爆破模式超声乳化治疗抗青光眼术后白内障

目的:探讨在抗青光眼滤过术后的白内障患者应用爆破超声能量模式进行超声乳化白内障吸出术的安全性及临床效果。方法:将52例(68眼)抗青光眼滤过术后的白内障患者随机分为连续及爆破两组,分别采用连续及爆破2种不同的超声能量模式进行超声乳化白内障吸出联合人工晶状体植入术。记录两组术中所用的有效超声时间、超声能量,术后检查患者的视力、角膜水肿情况,并检查角膜内皮细胞密度。结果:连续组及爆破组术中实际使用的超声能量分别为(29.17±4.79)%和(15.86±5.33)%;有效超声时间分别为(69±18)s和(34±12)s。比较两组所用的有效超声能量及时间,差异均具有显著性意义(P<0.05)。术后第1天爆破组的角膜水肿情况轻于连续超声组(P<0.05),术后1周爆破组的角膜内皮丢失率明显低于连续组(P<0.05)。两组患者术后的视力均得到提高,达到0.5及以上者爆破组50%、连续组44.1%,两组间差异无显著性(P>0.05)。术后眼压爆破组平均升高0.81 mmHg、连续组平均升高1.17 mmHg,两组比较差异无显著性(P>0.05)。两组患者术后均未见功能性滤过泡瘢痕化。结果:应用爆破模式在抗青光眼滤过术后患者行超声乳化白内障吸除术,可减少有效超声能量和时间,降低角膜内皮细胞丢失率,减轻术后早期角膜水肿,具有良好的临床疗效及安全性。

Application of Burst Mode Phacoemulsification in Glaucomatous Eyes After Filtering Surgery

Objective: To evaluate the clinical outcome of burst mode phacoemulsification in eyes that had undergone glaucoma filtering surgery.Methods: A randomized prospective study of 52 consecutive cases(68 eyes) of glaucomatous eyes after filtering surgery was conducted.The patients had similar intraocular pressure(IOP) and stages of cataract,and were matched in sex and age. All cases received phacoemulsification with posterior chamber intraocular lens implantation by one surgeon and randomly assigned to one of the two groups(the burst mode group and the continuous mode group).The effective phaco time and the actual power were recorded.The visual acuity,corneal edema,IOP,and endothelial cell loss were compared between the two groups.(Results:) The postoperative visual acuity of all patients improved in different degrees.The mean postoperative IOP increased by 0.81 mmHg in burst mode group and by 1.17 mmHg in continuous mode group.The functional filtering bleb was not apparently cicatrized.The mean effective phaco time of burst group was statistically shorter than that of the continuous mode group.The actual power of burst group was statistically lower than that of the continuous mode group.Corneal clarity on the first and third postoperative day of the burst group was better in comparison to the continuous mode group.The mean endothelial cells loss in burst group was significant less than,the other group one week after surgery.Conclusion: Glaucomatous eyes with cataract after filtering operation can rehabilitate their visual acuity and maintain the functional filtering bleb by phacoemulsification with foldable intraocular lens implantation through a temporal clear corneal incision.The use of burst mode phaco power reduces significantly the effective phaco time and the amount of ultrasound energy.The decreased energy utilization has significant benefits including diminished injury to surrounding ocular structures,less corneal edema,endothelial cells loss and rapid visual rehabilitation.