复合式小梁切除术与超声乳化白内障吸除术分期手术临床探讨

目的 通过对复合式小梁切除术、超声乳化白内障吸除术与可折叠式人工晶状体植入术分期手术治疗的回顾性分析，探讨青光眼合并白内障的手术方式选择。方法 收集2000年至2002年期间行复合式小梁切除术，而后再行超声乳化白内障吸除术与可折叠式人工晶状体植入术54例58只眼，对2种手术前后的白内障，视力及眼压进行比较，并对2种手术间隔时间的相关因素进行分析。结果 复合式小梁切除术后品状体混浊程度加重、视力下降，经超声乳化白内障吸除术与可折叠式人工晶体植入术后视力基本回复。短期内白内障手术未影响小梁切除术后的眼压。抗青光眼手术与白内障手术间的间隔时间与患者年龄及青光眼术前眼压无相关性（P〉0．05）。原发性闭角型青光眼的手术间隔时间短于原发性开角型青比眼，差异有统计学意义（P〈0．05）。结论 对于原发性闭角型青光眼，存选择下术治疗方式时须考虑白内障的影响。对于低视力患者，当需要进行滤过性手术时，复合式小梁切除术与超声乳化白内障吸除术的联合治疗可能优于分期手术治疗。

Clinical analysis of phacoemulsification after trabeculectomy

Objective To discuss the surgical management of glaucoma combined with cataract through analysis of the results of trabeculectomy followed by phacoemulsification and foldable intraocular lens implantation. Methods Fifty-eight patients (58 eyes) underwent phacoemulsification after trabeculectomy. Cataract vision and intraocular pressure before and after surgeries were compared. The related factors with the interval between trabeculectomy and phacoemulsification were also analyzed. Results The vision and cataract were deteriorated after trabeculectomy, and the vision were recovered after phacoemulsification. Phacoemulsification had few effect on the postoperative pressure control. The interval between trabeculectomy and phacoemulsification was not related with age and preoperative intraocular pressure ( P > 0. 05 ). The interval between surgeries in angle-closure glaucoma was shorter than in open-angle glaucoma. Conclusion Cataract is an important consideration factor for the surgery management of primary angle-closure glaucoma. The combined trabeculectomy and phacoemulsification maybe the first choice in the surgical treatment of angle-closure glaucoma with low visual acuity when filtrating surgery is necessary.