青光眼白内障联合术植入不同材料人工晶状体效果评价

目的比较青光眼白内障联合术中植入不同材料人工晶状体（IOL）的临床效果。方法回顾性分析行青光眼白内障联合术70例（76眼），其中植入PMMA IOL30例（36眼），硅胶IOL23例（23眼），丙烯酸酯折叠IOL17例（17眼）。对治疗效果进行评价，平均随访期限为10．5月。结果3组间术后眼压和最佳矫正视力差异无统计学意义。前房纤维素样渗出物和IOL表面沉积物发生率，硅胶组高于PMMA组和丙烯酸酯组，但差异无统计学意义。后发障发生率，丙烯酸酯组和硅胶组显著低于PMMA组，差异有统计学意义。结论行青光眼白内障联合术植入PMMA，硅胶与丙烯酸酯IOL在降眼压和提高视力方面具有相似的效果。但硅胶IOL的前房纤维素样渗出物及IOL表面沉积物发生率高于PMMA和丙烯酸酯IOL。丙烯酸酯和硅胶IOL的后发障发生率低于PMMA IOL。

Comparison of PMMA, silicone and acrylic intraocular lenses in combined phacoemulsification and trabeculectomy

Objective To compare the outcome of phacotrabeculectomy with implantation of poly-methyl methacrylate(PMMA),silicone or acrylic intraocular lens(IOL).Methods Seventy patients(seventy-six eyes) with glaucoma and cataract that underwent phacotrabeculectomy with implantation of a PMMA IOL(36 eyes) or a foldable silicone IOL(23 eyes) or a foldable acrylic IOL(17 eyes).Preoperative and postoperative uncorrected visual acuity and best corrected visual acuity,intraocular pressure(IOP),inflammation and complications were examined up to 6 months.Results In all three groups the early and late mean postoperative IOPs were significantly lower than the preoperative ones(P<0.05),with no intergroup differences(P=0.24).All groups showed improvement in mean uncorrected visual acuity(P<0.05),the best corrected visual acuity achieved 0.5 or better were attended in 72.2% in the PMMA group,73.9% in the silicone group and in 70.6% in the acrylic group.The visual activity differences among the groups were not significant(P=0.973).The fibrin reaction in the anterior chamber silicone group and giant cell deposits on the IOL were founded in 16.7%,26.1% and 11.8%,in the PMMA,silicone and acrylic groups respectively.The differences among the groups were not significant(P>0.05).The rate of posterior capsulotomy opacification was lower with the acrylic IOL(5.9%) or the silicone(8.7%) than with PMMA(16.7%) IOLs(P=0.08).Conclusions In patients with glaucoma and cataract,phacotrabeculectomy with PMMA,silicone or acrylic IOL are equally effective in lowering the lOP and improving visual acuity.However,incidence of fibrin reaction and lens deposits are higher in those eyes which received a silicone IOL.Those eyes with an acrylic IOL or silicone IOL has a lower rate of posterior capsule opacification.