG patients than non-glaucomatous.The posture induced IOP variation is lowest in the sitting position and highest in the supine flat position.Evaluation of posture induced IOP changes may be an important tool in the management of glaucoma.     

Preliminary report on screening IGSF3 gene mutation in families with congenital absence of lacrimal puncta and canaliculi

AIM: To investigate the efficacy and safety of phacoemulsification combined with goniosynechialysis and/or endoscopic cyclophotocoagulation (PGE group and PG group) for the treatment of patients with coexisting primary angle-closure glaucoma (PACG) and cataracts. Methods: The clinical data of patients with PACG and cataract were retrospectively reviewed. There was a total of 88 eyes in the study and were divided into two groups, 42 eyes in PGE group and 46 eyes in PG group. Surgery success cumulative survival, preoperative and postoperative intraocular pressure (IOP), number of IOP-lowering medications, best corrected visual acuity (BCVA) in the two groups were observed for more than 12mo and compared within each group and between two groups. Results: The mean IOP in Phaco-GSL-ECP group declined from 24.9 mm Hg preoperatively to 14.1 mm Hg at the first month after operation (P＜0.001) and 16.2 mm Hg at the last visit (P＜0.001). The mean IOP in Phaco-GSL group declined from 24.1 mm Hg preoperatively to 13.0 mm Hg at the first month (P＜0.001) and 15.3 mm Hg at the last visit (P＜0.005). The mean medications reliance in Phaco-GSL-ECP group was reduced from 1.62 preoperatively to 0.13 at the last visit (P＜0.001), meanwhile in Phaco-GSL group the mean medications reliance was reduced from 0.87 to 0.10 (P＜0.001). There was significant difference at baseline, then disappeared at the last visit (P=0.01 vs P=0.867). At the last visit, BCVA increased from 0.21 to 0.60 in Phaco-GSL-ECP group (P＜0.001) and from 0.25 to 0.67 in Phaco-GSL group (P＜0.001). The success rate of Phaco-GSL-ECP group at 1mo visit was 95.2%, at the last visit was 70.7%. The success rate of Phaco-GSL at 1mo was 100%, was 73.4% at the last visit. Conclusion: Phaco-GSL-ECP shows promise for PACG patients with cataracts to reduce IOP, lighten the medication burden and improve visual acuity, and Phaco-GSL still has its value in specific patients.     

The Clinical Outcomes of Three Surgical Managements on Primary Angle-closure Glaucoma

Purpose: To investigate the efficacy of trabeculectomy, phacotrabeculectomy and phaco-emulsification in the management of primary angle closure glaucoma (PACG). Methods: A prospective observational study was performed in 88 chronic PACG patients (97 eyes) who were divided into three groups following defined indications to receive different surgical interventions. The indications and clinical outcomes were evaluated. The mean follow-up was (17.7±4.9) months. Results: Success rate in trabeculectomy, phacotrabeculectomy and phacoemulsification group was 81.08%, 78.57‰ and 81.25‰, respectively. The anterior chamber depth was deeper and the angle was wider postoperatively vs. preoperatively both in phaco-trabeculectomy and phacoemulsification group. No obvious changes were seen in trabeculectomy group. The coefficient of outflow facility of aqueous humor (C values) significantly increased in three groups postoperatively (P < 0.01). No severe intra-operative complications were found and the incidence of postoperative complications was low. Five eyes sustained hypotony 3±1.87 months in trabeculectomy group and 1 eye happened malignant glaucoma in phacotrabeculectomy group. The visual acuity in patients with phacotrabeculectomy plus intraocular lens implantation and those only with phacoemulsification plus intraocular lens implantation were improved 78.57% and 93.74%, respectively. No significant improvement was found in trabeculectomy group (χ2 = 47.10, P < 0.001). Conclusion: Three surgical interventions were beneficial to manage PACG and with co-existing cataract. The indication choosing was suggested according to visual acuity, angle closure circumference, cataract, medication requirements and optic nerve damage. Phacotrabeculectomy was recommended for angle closed ≥180° circumference while phacoemulsification for angle closed < 180°.     

Phacoemulsification in Patients with Secondary Glaucoma Caused by Uveitis

Purposes: To evaluate the effect of phacoemulsification in the patients with uveitis,secondary glaucoma and complicated cataract.Methods: Phacoemulsification and implantation of a foldable intraocular len wasperformed in 12 patients(13 eyes) with uveitis, secondary glaucoma and complicatedcataract. The complications, intraocular pressures (IOP), and visual acuity wereobserved postoperatively.Results: No severe complication was found in the patients postoperatively or within theoperation procedure. The visual acuity was improved after the operation ( P < 0. 05) .The intraocular pressures and/or the number of antiglaucoma medications reduced in 3months of the follow-up time.Conclusion: phacoemulsification is the best way to treat the patients with secondaryglaucoma and complicated cataract caused by uveitis.     

Analyzing cytokines as biomarkers to evaluate severity of glaucoma

AIM: To analyze cytokines as biomarkers for evaluation of severity of glaucoma. METHODS: This was a prospective case-control study including 29 eyes with glaucoma. Besides, 28 eyes with senile cataract were used as control. Patients were classified into four groups: acute angle closure glaucoma (AACG), chronic angle closure glaucoma (CACG), primary open angle glaucoma (POAG) and senile cataract. Undiluted vitreous samples were collected, then vitreous concentrations of 9 types of cytokines were determined by cytometric bead assay system: γ-interferon (IFNg), interleukin (IL)-10, IL-2, IL-4, IL-5, interferon-γ-inducible protein (IP)-10, monocyte chemoattractant protein (MCP)-1, tumor necrosis factor (TNF) -α, and vascular endothelial growth factor (VEGF). We also recorded the intraocular pressure (IOP) of patients in each group and Pearson correlated analysis was performed to analysis the correlation between each type of cytokine with IOP. RESULTS: Vitreous levels of IL-2, IL-5, MCP-1, TNF-α and IP-10 were significantly higher (P<0.05) in AACG group. Patients with AACG, CACG and POAG have higher IOP than senile cataract, but we didn’t find any significant correlation between IOP with any type of the cytokines. CONCLUSION: Inflammation and immune reaction have a strong link with the pathology of glaucoma especially AACG. Some cytokines may act as biomarkers to evaluate the severity of glaucoma. Anti-inflammatory treatments and controlling of IOP are necessary for the therapy of glaucoma.     

Two-year outcomes of ab interno trabeculectomy with the Trabectome for Chinese primary open angle glaucoma: a retrospective multicenter study

AIM: To evaluate the 2-year efficacy and safety of ab interno trabeculectomy with the Trabectome in Chinese primary open angle glaucoma (POAG) patients. METHODS: This was a multicenter, retrospective, observational study and included POAG patients with or without visually-significant cataracts. The Chinese patients were enrolled from three glaucoma centers and a group of comparable Japanese POAG patients was analyzed from our international Trabectome database. The patients received Trabectome or a combined surgery with phacoemulsification and intraocular lens implantation. The primary outcome was intraocular pressure (IOP) reduction. Secondary outcomes included reduction of glaucoma medications, surgical complications, and success at 2y. Success was defined as: 1) IOP≤21 mm Hg and at least 20% IOP reduction from baseline after 3mo at any two consecutive visits; 2) no additional glaucoma surgery required. RESULTS: A total of 42 Chinese POAG patients from three glaucoma centers were enrolled. Twelve patients underwent Trabectome surgery combined with phacoemulsification and intraocular lens implantation while the remainder underwent Trabectome surgery alone. Thirteen patients had a history of failed glaucoma surgery and were considered as complicated cases. In China data, the mean preoperative IOP was 21.4±1.23 mm Hg. The Trabectome lowered IOP to 17.9±1.8 mm Hg at 2y (P=0.05). The number of glaucoma medications also decreased significantly from a baseline of 2.0±0.9 to 1.1±0.8 at 2y post-surgery (P=0.04). The overall 2-year success rate was 78%, with patients undergoing combined surgery having a higher success rate compared with those undergoing Trabectome surgery alone (100% vs 76%). In Japan data, the mean preoperative IOP was 20.8±7.7 mm Hg. The Trabectome lowered IOP to 12.20±2.0 mm Hg at 2y. The number of glaucoma medications also decreased significantly from a baseline of 2.1±0.9 to 3.4±0.6 at 2y post-surgery. In all patients, no major complications were seen. CONCLUSION: Surgery with the Trabectome appears to be an efficient and safe procedure in Chinese POAG patients in the long-term.     

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

Objective To evaluate the clinical effects of the two-site incision combined surgery of phacoemulsification, foldable intraocular lens implantation and trabeculectomy for patients with glaucoma and cataract. Methods Retrospectively analyzed pre- and post-operation effects of visual acuity, intraocular pressure and filtering bleb morphology and complications. Thirty five eyes of 32 patients with glaucoma and cataract underwent the combined operations. Results All cases were followed up for 12 to 48 months. Intraocular pressure of 32 eyes was controlled under 21mmHg (1mmHg = 0. 133kPa) and 20 eyes lower than 15mmHg. The average intraocular pressure was from (28.16 ± 2.63 )mmHg pre-operation to ( 16.32 ± 3.45)mmHg post-operation (t =21.60, P ＜0. 05). The species of anti-glaucoma drugs from preoperative average of 2.59 ± 0.49 was decreased to only one kind in three patients postoperative. Postoperative visual acuity of 30 eyes (85.7%) was increased. The major complications were a transient corneal edema and iridocyclitis. Conclusions Combined phacoemulsification, foldable intraocular lens implantation and trabeculectomy in the treatment of glaucoma and cataract patients can control intraocular pressure and improve visual acuity.     

Factors that influence intraocular pressure after cataract surgery in primary glaucoma

Objective: We sought to find predictive factors for favourable postoperative intraocular pressure (IOP) after cataract surgery in patients with primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG).Study Design: Retrospective evaluation of patients who had undergone cataract surgery.Participants: Forty-eight patients with POAG and 48 patients with PACG.Methods: Various clinical factors were evaluated retrospectively in 96 patients. All patients had undergone standard 2.75-3.5 mm limbal incision cataract surgery. Clinical parameters in patients with successful postoperative IOP courses were compared with those in unsuccessful patients. Success was defined as an IOP between 6 and 21 mm Hg, with fewer antiglaucoma medications needed compared with before surgery, and no need of additional glaucoma surgery.Results: In POAG, eyes with a highest preoperative IOP of <31 mm Hg or those being treated with <3 antiglaucoma medications before surgery had a significantly higher probability of success. In PACG, the probability of success was significantly higher if the highest preoperative IOP was <42 mm Hg, the number of antiglaucoma medications before surgery was <3, or the areas of peripheral anterior synechiae were <4 clock hours.Conclusions: Primary small-incision cataract surgery using phacoemulsification and foldable intraocular lens implantation may be the procedure of choice in patients with medically controlled glaucoma and coexisting visually significant cataracts, considering the highest preoperative IOP and number of antiglaucoma medications in POAG and PACG, and the area of peripheral anterior synechiae in PACG.     

伴白内障的原发性房角关闭及闭角型青光眼超声乳化术的效果

目的 评价晶状体超声乳化吸出联合人工晶状体植入术( Phaco+ IOL)对原发性房角关闭(PAC)及原发性闭角型青光眼(PACG)合并白内障的手术效果.方法 合并白内障的PAC 24例(24眼)和PACG27例(27眼).药物控制眼压至21 mm Hg以下后,施行晶状体超声乳化吸出联合人工晶状体植入术,随访6个月,观察最佳矫正视力、眼压、房角周边前粘连范围等指标进行相关分析.结果 术后6个月视力较术前有明显提高(Z =5.025,P＜0.001).两组术后6个月眼压均较术前用药下眼压有显著下降(Z =51.685,P＜0.01),两组术后房角周边前粘连均有不同程度的减轻(PAC组Z=6.120,P＜0.001,PACG组Z=2.345,P=0.019).结论 白内障行超声乳化吸出能显著提高PAC和PACG的视力,降低眼压,开放房角,短期内避免PAC的再次发作.     

Primary lens extraction for glaucoma management: A review article

Recently, primary lens extraction alone gained more acceptance as an alternative surgical approach for glaucoma management. This view was supported by the advances in phacoemulsification and intraocular lenses with greater safety and visual recovery, in addition to a substantial reduction of intraocular pressure and deepening of the anterior chamber and filtration angle. The decrease in IOP after cataract surgery in primary open-angle glaucoma (POAG) is mild, less predictable, related to baseline levels, and may return to presurgical values after an initial period of reduction. Therefore, the IOP-lowering effect of primary cataract extraction in POAG may be insufficient to achieve adequate IOP control. The IOP reduction after lens extraction is consistently greater in eyes with primary angle closure glaucoma (PACG) than in eyes with POAG. Primary lens extraction in acute PACG eliminates, or at least, reduces the risk of recurrence of acute attacks and deepens the anterior chamber and widens the angle which reduces the risk of progression of peripheral anterior synechiae and development of chronic PACG. Primary lens extraction may be more preferable to glaucoma incisional surgery in mild to moderate PACG eyes with appositional angle closure. The decision to do lens extraction as a primary treatment for glaucoma should be individualized based upon several factors other than the effect on IOP. These factors include patients’ characteristics, surgeons’ skills and preferences, status of glaucoma control, type of cataract and intraocular lens implanted, and potential harm of laser treatment for late capsular opacification and fibrosis.     

超声乳化联合小梁切除术及术中应用5-氟尿嘧啶治疗青光眼合并白内障的长期疗效观察

目的探讨超声乳化联合小梁切除术及术中应用5氟尿嘧啶(5fluorouracil,5Fu)治疗青光眼合并白内障的疗效。方法对1996年1月至1998年12月,在新加坡国立眼科中心行超声乳化联合小梁切除术及术中应用5Fu治疗的71例(71只眼)原发性开角型青光眼(POAG)和原发性闭角型青光眼(PACG)患者的临床资料进行回顾性分析。除外随访时间<6个月的患者。结果术后患者平均眼压和平均用药种数均较术前明显降低,差异有统计学意义(P<001)。术后随访1~5年的患者眼压与术前比较均明显下降,差异有统计学意义(P<001)。手术完全成功率1、3及5年分别为842%、627%及553%。在手术完全成功的条件下,POAG与PACG(P=0281)、同一切口与不同切口(P=0487)手术疗效比较(采用Cox模型进行多因素生存分析),手术成功率差异无统计学意义(P>005)。但POAG与PACG术后平均眼压比较,差异有统计学意义(P=002)。术后较术前平均视力提高差异有统计学意义(P<001)。术后与术前平均视野缺损(MD)值(P=055)和模式标准差(PSD)值(P=064)比较,差异无统计学意义,表明患者术后视野保持稳定。术后4d发生眼内炎1例,术后晚期由于脉络膜渗漏和伤口漏引起低眼压2例。结论超声乳化联合小梁切除术及术中应用5Fu治疗POAG和PACG的成功率高,手术安全,长期观察疗效稳定。POAG与PACG或     

Long-term intraocular pressure control of trabeculectomy and triple procedure in primary open angle glaucoma and chronic primary angle closure glaucoma

To evaluate the long-term intraocular pressure (IOP) control of trabeculectomy and triple procedure (cataract extraction by phacoemulsification, intraocular lens implantation and trabeculectomy), 1,542 eyes of 900 patients with primary open angle glaucoma (POAG) or chronic primary angle closure glaucoma (CPACG) were included. When success was defined as an IOP reduction of at least 30% from baseline, with or without antiglaucoma medications, the overall probability of success of trabeculectomy and triple procedure was 0.613 and 0.733 at 15 years, respectively. The success probability of trabeculectomy and triple procedure in reducing IOP below 18 mm Hg was 0.748 and 0.825 at 15 years, respectively. In POAG and CPACG patients, trabeculectomy and triple procedure were effective in reducing IOP for up to 15 years after surgery.     

超声乳化白内障手术对剥脱综合征性青光眼的降眼压作用

目的 观察和分析剥脱综合征性青光眼患者行超声乳化白内障摘除人工晶体植入术后的眼压变化。方法 对7例伴有高眼压、明显影响视力的白内障但尚无严重的视神经、视野损害的剥脱综合征患者施行超声乳化白内障摘除人工晶体植入术，比较手术前后的眼压变化。结果 术前平均眼压31．57mmHg，术后1周时平均眼压18．19mmHg，降幅为13．38mmHg，术前术后眼压差异极显著。结论 伴有明显影响视力白内障的剥脱综合征性青光眼病人在行超声乳化白内障摘除人工晶体植入术后眼压会显著下降，对那些尚未发生明显视神经视野损害的剥脱综合征性青光眼患者，行超声乳化白内障摘除人工晶体植入术可有效降低眼压。     

原发性闭角型青光眼中白内障超声乳化联合IOL植入术的疗效

目的:评价白内障超声乳化联合人工晶状体(intraocular lens,IOL)植入术治疗眼压控制的急性闭角型青光眼和慢性闭角型青光眼患者的疗效及安全性。方法:将45例60眼白内障眼压控制的急性闭角型青光眼和慢性闭角型青光眼随机分为两组,一组采用白内障超声乳化联合IOL植入术,一组采用激光虹膜切开术(laser iridotomy,LI)。比较两组眼内压、抗青光眼药物使用数目、并发症、前房内皮细胞计数的差别。结果:IOL组中,随访6mo后的眼内压由术前的14.82±4.23mmHg下降到10.94±1.24mmHg,而LI组的眼内压并无明显变化(15.34±4.13mmHgvs14.68±4.77mmHg),采用重复测量资料的方差分析显示两组的眼内压变化有显著统计学差异(F=36.452,P<0.01)。IOL组6mo后基本未采用抗青光眼药物,而LI组使用抗青光眼药物个数为0.24±0.41个(P<0.05)。两组在并发症及前房内皮细胞计数方面无统计学差异(P>0.05)。结论:白内障超声乳化联合IOL植入可有效降低眼压控制的急性闭角型青光眼和慢性闭角型青光眼的眼内压水平,该治疗方法安全有效,是这类患者首选的治疗方法之一。     

超声乳化白内障吸除联合房角分离术治疗原发性闭角型青光眼的临床研究

目的 探讨超声乳化白内障吸除、人工晶状体植入联合房角分离对原发性闭角型青光眼治疗的临床效果和安全性.方法 连续性选取收治的原发性闭角型青光眼合并有白内障的患者133例145只眼,随机分为超声乳化组(Phaco组)和小梁切除手术组(Trab组).观察手术前后视力、前房深度、角膜内皮细胞密度、房水流畅系数(C值)、房角及眼压的变化情况并进行统计学处理.平均随访时间(13.2±5.6)个月.结果 Phaco组术后视力明显提高而Trab组提高不明显;眼压在6个月时Phaco组由术前(46.47±9.12)mmHg降低为(16.55±4.36)mmHg,Trab组由术前(48.25±7.52)mmHg降低为(16.87±5.01)mmHg,两组手术前后比较差异均有统计学意义;Phaco组前房深度由术前(1.55±0.26)mm加深为(3.38±0.35)mm,房角关闭度数由术前(290±25)度减少到(60±35)度,手术前后比较差异有非常显著性,而Trab组则无明显变化;房水流畅系数(C值)检测两组手术前后比较差异均有显著性改善;角膜内皮细胞密度检测两组手术前后差异则无显著性.结论 超声乳化白内障吸除、人工晶体植入联合房角分离术能够显著地加深前房,开放房角,有效地降低眼压,提高患者视功能,并具有手术安全性高、术后并发症少等优势,是治疗PACG合并自内障患者的一种安全有效的手术方法.     

激光虹膜成形联合白内障超声乳化吸除术治疗急性闭角型青光眼

目的 分析激光虹膜成形术联合白内障超声乳化吸除术,对药物治疗不能迅速缓解的合并白内障的原发性闭角型青光眼急性发作的治疗效果.方法 对药物治疗不能迅速缓解的合并不同程度白内障的原发性闭角型青光眼急性发作患者12例(14只眼)行激光虹膜成形术以开放房角、控制眼压,而后行白内障超声乳化吸除联合人工晶状体植人术,随访(3～12)月,观察房角、眼压、视力变化及并发症情况.结果 激光虹膜成形术后超声生物显微镜检查示所有术眼房角开放;激光虹膜成形术前眼压(44.5±6.3)mmHg,术后2h、4h的眼压分别为(20.5 4±3.5)mmHg、(11.9 4±2.9)mmHg,与光凝前眼压的差异均有统计学意义(t=21.4956,P=0.000;t=241.5631,P=0.000);白内障超声乳化术后2周、3月的眼压均低于21mmHg,平均分别为(16.54±2.7)mmHg、(15.84±2.6)mmHg;激光虹膜成形术后和白内障超声乳化吸除术后视力不同程度提高;无严重并发症.结论 激光虹膜成形术能有效缓解药物治疗无效的原发性闭角型青光眼急性发作,并可作为白内障超声乳化吸除术治疗急性闭角型青光眼的前期治疗.     

内路小梁切开联合白内障超声乳化吸除术治疗原发性开角型青光眼的短期疗效

目的 对比内路小梁切开联合白内障超声乳化吸除术和单纯内路小梁切开术治疗合并白内障的原发性开角型青光眼（primary open angle glaucoma，POAG）的早期手术效果和并发症。设计 病例对照研究。研究对象2018年3月至2019年3月在北京同仁眼科中心住院手术治疗的合并白内障的POAG患者36例（36眼）。方法 根据患者选择的手术方式，将患者分为两组：行内路小梁切开联合白内障超声乳化吸除术的POAG患者12例（12眼）为观察组，行内路小梁切开术的POAG患者24例（24眼）为对照组。记录并比较两组患眼术前、术后1、2、3、5天、1周、1个月时眼压、视力、并发症和使用降眼压药的种类。主要指标 眼压、视力、并发症和降眼压药物种类。结果 观察组和对照组术前最高眼压分别为（34.08±8.21）mmHg和（37.75±8.61）mmHg（P=0.46）,观察组术后第1天、1周、1个月的平均眼压分别为（20.75±11.89）mmHg、（21.23±8.72）mmHg、（15.00±2.22） mmHg，对照组术前、术后第1天、1周、1个月的平均眼压分别为（16.08±5.63）mm Hg、（22.08±11.48）mmHg、（16.05±5.25）mmHg，两组术后眼压整体变化趋势随时间降低（P<0.001）,两组间术后眼压波动虽然存在差异，但是无统计学意义（P=0.77）。观察组和对照组术后1个月降眼压幅度分别为53.09%±15.19%和55.68%±15.63%（P=0.64）。观察组和对照组术前降眼压药物使用种类分别为（2.67±0.99） 种和（3.08±0.72）种（P=0.16），术后1个月时分别下降至（0.17±0.58）种和（0.96±1.33）种（P=0.06）。观察组和对照组组术后眼压反跳发生率分别为16.67%和54.17%（P=0.03）。前房积血为术后最常见的并发症, 观察组发生率为83.3%，对照组为62.5%（P=0.21)。观察组和对照组睫状体脱离发生率分别为25.0%和75.0%（P=0.004）。观察组中，8眼（66.7%）术后生活视力提高，4眼（33.3%）视力恢复至术前水平，0眼视力降低；对照组中，20眼（83.3%）术后生活视力恢复至术前水平，4眼（16.7%）视力降低（P<0.001）。结论 对于合并白内障的开角型青光眼患者，内路小梁切开联合白内障超声乳化吸除术和单纯内路小梁切开术在术后1个月时降眼压作用相似。联合手术术后视力改善明显，眼压反跳发生率较单纯内路小梁切开术低，是一种安全有效的手术方式，远期效果有待进一步观察。