青光眼滤过术后硬核性白内障手术的改良研究

目的观察青光眼滤过术后硬核性白内障改良手术方式的临床效果。方法对青光眼小梁切除术后半年以上的硬核性白内障患者共82例（114眼）行颞侧角膜缘反眉弓板层巩膜隧道切口，开罐式破囊，水分离，用注水晶状体圈匙缓慢娩出晶体核，对有虹膜后粘连者进行分离，对瞳孔变形和散大者用0／10线进行瞳孔缝合成形。术中不做直肌牵引缝线和烧灼止血，避开滤过泡，整个手术过程均在密闭状态下完成。术后随访6～12个月，观察术后视力、眼压、滤过泡和并发症等。结果①110眼术后视力均有不同程度的提高，视力≥0．6者34眼（占29．82％）；0．4～0．6者47眼（占41．23％）；0．2．0．4者27眼（占23．68％）；≤0．2者6眼（占5．26％）；②术眼滤过泡保存完好，未出现滤过泡破损及粘连等情况；③术后瞳孔成形效果好，41眼的瞳孔上移、散大和变形得到改善；④术后眼压保持稳定，所有患者眼压均在8～20mmHg（平均为15．15±2．78mmHg）范围内，与术前眼压（平均15．23±2．87mmHg）比较，差异无统计学意义（t=0．21，P〉0．05）；⑤术后有38眼出现不同程度的角膜水肿，3眼出现较为严重的葡萄膜炎性反应，经治疗后均逐渐消退。结论采用本法改良的术式对青光眼滤过术后硬核性白内障施行摘除手术的疗效较好且操作简单、便于推广。

Extracapsular cataract extraction in sclerotic nucleus cataract through a small incision of improved after glaucoma surgery

Objective To observe the therapeutic effect of extracapsular cataract extraction of Ⅳ/Ⅴ grade sclerotic cataract with IOL implantation after glaucoma trabeculectomy through a small incisions.Methods Eighty-two cases(114 eyes)of Ⅳ/Ⅴ grade sclerotic cataract accepted cataract extraction through an anti-superciliary arch temporal corneal limbus lamellar scleral tunnel incision with IOL implantation after glaucoma trabeculectomy for more than half a year.Follow up 6-12 months.The postoperative vision,IOP,filtrate bleb and complications were observed.Results The postoperative vision were improved in 82 cases(114eyes) ,in which 34 eyes' (29.82%) vision ≥ 0.6,47 eyes' (41.23%) 0.4-0.6,27 eyes' (23.68%) 0.2-0.4,6 eyes'(5.26%) ≤0.2.The postoperative filtrate blebs were well-preserved and the pupils forming effective,41 of the pupils on the move,mydriasis and deformation were improved.The postoperative average IOP was(15.15 ±2.78)mm Hg(1 mm Hg = 0.133 KPa) ,and it was no statistically significant differences in pre-or post-operative intraocular pressure(t'= 0.21 ,P ＞ 0.05).There were 38 eyes with corneal edema and 3 eyes with uveitis after improved surgery.Conclusion This operative technique is effective to treat sclerotic cataract after glaucoma surgery.,which is simple and easy to promote.