青光眼滤过术后白内障患者行超声乳化联合人工晶状体植入术毕前房注射地塞米松的临床疗效

目的　评价青光眼滤过术后白内障患者行超声乳化联合人工晶状体植入术毕前房注射地塞米松的临床疗效。方法　选取青光眼滤过术后白内障患者９８例（１２０眼），由同一医师进行白内障超声乳化联合人工晶状体植入术。所有患者随机分组，对照组４８例（６０眼）术毕给予地塞米松注射液０．５ｍＬ（２．５ｍｇ）球结膜下注射；试验组５０例（６０眼）术毕前房内注射０．１ｍＬ（０．５ｍｇ）地塞米松注射液。观察并比较两组患者手术后最佳矫正视力、前房反应、眼压、角膜内皮细胞计数、六角形细胞比率的差异。结果　青光眼滤过术后白内障超声乳化联合人工晶状体植入术后１ｄ、３ｄ最佳矫正视力试验组比对照组效果更好，２组比较差异有统计学意义（Ｐ＜０．０５），术后１周最佳矫正视力两组间差异无统计学意义（Ｐ＞０．０５）；对照组与试验组术前，术后１ｄ、３ｄ、１周、１个月、３个月眼压组间比较差异均无统计学意义（均为Ｐ＞０．０５）；对照组与试验组术后１ｄ、３ｄ、１周前房炎症反应组间差异有统计学意义（均为Ｐ＜０．０５），试验组眼前房炎症反应较轻；对照组与试验组术后３ｄ、１周、１个月角膜内皮细胞密度、六角形细胞百分比及变异系数组间比较差异均有统计学意义（均为Ｐ＜０．０５），对照组较试验组术后细胞密度明显降低，六角形细胞百分比下降，变异系数增高。结论　青光眼滤过术后白内障超声乳化联合人工晶状体植入术毕前房注射地塞米松注射液是安全有效的，对术后短期内获得最佳矫正视力、减轻前房反应、减少角膜内皮细胞的丢失具有积极的临床意义。

Clinical research of injecting dexamethasone into anterior chamber after phacoemulsification in cataract patients following trabeculectomy of glaucoma

Objective To evaluate the safety and effectiveness of injecting dexamethasone into anterior chamber after phacoemulsification and intraocular lens implantation in cataract patients following trabeculectomy of glaucoma. Methods Ninetyeight patients ( 120 eyes) with cataract after trabeculectomy of glaucoma were performed phacoemulsification and intraocular lens implantation. A1l patients were randomIy divided into two groups :control group with 48 cases ( 60 eyes) received conjunctival injection of dexamethasone 2. 5 mg ( 0. 5 mL ) after operation , experimental group with 50 cases ( 60 eyes) received anterior chamber injection of dexamethasone 0. 5 mg (0. I mL) after operation. The postoperative best corrected visual acuity, anterior chamber reaction .intraocular pressure , corneal endothelial cell counting , ratio of hexagonal cells and retinal macular thickness in two groups were observed and compared. Results There was statistically significant difference in best corrected visual acuity at postoperative I day , 3 days between two groups (P < 0. 05 ) , the experimental group was better than the control group, while there was no significantly difference at postoperative I week between two groups (P > 0. 05 ) . There was no significantly difference in intraocular pressure at pre-operation and postoperative I day,3 days, I week. I month and 3 months between two groups ( all P > 0. 05 ) . There were statistically significant differences in anterior chamber reaction at postoperative I day,3 days and I week between two groups ( all P < 0. 05 ) ,the experimental group was slighter than the control group. There were statistically sigruficant differences in endothelial cell density , ratio of hexagonal cells and coefficient of variation at postoperative 3 days , I week and I month between two groups ( all P < 0. 05 ) , the endothelial cell density and ratio of hexagonal cells in the control group were lower than those in the experimental group , and the coefficient of variation was higher. Conclusion Anterior chamber injection of 0. 5 mg ( 0. I mL) dexamethasone is safe and effective after phacoemulsification and intraocular lens implantation in cataract patients following trabeculectomy of glaucoma , there are positive clinical sigruficances in achieving best corrected visual acuity in postoperative short-term , reducing anterior chamber reaction . and reducing the loss of corneal endothelial cells.