微导管辅助的内路部分黏小管成形联合内路部分小梁切开术与内路全周小梁切开术的早期疗效对比

目的 评估微导管辅助的内路部分小梁切开术联合内路部分黏小管成形术（简称GABiC）治疗原发性开角型青光眼（POAG）的疗效。设计 回顾性比较性病例系列。研究对象 2018年6月至2019年1月北京同仁医院18岁以上既往无其他抗青光眼手术史POAG患者30例（30眼）。方法 回顾行GABiC术与微导管辅助的内路360°小梁切开术（GATT）患者的病例资料,术后随访3个月。主要指标 眼压、降眼压药物用药情况、并发症、条件成功率、完全成功率。结果GABiC组7眼;GATT组23眼。术后3个月,GABiC组和GATT组眼压分别为17.0 ± 2.2 mmHg和14.7 ± 3.0 mmHg（P=0.081）;用降眼压药物分别为（0.3±0.8）种、（0.1±0.4）种（P=0.865）;绝对成功率分别为86% （6/7例）和83% （19/23例）（P=1.000）;条件成功率分别为100% （7/7例）和96% （22/23例）（P=1.000）。术后眼压反弹分别为14%、48%（P=0.193）,睫状体脱离分别为100%、100%,前房出血分别为57%、87%（P=0.120）。结论 短期随访结果显示,GABiC治疗POAG的效果和安全性与GATT无显著性差异。（眼科,2020,29： 304-308）     

微导管引导的内路小梁切开术治疗原发性先天性青光眼六个月的疗效

目的 评估微导管引导的内路小梁切开术治疗原发性先天性青光眼的效果。设计 回顾性病例系列。研究对象 2018年8月至2019年2月北京同仁眼科中心原发性先天性青光眼患者27例（30眼）。方法 患者接受微导管引导的内路小梁切开术，根据术中全周切开和次全周切开，以及是否有既往手术史分组。术后随访6个月。主要指标 眼压、降眼压药物及术后并发症。结果 术前平均眼压（31.5±6.1）mmHg，用药中位数3种（1~4种）；术后末次随访眼压（15.7±3.6）mmHg，用药中位数0种（0~3种）（P均<0.001）。全周切开组（17眼）及次全周切开组（13眼）的术前眼压及术后末次眼压均无统计学差异（P均＞0.05），但全周切开组的降眼压幅度为（54.7%±10.1%），明显大于次全周切开组（37.5%±16.8%，P=0.002）。初次手术组（16眼）与多次手术组（14眼）术前眼压、术后末次眼压及降眼压幅度的差异均无统计学意义（P均＞0.05）。术后早期均有前房积血, 6眼（20%）术后一过性眼压升高。结论 短期随访结果显示， 微导管引导的内路小梁切开术治疗角膜透明的原发性先天性青光眼是可行的。     

外路微导管辅助的360度小梁切开术治疗青少年性开角型青光眼和原发性开角型青光眼的临床对照研究

目的 评估微导管辅助小梁切开术治疗青少年性开角型青光眼（JOAG）和原发性开角型青光眼（POAG)的临床效果和安全性。设计 回顾性病例系列。研究对象2017年11月至2018年12月北京同仁医院接受微导管辅助的小梁切开术治疗的JOAG患者22例（26眼）,平均年龄（25.2±4.5）岁;POAG患者11例（14眼）,平均年龄（46.3±5.1）岁。方法 回顾患者的病历资料,记录眼压、抗青光眼药物使用数量、术中及术后并发症等。术后1、3、6、12个月随访。术后不使用降眼压药物眼压≤21 mmHg且眼压下降幅度≥20%为成功。主要指标 眼压、抗青光眼药物使用数量、术中及术后并发症。结果 所有患者均完成了12个月的随访。JOAG组术前平均眼压（30.6±7.5） mmHg,平均应用（3.5±1.0）种药物;术后12个月平均眼压（15.8±3.3 ) mmHg,平均应用（0.5±1.0）种药物,眼压降幅为44.9%±18.0%。POAG组术前平均眼压（25.4±6.2） mmHg,平均应用（3.4±0.9）种药物;术后12个月平均眼压（15.9±3.2） mmHg,平均应用（0.3±0.6）种药物,眼压降幅为35.8%±15.6%。JOAG组、POAG手术成功率分别为76.0%、78.6%。两组降眼压幅度和成功率均无显著性统计学差异（P=0.122、0.855)。均无严重手术并发症发生。结论 微导管辅助小梁切开术治疗JOAG和POAG均具有较好的短期降眼压效果及安全性。（眼科,2021, 30： 20-24）     

微导管辅助小梁切开术治疗儿童青光眼的疗效

目的：观察微导管辅助的小梁切开术治疗儿童青光眼的临床效果及术后1 年切开小梁的开放情况。 方法：前瞻性临床研究。纳入2018 年1 月至2019 年12 月于河南省立眼科医院青光眼中心接受微导 管辅助的小梁切开术治疗的4～16 岁儿童青光眼患者21 例（28 眼）。观察记录患者手术前后最佳矫正 视力（BCVA）、眼压、抗青光眼药物使用数量、房角情况、术中及术后并发症。术后随访1 年。采用 配对t检验、Wilcoxon符号秩和检验、Kruskal-Wallis H检验、Spearman秩相关分析等对数据进行分 析。结果：所有患者均完成了微导管辅助的小梁切开术,其中完全切开16 例（22 眼）,次全切开5 例 （6眼）。术前及术后末次随访的BCVA（LogMAR视力）分别为0.80（0.00～2.00）和0.75（0.00～1.60）, 差异无统计学意义（Z=-1.41,P=0.157）。术前及术后末次随访的眼压分别为（30.4±4.8）mmHg （1 mmHg=0.133 kPa）和（14.1±4.5）mmHg,末次随访眼压较术前明显降低（t=14.11,P<0.001）。术 前使用降眼压药物数量中位数为3（1～4）,末次随访时下降至0（0～3）（ Z=-4.35,P<0.001）。末次 随访时切开小梁开放范围中位数为302.5°（70°～360°）。所有患者中15例（21眼）手术完全成功,4例 （5眼）条件成功,2例（2眼）手术失败,这3类患者切开小梁开放范围中位数分别为330°（210°～360°）、 205°（180°～225°）、85°（70°～100°）,差异有统计学意义（χ2=15.20,P=0.001）。切开小梁开放范围 与眼压呈负相关（r=-0.82,P<0.001）。结论：微导管辅助的小梁切开术治疗儿童青光眼具有良好的 临床效果,且术后切开小梁开放范围是影响患者预后的重要因素。     

闭角型青光眼合并自内障两种术式的临床比较

目的探讨不同手术方法治疗慢性闭角型青光眼合并白内障的临床效果。方法54例67眼慢性闭角型青光眼合并白内障患者，随机分为2组，观察组39眼和对照组28眼。观察组行白内障超声乳化吸出人工晶状体植入联合小梁切除术，对照组行单纯白内障超声乳化吸出人工晶状体植入术，术后随访6～12月。结果术后2组早期视力差异无显著性。6月后因眼压较高引起视力下降者，观察组3眼，对照组8眼，2组差异显著（P〈0．05）；眼压控制在正常范围者（〈20．55mmHg，1kPa=7．5mmHg）观察组32眼，对照组20眼。对照组有5眼眼压在30mmHg以上，需手术治疗。2组间有显著性差异（P〈0．05）。术后2组并发症的发生无显著差异（P〉0．05）。结论慢性闭角型青光眼合并白内障，术前房角粘连≥3／4象限、眼压不易控制者，应选择青光眼白内障联合术，效果更加确切。[眼科新进展2005；25（5）：444—445]     

有无急性发作史的慢性闭角型青光眼患者小梁切除术18个月效果比较

目的 比较有无急性发作史的慢性闭角型青光眼（chronic angle closure glaucoma, CACG）患者行小梁切除术后18个月的效果。 设计 前瞻性比较性病例系列。 研究对象  4个临床中心参与的48例（48眼）具有急性发作史的原发性CACG患者（急性发作组）和101例（101眼）无急性发作史的原发性CACG患者（无急性发作组）。方法  所有患者经全面的眼科检查后行小梁切除术,术后随访18个月。记录手术前、手术后1、3天、1、2周、1、3、6、12、18个月的视力、眼压、用药情况及并发症。末次随访时无需使用降眼压药物的情况下眼压小于21 mmHg者认为手术成功。主要指标 眼压、视力变化（末次随访视力-基线视力）、眼压波动（随访中眼压的标准差）和手术成功率。 结果 手术前后视力的变化在急性发作组和无急性发作组分别为-0.06±0.47和0.02±0.36（P=0.166）。随访平均眼压分别为（14.9±4.0） mmHg和（14.6±2.8） mmHg（P=0.601）。随访中的眼压波动分别为（3.1±2.5）mmHg和（2.8±1.6）mmHg（P=0.452）。随访18个月时急性发作组和无急性发作组的眼压分别为（16.8±7.5） mmHg和（15.4±4.0） mmHg（P=0.259）。术后随访18个月急性发作组的手术成功率（85.7%）与无急性发作组的手术成功率（93.1%）的差异无统计学意义（?字2=2.11,P=0.146）。 结论  小梁切除术在有急性发作史和无急性发作史的CACG患者中18个月的手术成功率无明显差异。     

微导管引导的外路小梁切开术治疗儿童青光眼的短期疗效

目的 评估微导管引导的小梁切开术治疗初次手术和既往手术失败的儿童青光眼患者的有效性和安全性。设计 回顾性病例系列。研究对象2017年4月至2018年5月郑州市第二人民医院接受微导管引导的小梁切开术的儿童青光眼患者28例（39眼）。方法 回顾初次手术组（A组，15例22眼）及再次手术组（B组，13例17眼）患者手术前后的眼压、降眼压药物使用情况及术后并发症。比较两组术前、术后末次随访眼压及降眼压药物使用数量的变化及手术成功率。随访时间为6~17个月（中位数为13个月）。主要指标 眼压、降眼压药物种类、手术成功率。 结果A组术前平均眼压（31.23±6.05） mmHg，术后末次随访平均眼压（15.14±4.63）mmHg（t＝8.40，P<0.05）；术前使用降压药种类的中位数（范围）为3（1~4），术后为0（0~2）（Z＝3.97，P<0.05）。B组术前平均眼压（29.47±5.75）mmHg，末次随访平均眼压（15.65±4.03）mmHg（t＝6.97，P<0.05）；术前使用降压药种类的中位数为3（1~4），术后为0（0~2）（Z＝3.75，P<0.05）。末次随访A组完全成功率为77.27%，B组为88.24%（P=0.438)。所有患者术中及术后均无严重并发症。结论 随访半年以上的结果显示，微导管引导的小梁切开术治疗初次手术和再次手术的儿童青光眼均具有较好的疗效，且无严重并发症发生。     

儿童抗青光眼联合晶状体摘除手术的远期疗效分析

目的评价儿童青光眼合并晶状体异常病例联合白内障摘除及抗青光眼手术的效果。方法对21例32眼青光眼合并晶状体异常的儿童进行了抗青光眼手术及晶状体摘除手术。其中同期手术13例21眼,设为A组,行小梁切开或/和小梁切除、白内障摘除、后囊环形撕囊及前部玻璃体切除术。8例11眼为无晶状体眼,设为B组做为对照组,行小梁切除术或联合小梁切开术。术后随访平均46m。结果术前检查：全部病例均具有光觉反应,能合作检查视力者为光感视力。眼压平均45.11mmHg,A组平均43.16mmHg,B组平均49.20mmHg。术中检查多数都伴有眼前节发育异常,包括：房角发育不良、晶状体囊膜异常,小球状晶状体继发晶状体半脱位等。术后情况：术后近期平均眼压为20.66mmHg,21眼（65.6%）眼压控制正常。A组平均眼压20.78mmHg,17眼（81.0%）眼压控制正常,4眼发生一过性瞳孔阻滞。B组平均眼压20.35mmHg,10眼（90.9%）眼压控制在正常范围。至随访末期平均眼压为20.65mmHg,20眼（62.5%）眼压得到控制;A组5眼（23.8%）有再次手术史,其中3眼为瞳孔阻滞,随访末期平均眼压为19.79mmHg;B组4眼（36.4%）有再次手术史,无瞳孔阻滞发生。随访末期平均眼压为23.23 mmHg。结论对先天性白内障合并青光眼的儿童可以实施青光眼白内障联合手术,其手术风险小,效果好,并发症少。     

微导管辅助的小梁切开术治疗原发开角型青光眼的远期疗效

目的 评估微导管辅助小梁切开术治疗原发开角型青光眼的远期效果和安全性。设计 回顾性病例系列。研究对象 2015年10月至2018年5月北京同仁眼科中心接受微导管辅助小梁切开术治疗的原发开角型青光眼患者47例（63眼）。方法 所有患者均接受微导管辅助的小梁切开术,术后1、3、6个月,1、2、3、4、5年进行随访。以术后不使用降眼压药物,且眼压≤21 mmHg为完全成功,术后需要使用降眼压药物控制眼压≤21 mmHg为条件成功。分析术前与末次随访眼压情况与药物使用情况。根据患者进行小梁切开术前是否有青光眼手术史将患者分为两组,比较两组小梁切开术后的眼压和降眼压药物使用情况。主要指标 眼压、抗青光眼药物使用数量、术中及术后并发症,手术成功率。结果 术前平均眼压为（24.8±9.0）mmHg,术后末次复查的平均眼压为（16.9±4.7）mmHg（P=0.000）。术前用药（2.9±0.9）种,术后用药（0.7±1.0）种（P=0.000）。术后1、3、5年累积完全成功率分别为72.1%、62.7%、41.2%、,累积条件成功率分别为91.8%、88.1%、76.5%。术后早期所有患者均有不同程度的前房积血,部分患者出现一过性眼压波动。无严重远期并发症出现。末次随访时,术前有无抗青光眼手术史患者的眼压分别为(18.1±5.1)mmHg和(15.7±4.0)mmHg,与术前比两组之间无显著差异（P=0.098）。结论 微导管引导的小梁切开术对原发开角型青光眼是一种长期安全有效的降眼压手术方式。术前有无抗青光眼手术史对手术的降眼压效果无显著影响。（眼科,2021, 30： 435-439）     

基于爆破音的两种经巩膜睫状体光凝方案治疗难治性青光眼的疗效比较

目的 探讨根据爆破音调节经巩膜二极管激光睫状体光凝能量方案治疗难治性青光眼的疗效。设计 回顾性比较性病例系列。研究对象 难治性青光眼患者62例（62眼）。方法 将患者随机分为爆破音调节能量组（调节组）30例（30眼）,爆破音固定能量组（固定组）32例（32眼）。调节组在经巩膜二极管激光睫状体光凝术术中根据爆破音出现的频率不断调节能量。固定组以首次出现爆破音的能量完成手术。术后随访3个月。主要指标 激光总平均能量、爆破音数量、眼压、视力、用药数量、术后并发症。结果 术前及术后3个月调节组平均眼压分别为（46.1±10.7）mmHg和（15.8±6.9）mmHg;固定组分别为（44.9±12.3）mmHg和（16.7±8.2）mmHg。不使用降眼压药物眼压控制在 21 mmHg以下者,调节组占80.0%,固定组占65.6%（χ2=5.643,P=0.018）。爆破音数量与眼压下降幅度呈中度正相关（调节组r=0.517,P=0.001;固定组r=0.572,P=0.001）。调节组术后1例视力下降;固定组术后2例视力下降,1例持续性低眼压。结论 爆破音调节能量的经巩膜睫状体光凝方案较爆破音固定能量方案对难治性青光眼的的疗效更好。（眼科, 2020, 29： 147-151）     

Comparison of surgical outcomes of combined viscocanalostomy and cataract surgery with combined trabeculotomy and cataract surgery

PURPOSE: To compare the outcomes of combined viscocanalostomy, phacoemulsification, and intraocular lens (IOL) implantation with combined trabeculotomy, phacoemulsification, and IOL implantation in patients with primary open-angle glaucoma (POAG).DESIGN: Nonrandomized clinical trial.METHODS: Fifty-seven eyes (57 POAG patients) that underwent viscocanalostomy, phacoemulsification, and intraocular lens (IOL) implantation between March 2000 and April 2001 and were followed for over 6 months postoperatively comprised the viscocanalostomy (VCS) group. Fifty-seven of 105 eyes (105 POAG patients) that underwent trabeculotomy, phacoemulsification, and IOL implantation between April 1995 and February 2000 and were followed for over 6 months and < 2 years comprised the trabeculotomy (LOT) group. The reductions of postoperative intraocular pressure (IOP) and antiglaucoma medication use in both groups were compared. Best-corrected visual acuity (VA) and complication rates were secondary outcomes. The success probabilities related to postoperative IOP level in both groups were evaluated by Kaplan-Meier life-table analysis with log-rank test.RESULTS: Significant reductions of IOP and antiglaucoma medication use occurred in both groups up to 1 year postoperatively, but were not significantly different between the two groups. The success probabilities of the VCS group for IOP control under 21, 17, and 15 mm Hg were 95%, 74%, and 44%, respectively, at 6 months, 95%, 67%, and 32% at 1 year, and not significantly different from the LOT group. All eyes in the VCS group had VA equal to or better than baseline 3 months postoperatively. The incidences of postoperative fibrin reaction (14 eyes, 25%) and microperforations of the Descemet membrane (14 eyes, 25%) in the VCS group were higher than in the LOT group (P =.0004 and P <.0001, respectively).CONCLUSIONS: Intraocular pressure reduction and VA improvement after the two procedures were similar in Japanese patients with POAG and cataract.     

Factors leading to reduced intraocular pressure after combined trabeculotomy and cataract surgery

PURPOSE: To determine the factors that control intraocular pressure (IOP) after trabeculotomy combined with phacoemulsification and intraocular lens implantation as an initial procedure in adults with primary open-angle glaucoma (POAG). METHODS: A consecutive series of 141 eyes with POAG or ocular hypertension was prospectively recruited. One hundred five eyes were treated by combined trabeculotomy and cataract surgery (TPI group) and 36 eyes were treated by cataract surgery alone (PI group). The prognostic factors that correlate with successful IOP control after surgery were screened using the Cox multivariate analyses based on three definitions of success: IOP <21 mm Hg, <17 mm Hg, and <15 mm Hg, with or without eye drops. The factors examined were types of procedure (TPI or PI), age, sex, preoperative IOP level, number of preoperative antiglaucoma medications, eyes with high myopia (>-10 diopters), postoperative hyphema lasting longer than 4 days, and postoperative transient IOP spike (>30 mm Hg). RESULTS: TPI was a significant factor for IOP reduction in the three definition-based multivariate analyses. Other factors included patient age, preoperative IOP level, and postoperative IOP spike. The statistical significance of age was further confirmed using linear regression analysis and the Spearman correlation coefficient (Rs) between age and IOP level 3 months after surgery (R(2)=0.13, P = 0.0002 and Rs=-0.44, P < 0.0001, respectively in the TPI group). The success rates for IOP control <17 mm Hg and <15 mm Hg were significantly higher in patients 70 years and older than in younger patients, as determined using the Kaplan-Meier life table analysis with the Mantel-Cox logrank test in both TPI and PI groups. IOP reduction was significantly greater in older patients than in younger patients at every follow-up visit for up to 1.5 years for the TPI group and up to 1 year for the PI group. CONCLUSION: Advanced age is a favorable prognostic factor for successful control of IOP after combined trabeculotomy and cataract surgery. Older patients with POAG and visually significant cataract are good candidates for combined trabeculotomy and cataract surgery.     

Trabeculotomy combined with phacoemulsification and implantation of intraocular lens for primary open-angle glaucoma

Retrospective study examined the surgical effects of lowering intraocular pressure of trabeculotomy combined with phacoemulsification and implantation of an intraocular lens. Included in the retrospective study were 96 eyes of 64 patients with primary open-angle glaucoma. Preoperative mean IOP was 25.6 mmHg. At final examination, the IOP was well-controlled at 21 mmHg or lower without medications in 32 of 96 eyes. In another 62 eyes, the IOP was well-controlled with antiglaucoma medications. The postoperative IOPs were in the high teens after surgery. The life table analysis using Kaplan-Meier methods showed that the success probability after phacoemulsification and implantation of intraocular lens, combined with trabeculotomy (PIT)-I and PIT-II, were 93.9% and 82.6% at 4 years, respectively. Postoperative visual acuity improved by more than two lines in 79 of the 96 eyes. In no case was the visual acuity decreased by more than two lines. Deterioration of the visual field was found in 4 eyes. There were no complications such as shallow anterior chamber, choroidal detachment, malignant glaucoma, hypotonic maculopathy, and endophthalmitis. This triple procedure should be performed in the early stages of glaucoma.     

Trabeculotomy combined with phacoemulsification and implantation of intraocular lens for primary open-angle glaucoma

Retrospective study examined the surgical effects of lowering intraocular pressure of trabeculotomy combined with phacoemulsification and implantation of an intraocular lens. Included in the retrospective study were 96 eyes of 64 patients with primary open-angle glaucoma. Preoperative mean IOP was 25.6 mmHg. At final examination, the IOP was well-controlled at 21 mmHg or lower without medications in 32 of 96 eyes. In another 62 eyes, the IOP was well-controlled with antiglaucoma medications. The postoperative IOPs were in the high teens after surgery. The life table analysis using Kaplan-Meier methods showed that the success probability after phacoemulsification and implantation of intraocular lens, combined with trabeculotomy (PIT)-I and PIT-II, were 93.9% and 82.6% at 4 years, respectively. Postoperative visual acuity improved by more than two lines in 79 of the 96 eyes. In no case was the visual acuity decreased by more than two lines. Deterioration of the visual field was found in 4 eyes. There were no complications such as shallow anterior chamber, choroidal detachment, malignant glaucoma, hypotonic maculopathy, and endophthalmitis. This triple procedure should be performed in the early stages of glaucoma. Trabeculotomy is thought to relieve the resistance to aqueous outflow by mechanical cleavage of the trabecular meshwork and the inner layer of Schlemm's canal. This technique leads to aqueous outflow the from the opening of the internal trabecular meshwork to the collector channel. For this reason trabeculotomy was developed by a number of surgeons. Recently, however, trabeculotomy has not been selected for those patients with advanced stages of primary open-angle glaucoma because of the disadvantages such as transient intraocular pressure (IOP) elevation several days after surgery and somewhat higher levels (18 mmHg) of postoperative intraocular pressure (Fig. 1). To avoid the IOP spike (transient IOP elevation) after trabeculotomy, we reported previously that the new technique of trabeculotomy combined with outer sclerectomy was a useful surgical option. The results of our previous study indicated that the postoprative intraocular pressure levels after combined trabeculotomy and outer sclerectomy were significantly lower than that of trabeculotomy alone. On the other hand, trabeculotomy with mitomycin C is currently the standard filtration procedure for glaucoma. This technique, however causes severe postoperative complication such as hypotonic maculopathy, bleb leakage and late bleb infection. The major advantages of trabeculotomy preclude these severe complications resulting from creating progressive filtration of aqueous humor from the anterior chamber to the subconjunctival space. The recent advance of small-incision phacoemulsification procedure prompted phacoemulsification and implantation of intraocular lens and trabeculotomy. The theoretical advantages of smaller scleral, conjunctival incision, reduced stimuli to wound healing, and inflammation, could improve long-term IOP control in patients with glaucoma. Therefore several reports have been published on the surgical outcomes of combined trabeculotomy and modern phacoemulsification. These reports suggested that the combined trabeculotomy and a small-incision with intraocular lens implantation is effective in controlling IOP in patients with glaucoma.     

白内障超声乳化人工晶状体植入术对早期原发性青光眼眼压控制效果分析

目的 观察早期原发性青光眼行超声乳化联合人工晶状体植入术后眼内压(IOP)控制情况,分析与术后IOP控制效果相关的影响因素.方法 回顾性选择原发性闭角型青光眼(PACG)43例(43只眼)和原发性开角型青光眼(POAG)早期患者32例(32只眼),均行标准3.2mm透明角膜切口白内障超声乳化联合折叠人工晶状体植入术,术后2年定期随访.手术成功标准为:术后IOP保持在6～21mmHg,青光眼神经病变及相应视野缺损无明显进展,无需再行抗青光眼手术治疗.结果 白内障超声乳化联合人工晶状体植入术后,PACG组有28例(65.1%)、POAG组有12例(37.5%)术后IOP控制良好,2年累计生存率之间存在差异(P＜0.05).PACG组成功与失败病例在术前IOP(33.0±5.3)mmHg vs(40.1±3.6)mmHg,P＜0.01、抗青光眼药物数量(2.9±0.9vs4.1±0.4,P＜0.01)、房角粘连范围(2.9±0.5)钟点vs(4.2±0.8)钟点,P＜0.01)之间的差异具有统计学意义,而POAG组成功与失败病例在术前IOP(25.3±3.4)mmHgvs(35.4±3.6)mmHg,P＜0.01、抗青光眼药物数量(1.2±0.4vs2.8±0.9,P＜0.01)之间的差异具有统计学意义.Cox逐步回归分析发现,在PACG组中术前IOP(P＜0.05,RR=1.17)、PAS(P＜0.01,RR=3.971),在POAG组中术前IOP(P＜0.01,RR=1.284),与相应两组术后生存时间具有相关性.结论 在术前PACG患者考虑到IOP和房角粘连范围、POAG患者考虑到IOP的条件下,超声乳化联合人工晶状体植入术对于伴有白内障的早期原发性青光眼,是一种可供选择的有效的控制眼内压的治疗方法.

Abstract：

Objective To assess and find associated factors for favorable postoperative intraocular pressure (IOP) after cataract phacoemulsification with intraocular lens implantation in patients with primary glaucoma on early stage.Methods Forty-five patients (43 eyes) with primary angle closure glaucoma (PACG) and 32 patients with primary open angle glaucoma (POAG) were retrospectively selected.All patients had undergone standard 3.2mm limbal incision phacoemulsification,and 2 years of routine follow-up after cataract surgery.Success was defined as an IOP between 6-21mmHg,with fewer antiglaucoma medications needed than those during pre-operation,no obvious progressions of glaucomatous neuropathy and its coincident visual field loss,and no need of additional glaucoma surgery.Results After phacoemulsification with intraocular lens implantation,there were 28 cases (65.1%) in PACG group and 12 cases (37.5%) in POAG group with well controlled postoperative IOP,and the different of 2-year survival rate was statistically significant (P ＜0.05).There were significant different in the pre-IOP (33.0± 5.3mmHg vs 40.1 ± 3.6mmHg,P ＜0.01),the number ofantiglaucoma medications (2.9± 0.9 vs 4.1± 0.4,P＜0.01) and the extent of peripheral anterior synechiae (PAS) (2.9±0.5 clock hours vs 4.2± 0.8 clock hours,P ＜0.01) between success and failure cases in PACG group.The pre-IOP (25.3±3.4 mmHg vs 35.4±3.6 mmHg,P＜0.01),the number of antiglaucoma medications (1.2± 0.4 vs 2.8± 0.9,P ＜0.01) were significant different between the success and failure cases in POAG group.Cox stepwise regression analysis found that pre-IOP (P ＜0.05,RR=1.17) and the extent of PAS (P ＜0.01,RR=3.971) in PACG group and the pre-IOP (P＜0.01,RR=1.284) in the POAG group was significant associated with the corresponding survival time after cataract surgery.Conclusions Phacoemulsification with intraocular lens implantation may be an alternative procedure for effective IOP control of the patients with primary glaucoma on early stage coexisting with cataract on considering pre-IOP and the extent of PAS in PACG and pre-IOP in POAG.     

超声乳化白内障摘除联合内窥镜指导下的房角分离术治疗闭角型青光眼合并白内障的初步疗效

【摘要】 目的 观察超声乳化白内障摘除人工晶状体（IOL）植入联合内窥镜指导下的房角分离术治疗闭角型青光眼合并白内障的效果。设计 前瞻性病例系列。研究对象 53例55眼房角关闭180度以上、药物不能控制眼压的慢性闭角型青光眼合并白内障的患者。方法 患者接受超声乳化白内障摘除IOL植入后行内窥镜指导的房角分离术。先用黏弹剂行房角分离后用内窥镜检查房角未开放的时钟范围,对未分开部位,内窥镜下用黏弹剂针头进行第二次钝性房角分离。比较两次房角分离后房角未分开范围。术后随访3个月。术前C/D值与第一次房角分离后未分开钟点数进行相关分析。主要指标 视力、眼压、房角粘连范围。结果 第一次用黏弹剂房角分离后,55眼中房角全部开放13眼（23.6%）,房角关闭1~3个钟点13眼（23.6%）,4~5个钟点16眼（29.1%）,≥6个钟点13眼（23.6%）。第二次房角分离后55眼中24（43.6%）眼房角全部开放,房角关闭1~3个钟点23眼（42.0%）,4~5个钟点4眼（7.2%）,≥6个钟点4眼（7.2%）。术前平均眼压（25.6±10.9）mmHg,术后3个月（15.7±6.3）mmHg（P=0.000）。C/D值与第一次房角分离后的未开放钟点数成正相关（r=0.892,P=0.000）。术前用局部降眼压药（3.0±0.7）种,术后3个月仅1例需用2种局部降眼压药眼压控制在21 mmHg以下。结论 超声乳化白内障摘除联合内窥镜指导下的房角分离术可明显提高房角分离术的成功率,内窥镜下术者更方便观察房角结构。（眼科,2014, 23： 18-21）     

Combined phacoemulsification and goniotrephination on eyes with primary open-angle glaucoma and classical pseudoexfoliation glaucoma

BACKGROUND: Combined glaucoma and cataract operation has been demonstrated to be effective in controlling IOP and increasing visual acuity. Because of the differences between patients with primary open-angle glaucoma (POAG) and pseudoexfoliation glaucoma (PXEG), for cataract and glaucoma surgery alone we evaluated the effects and complications for simultanous surgical management. PATIENTS AND METHODS: In a retrospective study 103 patients were examined who underwent a combined phacoemulsification and goniotrephination between January 1993 and January 1997 and had no surgery before (110 eyes with POWG, 22 eyes with PXEG). RESULTS: The average age in the POAG group (75.1 +/- 8.7 years) was significantly less than in the PXEG group (79.3 +/- 5.9 years) (P < 0.05). The mean preoperative IOP in PXEG (31.8 +/- 10.3 mmHG) was significantly higher than in POAG (25.0 +/- 6.4 mmHg) (P < 0.0005). Due to the combined surgery the mean intraocular pressure decreased in both groups < 10 mmHg (days 1 and 7). PXEG had a significantly higher IOP at day 3 than POAG (12.3 +/- 8.4 mmHg versus 8.5 +/- 5.7 mmHg) (P < 0.05) and developed after combined operation IOP peaks > 25 mmHg into a significantly higher level (P < 0.05). Moreover, zonulolysis, rupture of the posterior capsule, vitreous loss and persistence of inflammatory response occurred more often in PXEG, but there was no significant difference compared to POAG. CONCLUSION: PXEG has an higher incidence of typical problems of phacoemulsification, a temporary increase of IOP and prolonged inflammation after combined cataract and glaucoma surgery than POAG, but there is a similar risk compared to a single procedure.     

瞳孔扩张器在小瞳孔白内障超声乳化手术中的应用及比较

目的 比较小瞳孔白内障超声乳化手术中应用OASIS和Malyugin Ring两种瞳孔扩张器的手术效果。设计 前瞻性比较性病例系列。研究对象 在北京同仁医院确诊并拟行小瞳孔白内障手术患者20例（20眼）。方法 小瞳孔白内障患者20例（20眼）随机分为两组,其中术中采用Malyugin Ring瞳孔扩张器扩张瞳孔者11眼（1组）,采用OASIS瞳孔扩张器扩张瞳孔者9眼（2组）。所有患者均施行3.2 mm透明角膜切口超声乳化吸除,术后1周,1、3、6个月随访复查,比较两组间手术前后最佳矫正视力、眼压、角膜内皮细胞计数、瞳孔大小等。主要指标 最佳矫正视力、眼压、角膜内皮细胞计数、瞳孔大小。结果 所有手术均由同一医师顺利完成,人工晶状体全部囊袋内植入,无术中并发症发生。手术前第1组和第2组的最佳矫正视力,分别为0.18±0.16和0.16±0.14（P=0.836）;术后6个月第1组和第2组的最佳矫正视力分别为0.53±0.4和0.77±0.23（P=0.124）。术后6个月,第1组和第2组的眼压分别为（12.4±2.2） mmHg和（12.7±6.4） mmHg（P=0.364）;角膜内皮细胞计数分别为（2089±729）个/mm2和（1246±516）个/mm2（P=0.007）;瞳孔直径分别为（3.50±1.24） mm和（4.70±1.57）mm,均较术前瞳孔直径（分别为2.23±0.85 mm和1.94±0.50 mm）大（P=0.042,0.049）。结论 小瞳孔白内障超声乳化手术时应用OASIS和Malyugin Ring两种瞳孔扩张器辅助均能在术中有效扩大并维持瞳孔扩张状态;术后瞳孔均较术前扩大;两组间术后视力恢复和眼压无明显差异, Malyugin Ring较OASIS瞳孔扩张器更有助于减少术中角膜内皮细胞丢失。