Cataract surgery in 79 patients with relative anterior microphthalmus (RAM): a review of anatomy, associated pathology and complications

BACKGROUND: Naumann has coined the term relative anterior microphthalmus (RAM) for eyes with a dysproportional small anterior segment but no further malformation. Those eyes are characterized by corneal diameters of < 11 mm and total axial length of > 20 mm. PATIENTS AND METHODS: To evaluate and define morphometrical data and risk factors for cataract surgery in patients with relative anterior microphthalmus (RAM) 112 cataract operations of 79 patients with RAM were analysed. Associated ocular pathology (such as glaucoma, previous surgical interventions, etc.) and complications of cataract surgery were recorded. RESULTS: Average corneal diameter was 10.7 +/- 0.34 mm, AC-depth was 2.20 +/- 0.49 and average lens thickness 5.05 +/- 0.45 mm. Fifty five percent of the patient revealed myopic refraction. There was a high incidence of glaucoma (77%), cornea guttata (46.6%) and Pseudoexfoliation syndrome (16%) in the RAM-group. Sixty percent of patients previously underwent glaucoma surgery. After cataract surgery 51.2% of patients achieved a visual acuity of > 0.5; 69.8% > 0.4. The IOP was preoperatively 16.5 +/- 5.8 mm Hg (with 1.3 +/- 1.4 antiglaucomatous drugs). Postoperatively IOP dropped significantly to 13.6 +/- 3.2 mm Hg (with significant reduction of treatment (0.6 +/- 1.0) (p < 0.01). The anterior chamber depth deepened from 2.42 +/- 0.47 mm to 3.33 +/- 0.72 mm. CONCLUSIONS: The special anatomical situation in RAM is responsible for the high incidence of glaucoma and postoperative complications after cataract surgery. Cataract surgery helps not only to restore vision but also facilitates handling and regulation of intraocular pressure.     

Relative anterior microphthalmos: morphometric analysis and its implications for cataract surgery

PURPOSE: To evaluate morphometric data and risk factors for complications of cataract surgery in patients with relative anterior microphthalmos (RAM). DESIGN: Retrospective, comparative study (Part I) and matched pairs analysis with controls (Part II). PARTICIPANTS: Sixty-two patients with RAM who underwent cataract surgery at the Department of Ophthalmology, Ruprecht-Karls-University of Heidelberg, Germany, between 1989 and 1997. RAM is defined as eyes with horizontal corneal diameters 20 mm, and no other morphologic malformation. MAIN OUTCOME MEASURES: Part I: Patients were examined preoperatively for anterior chamber (AC) depth, lens thickness, total axial length, and refraction. Associated ocular pathologic conditions (such as glaucoma or previous surgical interventions) were recorded. Part II: A matched pairs analysis concerning the anatomic features was performed with a group of 17 patients with RAM and 17 patients (controls) that matched the RAM group in terms of axial length, age, and gender but showed corneal diameters >11 mm. RESULTS: Part I: Anatomic parameters in RAM showed an average corneal diameter of 10.7 +/- 0.34 mm, AC depth of 2.20 +/- 0.49 mm, and average lens thickness of 5. 05 +/- 0.45 mm. Fifty-five percent of the patients had myopic refraction. There was a high incidence of glaucoma (77.4%), cornea guttata (45.2%), and pseudoexfoliation syndrome (16.1%) in the RAM group. Sixty percent of patients had undergone previous glaucoma surgery. After cataract surgery, 51.2% of patients achieved a visual acuity of >20/40 and 69.8% of >20/50. Temporary corneal edema (54. 8%) and ciliolenticular block (11.6%) were the most important complications after cataract surgery. Part II: Matched pairs analysis showed significant differences between RAM and controls in terms of AC depth (P =0.029) but no difference in lens thickness (P = 0.12). CONCLUSIONS: Relative anterior microphthalmos can be characterized in terms of morphometric data as eyes with corneal diameters 相似文献   

The clinical outcomes of cataract extraction by phacoemulsification in eyes with primary angle-closure glaucoma (PACG) and co-existing cataract: a prospective case series

PURPOSE: To evaluate the clinical outcomes of minimally invasive cataract extraction by phacoemulsification, with primary intraocular lens implantation, in eyes with primary angle-closure glaucoma (PACG) and co-existing cataract. MATERIALS AND METHODS: Consecutive primary angle-closure glaucoma patients with co-existing visually significant cataract were invited to participate in this prospective study. After obtaining informed consent, cataract extraction by phacoemulsification through a clear corneal incision was performed under topical anesthesia. Foldable intraocular lenses were implanted in the same setting. These patients were then followed up for a minimum of 1 year. Outcome measures included intraocular pressure (IOP), requirement for glaucoma drugs, and visual acuity. RESULTS: Twenty-one primary angle-closure glaucoma eyes of 21 patients were recruited. Mean age (+/- SD) was 73.7 +/- 8.1 years (range, 60-87 years). There were 12 female patients and 9 male patients, with 13 right eyes and 8 left eyes. Nine eyes (42.9%) had history of acute primary angle closure. Mean follow-up duration was 20.7 +/- 3.6 months (range, 13-26 months). Intraocular pressure was decreased from a mean preoperative level of 19.7 +/- 6.1 mm Hg (range, 11 mm Hg-40 mm Hg) to 15.5 +/- 3.9 mm Hg (range, 9 mm Hg-26 mm Hg) at final follow-up (P = 0.022) (paired t test). The number of glaucoma eye drops required was decreased from a mean preoperative level of 1.91 +/- 0.77 (range, 1-3) to 0.52 +/- 0.87 (range, 0-3) at final follow-up (P < 0.001) (paired t test). In 10 eyes (47.6%), visual acuity improved significantly after surgery. In 9 eyes (42.9%), visual acuity remained the same. In 2 eyes (9.5%), visual acuity deteriorated significantly after surgery. Mean cup-to-disc ratio was 0.6 +/- 0.2 (range, 0.3-0.9) preoperatively, and 0.7 +/- 0.2 (range, 0.3-0.9) postoperatively (P = 0.047) (paired t test). CONCLUSIONS: In primary angle-closure glaucoma patients with co-existing cataract, cataract extraction alone (by phacoemulsification) can significantly reduce both intraocular pressure and the requirement for glaucoma drugs.     

小切口小梁切除联合超声乳化白内障吸除术治疗青光眼合并白内障

目的　探讨 3 5mm小切口小梁切除联合超声乳化白内障吸除后房型人工晶状体植入术 (三联手术 )治疗青光眼合并白内障患者的效果。方法　应用小切口三联手术对 2 0例 (2 6只眼 )青光眼合并白内障患者进行手术治疗。术后随访 3～ 41个月 ,平均 16 1个月。结果　术前平均眼压(2 3 0 1± 2 6 3)mmHg(1mmHg =0 133kPa) ,术后随访最终平均眼压降至 (13 93± 1 85 )mmHg(P <0 0 0 1)。术后随访最终矫正视力范围 0 0 5～ 1 0 ,其中≥ 0 6者 17只眼 (6 5 % ) ,术后平均散光度0 81D ,其中 4只眼无散光度。术后早期 2只眼使用降眼压药物 ,随访后期无使用者。术后早期并发症角膜水肿 5只眼 (19% ) ,浅前房 3只眼 (12 % ) ;晚期并发症后发性白内障 6只眼 (2 3% )。结论　小切口三联手术治疗青光眼合并白内障患者 ,具有恢复有用视力、稳定眼压、减少术后用药、并发症少等理想效果。     

The efficacy and safety of combined phacoemulsification, intraocular lens implantation, and limited goniosynechialysis, followed by diode laser peripheral iridoplasty, in the treatment of cataract and chronic angle-closure glaucoma

PURPOSE: To report the efficacy and safety of combined phacoemulsification, intraocular lens implantation, and limited goniosynechialysis, followed by diode laser peripheral iridoplasty, in the treatment of cataract and chronic angle-closure glaucoma. METHODS: Patients with chronic angle-closure glaucoma with total synechial angle closure and intraocular pressures higher than 21 mm Hg on maximally tolerated medications, and concurrent cataract, underwent phacoemulsification with posterior chamber intraocular lens implantation and goniosynechialysis followed by diode laser peripheral iridoplasty to the inferior half of the angle. Intraoperative complications, postoperative visual acuity, intraocular pressures, and complications were evaluated. RESULTS: Seven eyes of seven patients received the operation, and the mean follow-up was 8.9 months (range, 2-16 months). The mean preoperative intraocular pressure was 33.0 +/- 4.8 mm Hg. The mean postoperative intraocular pressure at most recent follow-up was 13.3 +/- 2.9 mm Hg. The absolute success rate (intraocular pressure less than 21 mm Hg without medication) was 100%. The visual acuity of all eyes improved by more than two Snellen lines. Postoperative complications included intraocular pressure spike, hyphema, and transient corneal decompensation. CONCLUSION: It appears that phacoemulsification with intraocular lens implantation combined with inferior 180 degree goniosynechialysis followed by diode laser peripheral iridoplasty is an effective and safe surgical procedure for treating chronic angle-closure glaucoma with total synechial angle closure and cataract.     

小切口联合手术治疗慢性闭角型青光眼合并白内障20例

目的:观察小切口白内障囊外摘除、后房型人工晶状体植入联合房角分离、小梁切除术（简称联合手术）治疗慢性闭角型青光眼合并白内障的临床疗效。方法:对20例26眼慢性闭角型青光眼合并白内障患者施行联合手术,术后观察视力、房角、眼压及滤过泡和并发症情况,随访4~10mo。结果:所有患者术后视力均有不同程度提高,术后房角可见不同程度的开放,周边虹膜粘连范围缩小,所有眼压控制在正常范围,22眼存在功能性滤过泡,主要并发症是前房出血、短暂角膜水肿。结论:采用联合手术治疗慢性闭角型青光眼合并白内障能够有效控制眼压、提高视力,手术安全、有效。     

青光眼合并白内障联合手术的疗效观察

目的观察晶状体超声乳化人工晶状体植入联合小梁切除术治疗青光眼合并白内障的临床效果。方法青光眼合并白内障37例（42眼）应用联合手术治疗,随访3—24个月,观察术后视力、眼压、滤过泡及并发症情况。结果术后3个月视力均有不同程度的提高;0．3及以上者占83．33％。术后3个月眼压有41眼（97．62％）控制在9～16mmHg。术后6个月功能性滤过泡36眼（85．71％）。术后并发症有：葡萄膜反应、角膜水肿、暂时性眼压升高等,经治疗后缓解。结论青光眼合并白内障联合手术,既能控制眼压,又能改善视力,避免了分期手术给患者造成的痛苦,减少了术中术后并发症的发生。     

Preliminary clinical study on the management of angle-closure glaucoma by phacoemulsification with foldable posterior chamber intraocular lens implantation]

OBJECTIVE: To investigate the clinical results of phacoemulsification with foldable posterior chamber intraocular lens (PC-IOL) implantation in the management of angle-closure glaucoma with cataract. METHODS: Phacoemulsification with PC-IOL implantation performed on 47 eyes (42 cases) with angle-closure glaucoma and cataract was retrospectively studied, including 26 eyes with primary acute angle-closure glaucoma, 12 eyes with primary chronic angle-closure glaucoma, 5 eyes with secondary acute angle-closure glaucoma and 4 eyes with secondary chronic angle-closure glaucoma. RESULTS: After a mean postoperative follow-up of (18.40 +/- 9.51) months, the intraocular pressure was reduced from a preoperative mean of (25.47 +/- 18.43) mm Hg to a postoperative mean of (11.99 +/- 4.48) mm Hg (t = 4.918, P < 0.001). The mean anterior chamber depth was (1.69 +/- 0.46) mm preoperatively and (2.28 +/- 0.36) mm postoperatively (t = 7.738, P < 0.001). The best-corrected visual acuity was improved in 41 of 47 eyes (87.2%). CONCLUSION: Phacoemulsification with posterior chamber foldable intraocular lens implantation can be a good alternative in treating angle-closure glaucoma with cataract.     

新型弹性开放襻前房型人工晶状体的长期疗效观察

目的探讨新型弹性开放襻前房型人工晶状体(ACIOL)植入的手术方法,评价其长期疗效和安全性。方法对34只眼行白内障摘除联合前段玻璃体切除及Ⅰ期ACIOL植入术、49只术后无晶状体眼行Ⅱ期ACIOL植入术。年龄16～80岁,平均43.5岁。检查视力、眼压、角膜内皮细胞、房角和手术并发症等情况。随访3～7年,平均4.8年。结果65只眼(78.3%)术后最佳矫正视力≥0.5,Ⅱ期植入者裸眼或矫正视力均达到术前最佳矫正视力。眼压术前平均为(13.55±3.21)mmHg(1mmHg=0.133kPa),末次随访时(13.40±4.29)mmHg(t=0.5427,P=0.5888)。角膜内皮细胞密度:Ⅰ期植入组术前平均为(2497±629)个/mm2,末次随访时(1995±648)个/mm2,细胞损失率为(20.6±14.1)%;Ⅱ期植入组分别为(2459±681)个/mm2,(2238±817)个/mm2和(10.0±17.4)%。两组比较,Ⅰ期植入组损失率较高(P=0.023)。人工晶状体(IOL)支点多位于房角隐窝或巩膜突,少数位于虹膜根部或小梁网,未见有触及角膜内皮细胞者。小梁网色素较术前有不同程度地增加。术后早期并发症:高眼压7只眼(8.4%)、低眼压5只眼(6.0%)、前房出血2只眼(2.4%)、IOL旋转及移位3只眼(3.6%);晚期并发症有继发性青光眼2只眼(2.4%)、瞳孔变形1只眼(1.2%)、视网膜脱离2只眼(2.4%)和角膜内皮功能失代偿2只眼(2.4%)。结论新型弹性开放襻前房型人工晶状体植入术对于无囊膜支撑的无晶状体眼是一种可选择的手术方式,术后需长期随访以及时发现和处理并发症。严格掌握手术适应证并注重手术技巧,可以减少手术并发症。     

Surgical outcomes of combined phacoemulsification and glaucoma drainage implant surgery for Asian patients with refractory glaucoma with cataract

PURPOSE: To examine the safety and efficacy of combined phacoemulsification and glaucoma drainage implant surgery in providing reduction of intraocular pressure (IOP) and visual rehabilitation in eyes with refractory glaucoma and cataract. DESIGN: Interventional case series. METHODS: A retrospective chart review was performed on all subjects who underwent combined phacoemulsification with intraocular lens implantation and glaucoma drainage implant surgery by a single surgeon at the National University Hospital, Singapore. The implants used were the 185 mm2 Ahmed glaucoma valve and the 350 mm2 Baerveldt glaucoma implant. In terms of IOP, a complete success was defined as IOP of between 6 to 21 mm Hg without medication, qualified success as IOP between 6 to 21 mm Hg with one or more medication, and failure as a sustained IOP of >21 mm Hg or <6 mm Hg with or without one or more medication on two or more visits. RESULTS: A total of 32 combined phacoemulsification and glaucoma implant surgeries in 32 patients was performed. All patients were of Asian origin, and the mean age was 58 +/- 16 years (range, 20-78 years). The Baerveldt glaucoma implant and Ahmed glaucoma valve implant were inserted in 16 eyes each. With a mean follow-up of 13 +/- 5 months (range 6 to 22 months), IOP was reduced from a mean of 28.0 +/- 11.5 mm Hg to 15.2 +/- 6.0 mm Hg postoperatively (P <.0001), whereas the number of antiglaucoma medications decreased from a mean of 2.4 +/- 1.4 to.3 +/-.7 (P <.0001) at last follow-up. Overall, there were 24 eyes (75%) that were classified as complete successes, 4 eyes (12.5%) that were qualified successes, and 4 eyes that failed (12.5%). Twenty-three eyes (72%) had improvement of visual acuity, while only one eye had a loss of more than 1 line of Snellen acuity. There was no case that encountered an intraoperative complication, and postoperative complications occurred in 12 eyes (38%), the most common of which was hypotony (in six eyes, 19%). CONCLUSION: For subjects with refractory glaucoma and cataract, combined phacoemulsification and glaucoma drainage implant surgery provide good visual rehabilitation and control of IOP, with low incidence of complications.     

Surgical outcome of combined trabeculotomy and cataract surgery

PURPOSE: To evaluate the efficacy of combined trabeculotomy and cataract surgery in lowering intraocular pressure and improving visual acuity in adults with primary open-angle glaucoma. PATIENTS AND METHODS: A consecutive series of 141 eyes with primary open-angle glaucoma or ocular hypertension was prospectively recruited. One hundred five eyes with visual field defects were treated by trabeculotomy combined with phacoemulsification and intraocular lens implantation (TPI group), and 36 eyes without visual field defects underwent cataract surgery (PI group). Patients in the TPI and PI groups were followed for more than 6 months after surgery (578.1 +/- 35.8 days and 616.0 +/- 58.5 days, respectively). The intraocular pressure reductions after surgery were compared between the groups to evaluate the effect of combined trabeculotomy and cataract surgery. Visual acuity and the complication rate in the two groups were secondary outcomes. The success probabilities of both groups were evaluated by Kaplan-Meier life table analysis with log rank test. RESULTS: A significant intraocular pressure reduction was observed in the TPI and PI groups up to 3 years and up to 1 year and 6 months after surgery, respectively; the magnitude of the reduction was significantly larger in the TPI group up to 3 years after surgery. The success probabilities of TPI group for intraocular pressure control under 21, 17, and 15 mm Hg were 95.8%, 58.7%, and 30.0%, respectively, 1 year after surgery, and 84.9%, 29.5%, and 13.5%, respectively, 3 years after surgery; the success probabilities were significantly higher than those of the PI group. Of 105 eyes, 104 (99.0%) had visual acuity equal to or better than the baseline acuity 3 months after combined trabeculotomy and cataract surgery. CONCLUSION: Combined trabeculotomy and cataract surgery normalizes intraocular pressure and improves visual acuity in adults with glaucoma and coexisting cataract.     

Phacoemulsification and intraocular lens implantation for angle closure glaucoma after the relief of pupillary block

PURPOSE: We studied the surgical outcomes of phacoemulsification and intraocular lens (IOL) implantation for cataract and/or uncontrolled intraocular pressure (IOP) in eyes with angle closure glaucoma. SETTING: Department of Ophthalmology, National Nagasaki Medical Center, Nagasaki, Japan. METHODS: Eighteen eyes from 15 patients after laser iridotomy (17 eyes) or peripheral iridectomy (1 eye) had undergone surgery and were studied. We used an iris retractor in 7 eyes due to insufficient mydriasis and a capsular tension ring in 2 eyes due to phacodonesis during the operation. The patients were followed up for at least 6 months (13.8 +/- 7.2 months; range: 6-36 months). RESULTS: The mean IOP significantly decreased from 17.4 +/- 8.1 to 13.5 +/- 3.3 mm Hg at 6 months after surgery. The IOP was below 21 mm Hg in all eyes. The visual acuity was not worsened in any eyes and became better than 2 Snellen lines in 14 eyes. The corneal endothelial cell count decreased from 2,365 +/- 517 to 1,960 +/- 661/mm2 (18.3 +/- 17.2%). CONCLUSIONS: Phacoemulsification and IOL implantation is useful in IOP control for angle closure glaucoma after relief of pupillary block. However, we should take care of operative complications because of a shallow anterior chamber, poor mydriasis and zonular weakness.     

超声乳化白内障吸除联合小梁切除术治疗闭角型青光眼合并白内障

目的:观察超声乳化白内障吸除人工晶状体植入联合小梁切除术治疗闭角型青光眼合并白内障的临床效果。方法:对闭角型青光眼并白内障36例46眼行超声乳化白内障吸除折叠式人工晶状体植入联合小梁切除手术治疗。术前、术后分别详细记录患者视力、眼压、滤过泡、前房深度、房角及眼底情况。结果:术后随访3mo～2a,43眼(93.5%)视力较术前明显提高,44眼(95.7%)眼压保持在正常范围,术后眼压<21mmHg。35例46眼患者前房深度术前平均为2.1±0.3mm,术后平均3.8±0.4mm,术后所有患者前房深度均加深,术前关闭的前房角也有不同程度的开放。6眼(13.0%)角膜水肿,无角膜内皮失代偿。结论:合并白内障的闭角型青光眼患者行超声乳化白内障吸除联合小梁切除术安全有效,能够有效降低眼压、加深前房、开放房角,提高视力。     

Combined endoscopic erbium:YAG laser goniopuncture and cataract surgery

PURPOSE: To study the safety and efficacy of endoscopic erbium:YAG (Er:YAG) laser goniopuncture combined with cataract surgery to treat glaucoma. SETTING: Department of Ophthalmology, Albert-Ludwigs-University Freiburg, Freiburg, Germany, and Institute of Applied Physics, University of Bern, Bern, Switzerland. METHODS: In this nonrandominized clinical trial, 20 eyes of 20 patients with cataract and glaucoma were treated by combined phacoemulsification and Er:YAG goniopuncture. The primary study endpoints were intraocular pressure (IOP), visual acuity, and number of antiglaucoma drugs 1 year after surgery. Two- and 3-year postoperative data were also measured. This prospective treatment arm was compared to a retrospective inclusion-matched control group treated by cataract surgery alone. RESULTS: The mean IOP dropped by 30% (23.5 mm Hg +/- 3.9 [SD] to 16.3 +/- 2.7 mm Hg) after 12 months in the laser-treated group (P<.0001) and by 9% (19.8 +/- 1.3 mm Hg to 18.1 +/- 1.8 mm Hg) in the control group (P =.12). After 3 years, the mean IOP in the laser group was 15.0 +/- 2.0 mm Hg. The mean number of antiglaucoma drugs needed decreased from 1.6 +/- 0.9 to 0.5 +/- 0.8 in the laser group (P<.0001) and from 1.0 +/- 0.9 to 0.8 +/- 0.9 in the control group (P =.21). Anterior chamber hemorrhage occurred in 12 eyes after laser treatment and resolved within 72 hours in all but 1 patient who was on warfarin sodium (Coumadin) therapy. There were no cases of hypotony in either group. CONCLUSIONS: Endoscopic Er:YAG laser goniopuncture was a successful adjunct to cataract surgery in glaucoma patients. Sustained IOP reduction was achieved with few postoperative complications.     

Combined phacoemulsification and goniotrephination in primary open-angle glaucoma and pseudoexfoliation glaucoma - a retrospective analysis

BACKGROUND: During the last few years combined cataract and glaucoma surgery is an established method to control intraocular pressure (IOP) and visual rehabilitation in patients with cataract and glaucoma. Despite this, there are currently only few data concerning the results of combined surgery for primary open-angle glaucoma (POAG) and pseudoexfoliation glaucoma (PEXG). PATIENTS AND METHODS: To study the course of PEXG and POAG with respect to IOP regulation and visual acuity, 100 eyes with POAG (72 patients) and 22 with PEXG (19 patients) were evaluated which underwent a combined phacoemulsification and goniotrephination between 1993 and 1997. All patients had no glaucoma or other ocular surgery before. The mean follow up after operation was 39.5 (range 16 - 72) months. RESULTS: The mean preoperative IOP in PEXG (31.8 +/- 10.3 mm Hg) was significantly higher than in the POAG group (25.3 +/- 6.4 mm Hg) (p=0.0004). At follow up IOP decreased to 16.7 +/- 2.8 mm Hg (POAG) and 15.1 +/- 4.0 mm Hg (PEXG) (p < 0.0001). The absolute IOP lowering effect was significantly better for PEXG than for POAG (p=0.0003). All patients received medical treatment before surgery, whereas at follow up 59.0 % (POAG) and 81.8 % (PEXG) were untreated. The median preoperative visual acuity for the POAG was 0.32 (PEXG 0.25), visual outcome 0,63 (PEXG 0.5). CONCLUSION: The combined cataract and glaucoma surgery is a successful method of IOP control and visual rehabilitation. It seems that there is a tendency for a better efficiency and an untreated IOP regulation after surgery for PEXG. Thereby early surgical intervention could be an advantage for this glaucoma entity.     

恶性青光眼34眼治疗回顾分析

 目的 探讨恶性青光眼不同手术方式的治疗效果。设计 回顾性病例系列。研究对象 2009-2011年武汉爱尔眼科医院31例（34眼）恶性青光眼患者,发生于小梁切除术后、术中及青白联合术后者分别为28眼（82.4%）、4眼（11.8%）、2眼（5.9%）。方法 回顾恶性青光眼发病特点、治疗方式及效果。平均随访（21.7±6.5）个月。主要指标 矫正视力、眼压、前房深度及并发症。结果 阿托品治疗有效者4眼 （11.8%）,激光后囊膜及玻璃体前界膜切开2眼（5.9%）,前段玻璃体切除联合前房成形术12眼（35.3%）,超声乳化白内障摘除人工晶状体植入术8眼（23.5%）,超声乳化白内障摘除人工晶状体植入联合前段玻璃体切除8眼（23.5%）。术后1个月恶性青光眼复发者3眼。眼压由治疗前的（42.5±11.8）mm Hg降至治疗后的（15.3±4.2）mm Hg（P=0.000）;前房轴深由治疗前的（0.3±0.4）mm升至（2.4±0.4）mm（P=0.000）。术前矫正视力大于指数的18眼术后矫正视力提高至0.1~0.3者7眼,0.3以上者6眼。1眼玻璃体切除术后少量玻璃体积血,1眼角膜内皮失代偿,1眼阿托品过敏。结论 恶性青光眼多需晶状体玻璃体手术治疗;根据患者具体情况适时手术治疗多可获得较好的保存视力效果。（眼科,2013,22：38-41）     

Combined intraocular lens implantation and glaucoma implant (tube shunt) surgery in pediatric patients: a case series.

PURPOSE: We sought to investigate the outcomes of children who underwent simultaneous intraocular lens (IOL) implant and glaucoma implant surgery. METHODS: Medical records of all patients who underwent simultaneous IOL implant and glaucoma implant surgery from January 1995 through August 2003 by a single surgeon were reviewed. Criteria for success included intraocular pressure 相似文献   

晶状体超声乳化吸除及人工晶状体植入术对闭角型青光眼眼压及前房深度的影响

目的评价品状体超声乳化吸除及后房型折叠式人工晶状体植入术或联合小梁切除术，治疗合并有自内障的闭角型青光眼，观察其术后眼压、前房深度及视力等的变化。方法回顾分析27例（30只眼）闭角型青光眼合并白内障患者。经综合降眼压治疗3～4d，眼压低于25mmHg者21只眼，即行巩膜隧道切口晶状体超声乳化吸除及后房型折叠式人工晶状体植入术，眼压高于25mmHg者9只眼，即行巩膜隧道切口晶状体超声乳化吸除及后房型折叠式人工晶状体植入联合抗代谢药物及小梁切除术。随访3—6个月。结果所有患者术中、术后没有出现严重的并发症，术后视力均有提高，术后眼压都得到控制。平均眼压由术前的20．28mmHg降至11．07mmHg；中央前房深度由术前的2．14mm加深到3．43mm。术后眼压、中央前房深度与术前相比均有显著性差异。术后前房角开放均≥180°。结论晶状体超声乳化吸除及后房型折叠式人工晶状体植入术或联合小梁切除术，是治疗合并有白内障的闭角型青光眼的有效方法。     

Cataract surgery in patients with end-stage glaucoma

BACKGROUND: The purpose of this study was to assess the benefit of cataract surgery in patients with advanced cataract and glaucoma. METHODS: In a prospective study, we investigated 12 consecutive patients (12 eyes). Inclusion criteria were the diagnosis of cataract and end-stage glaucoma with a cup-disc ratio (CD) of 0.9-1.0 and marked visual field defects with partially preserved central function. Preoperatively, at the third postoperative day and after 6 months (2-11 months), the visual acuity (V), the intraocular pressure (IOP), the number of antiglaucomatous drugs and the visual fields were assessed. Furthermore, the surgical procedure and possible complications were noted. In all patients cataract surgery was performed with topical anaesthesia. RESULTS: 10 patients were treated with cataract surgery alone, whereas 2 patients underwent combined cataract and glaucoma surgery. The mean visual acuity improved significantly from 0.3 to 0.5 (p = 0.007). Additionally a significant intraocular pressure reduction of 4.4 mm Hg (p = 0.007) was observed. The number of antiglaucomatous drugs decreased from 1.5 preoperatively to 0.8 postoperatively. The mean deviation (MD) improved from -27.5 dB up to -26.4 dB (p = 0.036) after 6 months. CONCLUSION: Patients with progressive cataract and end-stage glaucoma can benefit from cataract surgery. Although marked visual field defects were present, an increase in visual acuity as well as a decrease of intraocular pressure may be achieved without worsening of the visual fields.     

Circumferential viscodilation and tensioning of Schlemm canal (canaloplasty) with temporal clear corneal phacoemulsification cataract surgery for open-angle glaucoma and visually significant cataract: one-year results

PURPOSE: To evaluate the safety and efficacy of circumferential viscodilation and tensioning of the inner wall of Schlemm canal, a new nonpenetrating surgical procedure (canaloplasty) to treat open-angle glaucoma (OAG), combined with clear corneal phacoemulsification and posterior chamber intraocular lens (IOL) implantation. SETTING: Multicenter surgical sites. METHODS: This international multicenter prospective study comprised adult patients with OAG having combined glaucoma and cataract surgery. Patients with qualifying treated preoperative intraocular pressure (IOP) of at least 21 mm Hg or higher and open angles were eligible. Evaluation was performed at baseline and 1 day, 1 week, and 1, 3, 6, and 12 months postoperatively. Intraoperative and postoperative high-resolution ultrasound imaging was used to assess Schlemm canal and anterior segment angle morphology, including distension of the trabecular meshwork due to the tensioning suture. RESULTS: Data from 54 eyes that had combined glaucoma and cataract surgery performed by 11 surgeons at 9 study sites were analyzed for this interim analysis. The mean baseline IOP was 24.4 mm Hg+/-6.1 (SD) with a mean of 1.5+/-1.0 medications per eye. In all eyes, the mean postoperative IOP was 13.6+/-3.8 mm Hg at 1 month, 14.2+/-3.6 mm Hg at 3 months, 13.0+/-2.9 mm Hg at 6 months, and 13.7+/-4.4 mm Hg at 12 months. Medication use dropped to a mean of 0.2+/-0.4 per patient at 12 months. Surgical complications were reported in 5 eyes (9.3%) and included hyphema (n=3, 5.6%), Descemet tear (n=1, 1.9%), and iris prolapse (n=1, 1.9%). Transient IOP elevation of more than 30 mm Hg was observed in 4 eyes (7.3%) 1 day postoperatively. CONCLUSION: Circumferential viscodilation and tensioning of Schlemm canal combined with clear corneal phacoemulsification and posterior chamber IOL implantation was a safe and effective procedure to reduce IOP in adult patients with OAG.