剥脱综合征并发白内障青光眼行超声乳化人工晶状体植入术联合小梁切除术的疗效观察

目的 观察剥脱综合征并发白内障青光眼患者行白内障超声乳化人工晶状体植入术联合小梁切除术的临床效果。方法 对同时合并白内障及青光眼的剥脱综合征7例(11只眼)，行白内障超声乳化人工晶状体植入术联合小梁切除术，术后随诊观察1年。结果 在术中仅有1只眼出现晶状体后囊破裂、玻璃体丢失，占9．1％；术后随诊1年。11只眼眼压均控制满意，占100％。视力在0．5者1只眼及以上者8只眼．占72．7％。结论 白内障超声乳化人工晶状体植入术联合小梁切除术。对同时合并白内障及青光眼的剥脱综合征患者来说是安全、有效的，部分患者术后视力欠佳是由于青光眼损害所致。     

Fuchs综合征并发白内障青光眼手术治疗的临床体会

目的: 探讨Fuchs综合征并发白内障青光眼的手术治疗效果。方法: 对Fuchs综合征患者16例16眼合并白内障行超声乳化联合人工晶状体植入术,2例2眼合并白内障及青光眼行超声乳化人工晶状体植入术联合小梁切除术,观察术前和术后视力、眼压以及治疗效果。结果: 患者18例18眼术后视力均有明显提高,术后3mo视力(含矫正)≥0.5者16眼(88.89%),10眼后囊混浊行YAG激光后囊切开术后视力均≥0.5。2眼合并青光眼者术后眼压降至正常范围。结论: 超声乳化联合人工晶状体植入术以及联合小梁切除术治疗Fuchs综合征并发白内障青光眼效果良好,安全可靠,术后反应轻,并发症少,是可行的手术方法。     

超声乳化白内障手术对剥脱综合征性青光眼的降眼压作用

目的 观察和分析剥脱综合征性青光眼患者行超声乳化白内障摘除人工晶体植入术后的眼压变化。方法 对7例伴有高眼压、明显影响视力的白内障但尚无严重的视神经、视野损害的剥脱综合征患者施行超声乳化白内障摘除人工晶体植入术，比较手术前后的眼压变化。结果 术前平均眼压31．57mmHg，术后1周时平均眼压18．19mmHg，降幅为13．38mmHg，术前术后眼压差异极显著。结论 伴有明显影响视力白内障的剥脱综合征性青光眼病人在行超声乳化白内障摘除人工晶体植入术后眼压会显著下降，对那些尚未发生明显视神经视野损害的剥脱综合征性青光眼患者，行超声乳化白内障摘除人工晶体植入术可有效降低眼压。     

剥脱综合征与青光眼

目的分析13例20只剥脱综合征眼的青光眼发生情况及其临床特点和治疗效果。方法回顾总结了13例20只剥脱综合征眼的青光眼发生率及其临床特点、治疗方法及疗效。结果13例20只剥脱综合征眼中合并青光眼10例13只，占65％，全部为开角型。眼压15．5～43．38mmHg．平均26．13mmHg。眼底视盘C／D0．3～1．0，其中≥0．6者8眼，占40％，0．8～1．0者6只眼，占30％。4只眼行单纯超声乳化白内障摘除术后眼压下降。1眼行小梁切除术，术后眼压控制良好。2眼曾行小梁切除术，但术后眼压仍高，视神经进行性损害最终失明。1眼白内障术后眼压仍高，需应用药物。结论剥脱综合征具有较高的青光眼发生率，其眼压难于控制、视野进行性损害迅速、对药物治疗反应差，应及早手术干预。对于处在较早期、较轻微的、视神经尚未严重损害者，单纯超声乳化白内障手术有效，对于已发生严重视神经损害者须行青光眼手术。     

剥脱综合征并发白内障患者超声乳化术后2a眼压变化及其相关因素的临床研究

目的:研究剥脱综合征并发白内障患者和老年性白内障在超声乳化术后2a内眼压变化情况及相关因素。方法:对49例54眼剥脱综合征并发白内障的患者实施超声乳化人工晶状体植入术,依据眼压情况又分为剥脱综合征并发白内障(XFS)亚组(29例31眼)及剥脱综合征并发白内障和青光眼(XFG)亚组(20例23眼)。同期选择老年性白内障患者134例152眼行超声乳化人工晶状体植入术作为对照依据眼压情况分为白内障亚组(86例93眼)及并发开角青光眼组(POAG)亚组(48例59眼)。两组眼压用药控制正常后手术。比较两组在超声乳化术后2a内眼压的变化。结果:术前剥脱组基础眼压高于对照组(21.85±2.23mmHgvs18.62±3.12mmHg,P=0.002)。在超声乳化术后2a内,两组眼压均降低(17.60±3.23mmHgvs15.08±3.18mmHg,P=0.0037)。统计分析表明与术中灌注量相关。XFG组眼压降低更明显。结论:在超声乳化术后2a内,剥脱综合征组比对照组眼压降低明显。     

囊袋张力环植入在剥脱综合征性青光眼术后白内障超乳术中的应用

目的：探讨囊袋张力环(capsular tension ring,CTR)植入联合超声乳化人工晶状体(intraocular lens,IOL)植入术治疗剥脱综合征性青光眼术后白内障的安全性和有效性。

方法：回顾性分析2012-01/2013-06对连续性收治的剥脱综合征性青光眼小梁切除术后白内障10例10眼行超声乳化白内障摘除联合CTR及IOL植入术,Ⅱ级核1眼,Ⅲ级核4眼,Ⅳ级核5眼,其中Ⅳ级核合并虹膜、晶状体震颤1眼。分析术后裸眼及矫正视力、术中术后并发症、前囊撕囊口、IOL位置、术后眼压情况。随访3～14mo。

结果：所有患者均安全实施超声乳化白内障摘除、囊袋张力环及IOL植入术。其中改良悬吊双钩CTR 1眼,标准CTR 9眼。术眼矫正视力≥0.5者3眼,0.3～者2眼,≤0.1者5眼,所有患者均IOL无偏位,眼底均有不同程度的视神经萎缩。术前平均眼压16.78±2.48mmHg,术后3mo平均眼压16.01±2.33mmHg(t=1.9955,P<0.05)。术中术后最常见并发症为角膜水肿、瞳孔散不大、皮质残留、悬韧带松弛。

结论：剥脱综合征性青光眼小梁切除术后并发白内障,选择合适类型和合适时机的CTR植入可提高超声乳化手术安全性,防止IOL偏位,减少手术并发症的发生,早期手术并发症更少。     

超声乳化白内障吸除术对不伴青光眼剥脱综合征患者眼压的影响

目的:评价白内障超声乳化吸除术对不伴青光眼的剥脱综合征(exfoliation syndrome,XFS)患者眼压(IOP)的影响。方法:接受白内障超声乳化吸除术的不伴青光眼的剥脱综合征患者36例(38眼),不伴有剥脱综合征的白内障患者76例(76眼)。透明角膜切口白内障超声乳化吸除联合折叠人工晶状体植入,术后随访6~12mo,观察术后眼压的变化。结果:XFS组与Non-XFS组术前眼压分别为16.79±2.78mmHg,15.67±2.98mmHg(P>0.05)。XFS组术后1d;1wk;1,6,12mo眼压分别为16.32±3.26,13.59±3.55,13.24±2.38,14.53±2.27,15.10±2.09mmHg。Non-XFS组术后1d;1wk;1,6,12mo眼压分别为16.15±3.12,14.48±2.48,14.35±2.18,15.05±2.17,15.21±2.42mmHg。与手术前相比,术后1wk;1,6moXFS组患者眼压的下降程度较非XFS组的患者大(P<0.05)。术后12个mo,XFS组患者眼压仍较术前低,对照组患者眼压逐渐回到术前水平。结论:不伴青光眼的XFS患者超声乳化白内障吸出术后眼压较手术前明显下降,其下降程度大于非XFS患者。     

双内切口白内障超声乳化联合小梁切除术初步报告

目的:探讨双内切口白内障超声乳化联合小梁切除术对治疗青光眼合并白内障患者的疗效。方法:经同一主切口将透明角膜切口白内障超声乳化人工晶状体植入术和小梁切除术以不同内切口集合在一起,对35例46眼青光眼合并白内障患者进行手术,术后随访1～6mo。结果:眼压:术前眼压25～69(平均38.3)mmHg,术后最终眼压8～28(平均15.6)mmHg。视力:术前视力范围光感～0.5,术后随访最佳矫正视力0.02～1.0,其中21眼≥0.5,34眼≥0.3。结论:双内切口白内障超声乳化联合小梁切除术治疗青光眼合并白内障,有效利用切口,使2种手术的相互影响降到较低,手术安全、有效。     

小梁切除术后晶状体超声乳化术的临床观察

目的 评价青光眼小梁切除术后的白内障进行超声乳化人工晶状体植入术的效果.方法 对28例（30眼）青光眼小梁切除术后的白内障,采用超声乳化人工晶状体植入术,随访6月,观察术后视力及眼压等情况.结果 30眼术后视力均较术前明显提高,术后1月平均眼压较术前略有下降.结论 小梁切除术后白内障采用超声乳化人工晶状体植入术,可以保存原有青光眼滤过泡,术后反应轻,视力恢复好,手术安全可靠.     

联合手术治疗青光眼合并白内障的临床观察

目的:探讨治疗青光眼合并白内障的手术方法及临床效果。方法:对45例45眼青光眼合并白内障患者施行白内障超声乳化及人工晶状体植入联合隧道内小梁切除术。结果:术前视力<0.1者32眼,0.1～0.3者13眼。术后视力<0.1者6眼(13%),0.1～0.5者22眼(49%),>0.5者17眼(38%)。术前眼压26～60mmHg,术后42例眼压降至正常范围,3例经局部按摩、滴药后降至正常,平均眼压12.78±2.70mmHg。随访6～12mo,无1例眼压再升高。3例视力下降,经戴镜矫正视力提高。并发症主要是角膜水肿和虹膜炎症反应。结论:白内障超声乳化人工晶状体植入联合隧道内小梁切除术是治疗青光眼合并白内障的理想方法。     

白内障超声乳化切口内小梁切除术

目的 探讨白内障行超声乳化同一切口内小梁切除术治疗青光眼合并白内障的临床效果.方法 原发性闭角型青光眼及开角型青光眼合并白内障45例(45眼).行单一切口联合手术,即在超声乳化切口内做小梁切除术,分析手术后视力,眼压控制以及术后滤过泡形成情况.结果 术后矫正视力:0.02～0.08者3眼,0.1 ～0.3者5眼,0.4～1.0者37眼,视力较术前均有不同程度提高.术后眼压:42眼维持在正常;3眼辅助滴药降压.术后功能型滤过泡42眼.无严重并发症发生.结论 超声乳化同一切口内小梁切除术治疗青光眼白内障的联合手术是一种安全有效的手术方法.     

Phacoemulsification in patients with Baerveldt tube shunts

PURPOSE: To investigate the effects of phacoemulsification in glaucomatous eyes with functioning Baerveldt tube shunts. SETTING: Department of Ophthalmology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA. METHODS: This retrospective analysis followed 9 eyes of 8 patients with functioning Baerveldt tube shunts who had clear corneal phacoemulsification. Intraocular pressure (IOP), number of glaucoma medications, corneal thickness, visual acuity, and additional glaucoma surgery were measured. RESULTS: The mean follow-up was 21 months +/- 3 (SD) (range 17 to 25 months). The mean change in IOP and the number of glaucoma medications used did not significantly change at 1 month (P>.19), 1 year (P>.17), or the last follow-up (P>.17). At the last examination, 2 eyes had IOP increases of 2 to 4 mm Hg, 3 eyes had no change, and 4 eyes had decreases of 4 to 7 mm Hg. Intraocular pressure increased in 1 eye at 8 months and required a tube shunt revision. No eye developed corneal decompensation. Visual acuity improved in 8 eyes; the mean improvement was 4 +/- 3 Snellen lines. CONCLUSION: In most cases, phacoemulsification in glaucomatous eyes with a functioning Baerveldt tube shunt improved vision and maintained control of IOP.     

玻璃体腔注射Avastin辅助治疗新生血管性青光眼

目的 观察Avastin在新生血管性青光眼治疗中的作用.方法 16例(17只眼)尚有部分视功能的新生血管性青光眼患者,玻璃体腔注射Avastin,观察新生血管变化,2～3d后根据病情采用不同方式治疗,其中2例(3只眼)采用全视网膜激光光凝术,其余均采用手术治疗:复合式小梁切除术(11例,11只眼)、白内障超声乳化+小梁切除术(1例,1只眼),青光眼阀植入术(1例,1只眼),全视网膜冷冻+睫状体冷冻术(1例,1只眼),术后观察视力、眼压、虹膜新生血管情况、病人满意度.随访3～5个月.结果 玻璃体腔注射Avastin2～3d后,15例(16只眼)虮膜新生血管消褪,1例(1只眼)虹膜新生血管明显萎缩、变细,但未完全消退,有效率为93.33%.激光光凝或手术治疗后3个月时,视力较前提高和不变者达94.11%,无1例因手术而致失明.全视网膜激光光凝术有1例(1只眼),不用抗青光眼药物眼压恢复到了正常;1例(2只眼)需局部加用2种降眼压药物眼压恢复到正常.手术患者除复合式小梁切除术有1只眼需局部加用1种降眼压药物治疗,其余眼压均恢复到正常.16例(17只眼)虹膜均未见新生血管.除施行冷冻术的1例患者外,满意度较高.结论 玻璃体腔注射Avastin,可作为治疗新生血管性青光眼的辅助方法.使新生血管消褪后采用滤过性手术可缩短病程,减轻患者的痛苦,更有效的挽救患者的视力.     

超声乳化吸除白内障联合房角粘连分离术治疗急性闭角型青光眼

目的:探讨超声乳化白内障吸除联合折叠式人工晶状体植入联合房角分离术治疗急性闭角型青光眼临床疗效。方法:回顾性分析采用超声乳化白内障吸除联合折叠式人工晶状体植入联合房角分离术治疗急性闭角型青光眼80例80眼临床资料。结果:术后最佳矫正视力较术前显著提高;患者术后眼压显著下降(P<0.01);房角粘连关闭象限均有不同程度开放。结论:白内障超声乳化及前房分离治疗闭角型青光眼合并白内障具有安全、降眼压确切、增进视力和开放房角的效果。     

抗青光眼术后并发白内障的超声乳化摘除术

目的探讨抗青光眼术后白内障的超声乳化术的手术技巧,并评价手术效果.方法对41例(45眼)抗青光眼术后并发白内障的患者,行经颞侧透明角膜隧道切口的白内障超声乳化摘除和折叠式人工晶体植入术.结果除3眼术后第一天出现一过性眼压升高,其余术眼术后眼压均有所下降,但与术前比较无统计学差异.随访时矫正视力≥0.5者40眼(占89%);视力≤0.1者2眼(占4%),为绝对期青光眼患者.角膜内皮丢失率为10±3.0%.手术并发症主要是后囊破裂、晶体悬韧带部分离断和虹膜损伤.结论超声乳化吸除联合折叠式人工晶体植入术是治疗抗青光眼术后白内障的有效方法之一,应强调对角膜内皮细胞的保护和防止术后眼压的升高.     

Combined Baerveldt glaucoma drainage implant and trabeculectomy with mitomycin C for refractory glaucoma

PURPOSE: To describe the surgical technique and clinical outcomes of a procedure for refractory glaucoma, concurrent Baerveldt glaucoma implant (BGI) and trabeculectomy with mitomycin C. MATERIALS AND METHODS: Medical records of all patients who underwent combined Prolene-ligated BGI and trabeculectomy with mitomycin C were retrospectively reviewed. Main outcome measures were intraocular pressure (IOP), number of glaucoma medications, visual acuity, and complications. Kaplan-Meier survival analysis was used to determine success, defined as IOP < 22 mm Hg, no reoperation for glaucoma, and no loss of light perception vision. RESULTS: The mean +/- SD follow-up period for 38 eyes of 36 patients was 34 +/- 36 months (range, 3-121 months), during which 18 of 38 eyes (47%) required laser suture lysis of the Prolene suture. Intraocular pressure was reduced from a mean (+/- SD) preoperative value of 35.7 +/- 12.8 to 12.7 +/- 4.7 mm Hg at 1-year follow-up and 11.9 +/- 5.5 mm Hg at the last follow-up visit ( < 0.001). Number of medicines used for glaucoma was reduced from a mean +/- SD preoperative value of 2.5 +/- 0.9 to 0.5 +/- 0.6 at 1-year follow-up and 0.6 +/- 0.8 at the last follow-up visit ( < 0.001). LogMar visual acuity remained stable at mean of 1.15 +/- 0.85 preoperatively, compared with 1.14 +/- 1.05 at 1-year follow-up, but declined to 1.61 +/- 1.01 at the last follow-up visit, a loss of an average of four lines of vision ( = 0.004). Cumulative success was 91% at year 1, 86% at year 2, and 81% at year 3. Three eyes (8%) had suprachoroidal hemorrhages, one eye (3%) needed reoperation for an extruded implant, one (3%) eye had poor vision due to chronic hypotony, three eyes (8%) required additional glaucoma surgery during the postoperative period, and one eye (3%) needed revision of the implant for pressure control. CONCLUSIONS: Combined BGI and mitomycin C trabeculectomy provides excellent postoperative IOP control in patients with refractory glaucoma.     

超声乳化治疗白内障合并闭角型青光眼的临床体会

目的：观察超声乳化白内障摘除折叠人工晶状体植入术治疗白内障合并闭角型青光眼的临床效果。 方法：对29例29眼闭角型青光眼合并有白内障的患者行超声乳化白内障摘除折叠人工晶状体植入术,并对术后视力、眼压、前房角镜检查及并发症进行统计分析。 结果：患者28眼（96.5%）术后视力提高。25眼（86.2%）不需要用任何降眼压药物,眼压均维持在正常水平,3眼（10.3%）局部应用抗青光眼眼药水眼压控制正常,1眼（3.5%）行小梁切除术后眼压恢复正常。29眼房角镜检查房角较术前增宽。8例（27.6%）术后早期出现轻度角膜水肿,经治疗恢复正常。 结论：对合并白内障的原发性闭角型青光眼,术前房角粘连关闭≤270°者,可以考虑先行白内障超声乳化联合折叠人工晶状体植入术,可有效降低眼压,开放房角,提高视力,治疗效果良好。     

超声乳化人工晶状体植入术治疗白内障合并青光眼的临床观察

目的：观察超声乳化联合人工晶状体植入术治疗白内障合并青光眼的疗效。方法：回顾我院2010-03/2012-03收治的60例70眼行超声乳化联合人工晶状体植入术的白内障合并青光眼病例,观察治疗前后患者的眼压、前房深度和视力与术后并发症等情况。结果：治疗后患者的视力、前房深度较治疗前有显著提高,眼压明显下降,差异有统计学意义（P〈0.05）。结论：白内障超声乳化吸除联合人工晶状体植入术可安全有效地治疗白内障合并青光眼。     

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.