青光眼白内障联合手术预置小梁切口的疗效

目的：探讨小切口白内障囊外摘出和后房型人工晶状体囊袋内植入联合预置小梁切口小梁切除术治疗青光眼合并白内障的临床疗效。 方法：对21例青光眼合并白内障患者实施白内障囊外摘出和后房型人工晶状体囊袋内植入联合预置小梁切口小梁切除术,观察术后患者视力、眼压及并发症情况。 结果：所有患者术后眼压均降至正常范围内。术后视力均有不同程度的提高。术后1眼发生早期人工晶状体前膜,2眼暂时性角膜水肿。 结论：预置小梁切口和小切口白内障摘除及后房型人工晶状体植入联合小梁切除是安全、有效、经济的治疗方法,值得推广。     

小切口手法非超乳三联术治疗青光眼合并白内障在基层医院的应用

目的探讨小切口白内障囊外摘除联合人工晶状体植入及小梁切除术治疗急性闭角型青光眼合并白内障的临床疗效。方法选择41例41只眼青光眼合并老年性白内障患者作为研究对象,均接受小切口白内障囊外摘除联合人工晶状体植入及小梁切除术治疗,观察手术前后视力、眼压、术后并发症。结果术后随访6个月,平均眼压由术前的31.5±6.5mm Hg降至11.2±3.5mm Hg,差异有统计学意义（P〈0.05）;视力均有不同程度提高,差异有统计学意义（P〈0.05）。所有患者无严重并发症发生。结论白内障囊外摘除联合人工晶状体植入及小梁切除术治疗急性闭角型青光眼合并老年性白内障不仅安全有效、而且术后并发症轻微,值得临床推广应用。     

COMBINED EXTRACAPSULAR CATARACT EXTRACTION AND POSTERIOR CHAMBER INTRAOCULAR LENS IMPLANTATION AND TRABECULECTOMY

In a retrospective study in a consecutive series of operations performed by the author, 13 eyes in 10 patients underwent combined extracapsular cataract extraction, posterior chamber intraocular lens (IOL) implantation and trabeculectomy All had significant cataract and chronic open-angle glaucoma with field loss, uncontrolled or marginally controlled on maximum tolerable medical treatment
All had a postoperative reduction in intraocular pressure Significant complications included malignant glaucoma (in two eyes) and a late choroidal detachment (in one eye )
The indications for and the advantages of the combined procedure are discussed, emphasising the advantages of extracapsular cataract extraction (ECCE) and posterior chamber lens implantation, in patients with chronic open-angle glaucoma (COAG )     

Combined extracapsular cataract extraction and posterior chamber intraocular lens implantation and trabeculectomy

In a retrospective study in a consecutive series of operations performed by the author, 13 eyes in 10 patients underwent combined extracapsular cataract extraction, posterior chamber intraocular lens (IOL) implantation and trabeculectomy. All had significant cataract and chronic open-angle glaucoma with field loss, uncontrolled or marginally controlled on maximum tolerable medical treatment. All had a postoperative reduction in intraocular pressure. Significant complications included malignant glaucoma (in two eyes) and a late choroidal detachment (in one eye). The indications for and the advantages of the combined procedure are discussed, emphasising the advantages of extracapsular cataract extraction (ECCE) and posterior chamber lens implantation, in patients with chronic open-angle glaucoma (COAG).     

Combined cataract extraction and guarded sclerectomy. Reevaluation in the extracapsular era

Thirty-four eyes of 25 patients underwent a guarded sclerectomy in combination with either an intracapsular or extracapsular cataract extraction. The intraocular pressure was well-controlled in the early postoperative period in all but one case, and only one eye developed a flat anterior chamber that required surgical reformation. However, there was a high incidence of intraoperative and postoperative complications in both the intracapsular and extracapsular groups. These observations, as well as experience with extracapsular cataract extraction and posterior chamber lens implantation alone in glaucomatous eyes, have led to a reevaluation of the criteria for combined cataract and glaucoma surgery.     

小切口青光眼白内障联合手术17例分析

目的:探讨小切口白内障囊外摘出后房型人工晶状体囊袋内植入联合小梁切除术治疗青光眼合并白内障临床疗效。方法:对17例青光眼合并白内障患者实施白内障囊外摘出后房型人工晶状体囊袋内植入联合小梁切除术,观察术后患者视力、眼压及并发症情况。结果:所有患者术后眼压均降至正常范围内。术后视力均有不同程度的提高。术后1眼发生早期浅前房,2眼暂时性角膜水肿。结论:小切口青光眼白内障联合手术是治疗青光眼合并白内障安全有效的手术方式。     

Control of intraocular pressure in glaucomatous eyes after extracapsular cataract extraction with intraocular lens implantation

Two hundred sixty eyes of 195 patients having extracapsular cataract extraction (ECCE) with insertion of a posterior chamber intraocular lens were studied retrospectively. Of these cases, 160 eyes had preexisting glaucoma while 100 had no ocular pathology except for cataract. Intraocular pressure decreased significantly after ECCE in both groups and slowly returned to baseline within two years. The average postoperative visual acuity was better in the control group than in the glaucoma group. Patients with glaucoma were controlled with less medication after surgery. We believe that ECCE with insertion of a posterior chamber intraocular lens can be safely performed in glaucoma patients and has a beneficial effect on the control of glaucoma.     

Synthetic lens implantation in cataract patients with glaucoma

In 178 eyes (122 patients) with chronic glaucomas an extracapsular cataract extraction was performed in combination with an implantation of a posterior chamber lens. In 45 cases a filtrating glaucoma surgery had been performed before. A narrow pupil, caused by the miotic therapy, posterior synechias or changes after glaucoma surgery, made the cataract extraction difficult in most of the cases. The variations in the operation techniques which thereby became necessary are discussed. 0.5 to 4 years after the lens implantation visual acuity, visual field, ocular pressure and glaucoma medication were investigated. The postoperative results and the late results were very satisfying. Not only the increase of the visual acuity was essential especially for patients with defects of the visual field but also the therapeutic effect on the intraocular pressure. After the posterior chamber lens implantation significantly (p less than 0.001) more eyes had a well regulated intraocular pressure under 20 mmHg (87%) at the time of the late investigation than preoperatively (63%). 33% had to use the same medicaments as they had before, 2% had more, 64% less medicaments. Altogether 56% of the eyes did not need any topical therapy at the time of the late investigation. So even in the case of insufficiently regulated glaucomas we do no longer primarily perform an extracapsular cataract extraction together with the implantation of a posterior chamber lens combined with a goniotrephining surgery (Elliot-Fronimopoulos).     

抗青光眼滤过性手术眼的后房型人工晶体植入

为了探讨在已施行抗青光眼滤过手术的白内障眼进行白内障摘除和后房型人工晶体植入的手术方法以及手术对滤过泡的影响。对抗青光眼滤过手术后白内障２１只眼，避开滤过泡，选择了颞下方角膜缘切口进行白内障囊外摘除及后房型人工晶体植入，同时对小而固定的瞳孔进行瞳孔括约肌切开与缝合术。术后视力均有不同程度提高，７６．１９％术眼视力达０．．５，术后平均眼压升高０．４１ｋＰａ，功能滤过泡未见明显疤痕化。对于抗青光眼滤过     

手术治疗糖尿病性白内障60眼临床分析

目的:分析小切口白内障囊外摘出人工晶状体植入术和超声乳化白内障吸除人工晶状体植入术治疗糖尿病性白内障的疗效及并发症。方法:选择2006-01/2010-01确诊为糖尿病性白内障患者52例60眼,Ⅱ～Ⅲ级核47眼,采用超声乳化白内障吸除后房型人工晶状体植入术;Ⅳ～Ⅴ级核13眼,采用小切口白内障囊外摘出后房型人工晶状体植入术。结果:糖尿病患者52例60眼白内障术后视力均有不同程度的提高,其中50眼(83%)术后1wk裸眼视力≥0.4。术中术后主要并发症经处理对术后视力无影响。结论:对糖尿病性白内障患者采取恰当的术式,施行小切口白内障囊外摘出人工晶状体植入术或超声乳化白内障吸除人工晶状体植入术疗效肯定。     

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。     

Prospective intrapatient comparison of extracapsular cataract extraction and lens implantation with and without trabeculectomy

PURPOSE:To determine whether extracapsular cataract extraction and posterior chamber lens implantation combined with trabeculectomy provides better long-term results than extracapsular cataract extraction and lens implantation alone in a group of patients with primary open-angle glaucoma and cataract.METHODS:In a prospective, randomized clinical trial, 35 patients with bilateral, symmetric, primary open-angle glaucoma and visually disabling cataracts were randomly selected to undergo surgery with trabeculectomy in one eye and without in the other. All procedures were performed by a single surgeon in a private practice setting with follow-up for more than 5 years in all cases.RESULTS:After an average of 87 months of follow-up, extracapsular cataract extraction and posterior chamber lens implantation reduced intraocular pressure by 4.4 +/- 3.3 mm Hg, reduced the number of medications by 1.28 +/- 0.86, increased diopter vector of astigmatism by 1.49, and was associated with visual field loss in six of 35 eyes. After an average of 80 months of follow-up, extracapsular cataract extraction and posterior chamber lens implantation with trabeculectomy reduced intraocular pressure by 8.2 +/- 4.6 mm Hg (P =.0001), reduced the number of medications by 1.76 +/- 0.82 (P=.0002), increased diopter vector of astigmatism by 1.14, and was associated with visual field loss in one eye (P =.05). Both groups had similar improvement in visual acuity and perioperative complications.CONCLUSIONS:Extracapsular cataract extraction and posterior chamber lens implantation with trabeculectomy was beneficial in the long-term control of intraocular pressure and in prevention of visual field loss. This procedure should be considered for patients in whom long-term pressure control at a lower level would be beneficial in preventing further optic nerve damage.     

闭角型青光眼合并白内障联合手术的疗效观察

目的了解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原发性闭角型青光眼合并白内障的疗效。方法选取原发性闭角型青光眼合并白内障患者40例行超声乳化白内障吸除人工晶状体植入联合小梁切除术,记录术后三个月患者的视力、眼压、滤过泡。采用配对t检验,与术前眼压进行比较。结果术后三个月视力0.1-0.3共8只眼,0.4～0.5共22只眼,0.6～1.0共10只眼;眼压在8.7～20.3mmHg范围,平均15.5 mmHg,同术前比较,眼压下降有统计学意义(P<0.05)。未发生严重术中及术后并发症。结论联合手术是有效的安全的治疗青光眼合并白内障的方法。     

Nd-YAG laser hyaloidotomy for malignant glaucoma following one-piece 7 mm intraocular lens implantation.

Three cases of malignant glaucoma following extracapsular cataract extraction with 7 mm one-piece posterior chamber intraocular lens implantation are presented. Nd-YAG laser hyaloidotomy was successfully performed in all eyes, but was difficult and required several sessions in two eyes. In the third eye, which had a sector iridectomy, laser hyaloidotomy applied over the edge of the lens optic through the iridectomy resulted in brisk deepening of the anterior chamber and reduction of intraocular pressure. We propose that the one-piece 7 mm optic posterior chamber intraocular lens may constitute an obstacle to successful hyaloidotomy, mainly owing to its large size, as it may block aqueous percolation from the vitreous into the anterior chamber. Eyes prone to develop malignant glaucoma after surgery should have a sector or large peripheral iridectomy to facilitate postoperative Nd-YAG laser hyaloidotomy if required.     

白内障术中后囊破裂的Ⅰ期后房型人工晶状体植入术

目的评价白内障囊外摘出术中后囊破裂行前段玻璃体切割联合Ⅰ期后房型人工晶状体植入的手术效果。方法对１４８０例白内障囊外摘出联合后房型人工晶状体植入术中４９例后囊破裂,行前段玻璃体切割联合Ⅰ期后房型人工晶状体植入的手术技巧、术后并发症和术后视力等进行分析。结果手术后囊破裂率为３．３％,７０％患者人工晶状体植入囊袋内,３０％患者为睫状沟,８９．９％患者出院时裸眼视力≥０．５。结论白内障囊外摘出术中后囊破裂,行前段玻璃体切割联合Ⅰ期后房型人工晶状体植入是安全有效的。     

Uncontrolled primary angle closure glaucoma: results of early intercapsular cataract extraction and posterior chamber lens implantation

In this study we retrospectively evaluated the effect of intercapsular or extracapsular cataract extraction and posterior chamber lens implantation in 67 eyes of 57 patients with different types of primary angle closure glaucoma (PACG) in combination with cataract. We subdivided this patient population into three groups, based on the preoperative methods of intraocular pressure (IOP) control. The best results were obtained in patients with acute PACG (55% IOP reduction) and in patients with uncontrolled PACG (44% IOP reduction). In the other PACG groups an IOP reduction of between 20 and 33% was achieved. A long-term postoperative IOP of less than 21 mmHg was established in 63 eyes or 94%.In 91% the glaucoma medication was reduced, 65% of all eyes needed no glaucoma medication post-operatively.We conclude that an intercapsular cataract extraction with PC-IOL implantation should be considered in both controlled and uncontrolled PACG in patients with cataract, instead of filtering surgery or combined procedures.Even in eyes with relatively good visual acuity, cataract extraction might be considered as a means of achieving glaucoma control.     

A comparison of heparin-coated and uncoated intraocular lenses in glaucoma patients undergoing combined cataract extraction and trabeculectomy and in diabetic patients undergoing cataract extraction

The postoperative course of cataract extraction and IOL implantation combined with trabeculectomy in glaucoma patients and of cataract extraction with intraocular lens (IOL) in diabetic patients is more complicated than that of cataract extraction with IOL implantation in otherwise healthy eyes. The main complications are fibrin in the anterior chamber, pigment dispersion, and posterior synechiae. In an attempt to determine whether heparin-coated lenses reduce the rate of these complications, a prospective study was conducted on 19 glaucomatous eyes of 19 patients who underwent a combined procedure of trabeculectomy and extracapsular cataract extraction with IOL and 20 eyes of 20 diabetic patients subjected to extracapsular cataract extraction with IOL. In each category of patients, the early postoperative course in those who received heparin-coated lenses and those who received regular polymethyl methacrylate (PMMA) lenses was compared with respect to the inflammatory reaction, assessed by the amounts of cells and flare, and complications in terms of fibrin, posterior synechiae and pigment dispersion. The results of this preliminary study indicate a slightly higher rate of early postoperative complications with the heparin-coated lenses as compared to PMMA lenses.     

援非小切口手术治疗黑人白内障287例报告

目的:观察在援非期间对287例黑人白内障实施小切口手术的临床效果。方法:在非洲简陋的条件下对287例287眼黑人白内障实施巩膜隧道小切口非超乳白内障摘除术,植入硬质型人工晶状体,观察各类白内障术后裸眼视力及并发症。结果:一次性植入人工晶状体275例275眼,术后1wk裸眼视力≥0.3者240眼(83.6%),≥0.5者166眼(57.8%);角膜水肿53眼(18.5%),后囊膜破裂5眼(1.7%),前房反应38眼(13.2%)。结论:在非洲对于大规模黑人白内障选择小切口白内障摘除及人工晶状体植入手术,疗效可靠。     

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。     

糖皮质激素性白内障与人工晶体植入术

报告13例(21只眼)因局部或全身使用地塞米松或强的松引起的糖皮质激素性白内障。使用糖皮质激素的时间平均7.1年(6个月—30年)。男10例(16只眼),女3例(5只眼),平均年龄34岁(11—64岁),白内障形态主要是后囊下混浊。经停用糖皮质激素类药物后白内障未见好转。其中7例(11只眼)行白内障囊外摘除加后房型人工晶体植入术,术后91.1％的眼矫正视力在0.5以上,与5例(9只眼)行单纯白内障囊外摘除术的88.9％无显著性差异。提示糖皮质激素性白内障的患者同样可以植入后房型人工晶体。