超声乳化联合房角分离治疗原发性急性闭角型青光眼

目的：观察超声乳化吸除联合多次房角分离术治疗白内障合并原发性急性闭角型青光眼的临床疗效。
　　方法：回顾性分析我院临床诊断的34例42眼急性闭角型青光眼合并白内障患者,均行白内障超声乳化联合多次房角分离及人工晶状体植入术,随访3mo~1a,观察记录手术前后视力、眼压、房角变化及并发症情况,比较手术疗效。
　　结果：术后最佳矫正视力提高36眼(86%)。术后1wk,有2眼眼压仍高于25mmHg,其余患者的眼压在11~20(平均14.6±5.7) mmHg。手术前后眼压比较差异有统计学意义( P<0.05)。术后前房角关闭范围>180o的例数显著低于术前(P<0.05)。
　　结论：超声乳化白内障吸除联合多次房角分离治疗闭角型青光眼安全有效,能显著改善房角开放程度,降低眼压并提高术后视力。     

透明角膜切口晶状体超声乳化治疗原发性闭角型青光眼合并白内障

目的评价透明角膜切口白内障晶状体超声乳化吸出后房人工晶状体植入术治疗原发性闭角型青光眼合并白内障的疗效。方法回顾性分析闭角型青光眼伴白内障14例(27眼)。单纯行透明角膜切口白内障晶状体超声乳化吸出联合后房型人工晶状体植入术,术后随访8~20个月。结果所有患者术中术后无严重并发症,术后视力较术前明显提高,术后平均眼压(12.64±3.37)mmHg与术前用药后平均眼压(16.72±4.26)mmHg相比差异有统计学意义(配对t检验,P<0.01),周边前房较术前明显加深,前房角均重新开放或部分开放增宽。结论单纯透明角膜切口白内障晶状体超声乳化吸出后房型折叠人工晶状体植入术,可有效治疗合并白内障的闭角型青光眼。     

超声乳化联合房角分离术治疗合并闭角型青光眼的白内障临床观察

目的:观察超声乳化联合房角分离手术治疗合并闭角型青光眼白内障临床效果。方法:对合并闭角型青光眼的白内障患者56例60眼均在表面麻醉下行透明角膜切口的白内障超声乳化联合房角分离术。结果:术后仅3眼在1wk内眼压轻度增高(22～28mmHg),经治疗后眼压降至正常,随访3～12mo眼压正常。术后视力较术前明显提高,中央前房深度、房角与术前相比均有不同程度改善。结论:对于部分合并闭角型青光眼的白内障患者,超声乳化联合房角分离术是一种便捷、安全、有效的方法,具有降压和增视的双重效果。     

晶状体超声乳化人工晶状体植入治疗原发性闭角型青光眼

目的探讨晶状体超声乳化吸出联合后房人工晶状体植入术,治疗白内障合并原发性闭角型青光眼的疗效。方法本院收治白内障合并原发性闭角型青光眼37例(37眼),术前控制眼压,经视力、眼压、前房角镜和裂隙灯显微镜等检查后,均单独采用晶状体超声乳化吸出联合后房人工晶状体植入。结果术后随访6~18个月,视力较术前提高,视力>0.5者20眼,占54.05%,22例术后眼压<18mmHg,另5例用1种降眼压药物眼压控制在18mmHg以下。结论晶状体超声乳化后房人工晶状体植入可有效地治疗合并白内障的原发性闭角型青光眼。     

晶状体超声乳化术治疗急性闭角型青光眼合并白内障的临床观察

目的 观察超声乳化白内障吸出术联合后房型人工晶状体植入术治疗急性闭角型青光眼合并白内障的临床疗效.方法 回顾性分析2003年1月至2007年5月收治的急性闭角型青光眼合并白内障患者21例(22只眼),行透明角膜切口晶状体超声乳化吸除联合后房型人工晶状体植入术.随访1个月至1年,对比术前、术后视力,观察术后角膜内皮细胞数量、前房深度、前房角宽度和眼压变化.结果 20只眼眼压控制正常,2只眼需滴降眼压药物,22只眼最佳矫正视力均有不同程度提高.结论 超声乳化术治疗急性闭角型青光眼合并白内障手术安全、疗效可靠.     

超声乳化术治疗合并闭角型青光眼的白内障疗效观察

目的:探讨白内障术前合并临床前期或先兆期的闭角型青光眼患者,采用单纯的白内障超声乳化术治疗的效果。方法:对35例35眼合并闭角型青光眼的白内障患者,采用单纯的白内障超声乳化手术方法,术后随访观察视力、眼压、房角及前房深度变化。结果:术后患者视力均恢复至0.3～0.8,术后第1d,仅3眼眼内压轻度升高,达22～28mmHg,经治疗观察1wk后2眼眼内压恢复正常,仍有1眼眼内压升高至27mmHg,经局部用药控制,未再行手术治疗。结论:对于部分合并有青光眼的白内障患者行单纯的超声乳化手术能确实的恢复视力,控制眼压。     

超声乳化联合房角分离术治疗青光眼合并白内障的疗效

目的:观察超声乳化联合房角分离手术治疗合并闭角型青光眼白内障的临床效果。方法:对合并闭角型青光眼的白内障患者56例56眼均在表面麻醉+球后麻醉下行透明角膜切口的白内障超声乳化联合房角分离术。结果:术后仅5眼在4d内眼压轻度增高(25～30mmHg),经治疗后眼压降至20mmHg以下,随访3～24mo眼压正常。术后视力较术前明显提高,达0.3～0.8,中央前房深度、房角与术前相比均有不同程度改善。结论:对于部分合并闭角型青光眼的白内障患者,超声乳化联合房角分离术是一种便捷、安全、有效的方法,具有降压和增视的双重效果。     

超声乳化白内障摘出联合人工晶状体植入术治疗急性闭角型青光眼临床观察

目的 探讨治疗急性闭角型青光眼的手术方法.方法 施行超声乳化白内障摘出联合人工晶状体植入术治疗急性闭角型青光眼17例(17眼).结果 术后15眼眼压控制在13～21 mmHg.最佳矫正视力较手术前提高2～4行.结论 白内障行晶状体超声乳化摘出联合人工晶状体植入术是治疗急性闭角型青光跟的一种有效手术方式,特别是对于急性闭角型青光眼合并成熟期和近成熟期的白内障尤为适合.     

超声乳化白内障吸除人工晶状体植入术治疗原发性闭角型青光眼

目的探讨晶状体超声乳化吸除联合后房型人工晶状体植入术治疗白内障合并原发性闭角型青光眼的疗效。方法2002年2月～2004年3月本院收治白内障合并原发性闭角型青光眼34例（36只眼）。术前控制眼压,经视力检查、前房角镜和裂隙灯显微镜等检查后,均单独采用晶状体超声乳化吸除联合后房型人工晶状体植入术。术后随访1—12个月。结果32只眼视力较术前提高,视力〉0．5者占69．5％;33只眼术后眼压〈21mmHg（1mmHg=0．133kPa）,另3只眼用一种降眼压药物眼压控制在21mmHg以下;全部治疗眼前房加深,房角粘连范围减轻。结论超声乳化白内障吸除联合后房型人工晶状体植入术可有效地治疗合并白内障的原发性闭角型青光眼。     

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。     

Phacoemulsification and intraocular lens implantation in eyes with open-angle glaucoma

PURPOSE: To study the effect of phacoemulsification and intraocular lens implantation (PHACO IOL) on intraocular pressure (IOP) and glaucoma medication in open-angle glaucoma (OAG) eyes. METHODS: 38 open-angle glaucoma (OAG) eyes with cataract underwent phacoemulsification and intraocular lens implantation (PHACO IOL) performed by one surgeon (RJU). None of the patients had prior intraocular surgery. Surgery was performed by scleral incision on 37% and by clear corneal incision on 63%. Patients were re-examined on the first postoperative day, after one week, 4 months, and in 29 cases 1-3.7 (mean 2.8) years after the operation. RESULTS: The mean preoperative IOP was 18.4+/-3.3 mmHg with a mean of 1.7 glaucoma medications. On the first postoperative day, the mean IOP rose to 28.2 +/- 12.5 mmHg. IOP > or = 30 mmHg occurred in 39.5% of the eyes. After one week, IOP had returned to the preoperative level. After 4 months, IOP had further decreased to 16.1 +/- 3.8 mmHg (p = 0.0027). After a mean follow-up of 1-3.7 (mean 2.8) years, the average postoperative IOP was 15.1 +/- 2.9 mmHg, being significantly (p = 0.001) lower than the preoperative IOP with 86% of the patients having a mean of 1.6 drugs on average. The type of incision (scleral vs. corneal) did not affect the postoperative IOP level. Using the criteria of Bigger and Becker (1971) the long-term IOP control after PHACO-IOL surgery was improved or unchanged in 86% and worse in 14% of the preoperatively well-controlled OAG eyes. CONCLUSIONS: In OAG eyes PHACO IOL is associated with a significant decrease in IOP with less medication up to 1-3.7 (mean 2.8) years.     

透明晶状体超声乳化术治疗早期闭角型青光眼的效果观察

目的观察透明晶状体超声乳化术治疗早期原发性闭角型青光眼的临床效果。方法对郑州大学第一附属医院眼科2018年10月至2020年1月不伴有白内障的早期原发性闭角型青光眼29例(31只眼)的临床资料进行回顾性分析。患者均接受超声乳化人工晶状体植入术。术后随访6个月,观察眼压、视力、前房深度、小梁虹膜夹角及术后并发症等。结果术后各个时间点眼压均较术前下降(均P<0.05)。随访期末:28只眼(90.32%)眼压≤21 mmHg(1 mmHg=0.133 kPa);最佳矫正视力(logMAR)为0.10±0.06较术前0.12±0.07提高(t=2.115,P=0.043);中央前房深度(3.01±0.16)mm深于术前的(1.94±0.14)mm(t=-28.643,P<0.001);小梁虹膜夹角(31.58°±3.98°)大于术前的(16.11°±3.05°)(t=-28.300,P<0.001);周边前房深度深于术前(P<0.001)。术后除5只眼(16.13%)轻度角膜水肿外,未见其他并发症。结论透明晶状体超声乳化人工晶状体植入术治疗早期原发性闭角型青光眼是有效的。     

白内障超声乳化人工晶状体植入术对早期原发性青光眼眼压控制效果分析

目的 观察早期原发性青光眼行超声乳化联合人工晶状体植入术后眼内压(IOP)控制情况,分析与术后IOP控制效果相关的影响因素.方法 回顾性选择原发性闭角型青光眼(PACG)43例(43只眼)和原发性开角型青光眼(POAG)早期患者32例(32只眼),均行标准3.2mm透明角膜切口白内障超声乳化联合折叠人工晶状体植入术,术后2年定期随访.手术成功标准为:术后IOP保持在6～21mmHg,青光眼神经病变及相应视野缺损无明显进展,无需再行抗青光眼手术治疗.结果 白内障超声乳化联合人工晶状体植入术后,PACG组有28例(65.1%)、POAG组有12例(37.5%)术后IOP控制良好,2年累计生存率之间存在差异(P＜0.05).PACG组成功与失败病例在术前IOP(33.0±5.3)mmHg vs(40.1±3.6)mmHg,P＜0.01、抗青光眼药物数量(2.9±0.9vs4.1±0.4,P＜0.01)、房角粘连范围(2.9±0.5)钟点vs(4.2±0.8)钟点,P＜0.01)之间的差异具有统计学意义,而POAG组成功与失败病例在术前IOP(25.3±3.4)mmHgvs(35.4±3.6)mmHg,P＜0.01、抗青光眼药物数量(1.2±0.4vs2.8±0.9,P＜0.01)之间的差异具有统计学意义.Cox逐步回归分析发现,在PACG组中术前IOP(P＜0.05,RR=1.17)、PAS(P＜0.01,RR=3.971),在POAG组中术前IOP(P＜0.01,RR=1.284),与相应两组术后生存时间具有相关性.结论 在术前PACG患者考虑到IOP和房角粘连范围、POAG患者考虑到IOP的条件下,超声乳化联合人工晶状体植入术对于伴有白内障的早期原发性青光眼,是一种可供选择的有效的控制眼内压的治疗方法.

Abstract：

Objective To assess and find associated factors for favorable postoperative intraocular pressure (IOP) after cataract phacoemulsification with intraocular lens implantation in patients with primary glaucoma on early stage.Methods Forty-five patients (43 eyes) with primary angle closure glaucoma (PACG) and 32 patients with primary open angle glaucoma (POAG) were retrospectively selected.All patients had undergone standard 3.2mm limbal incision phacoemulsification,and 2 years of routine follow-up after cataract surgery.Success was defined as an IOP between 6-21mmHg,with fewer antiglaucoma medications needed than those during pre-operation,no obvious progressions of glaucomatous neuropathy and its coincident visual field loss,and no need of additional glaucoma surgery.Results After phacoemulsification with intraocular lens implantation,there were 28 cases (65.1%) in PACG group and 12 cases (37.5%) in POAG group with well controlled postoperative IOP,and the different of 2-year survival rate was statistically significant (P ＜0.05).There were significant different in the pre-IOP (33.0± 5.3mmHg vs 40.1 ± 3.6mmHg,P ＜0.01),the number ofantiglaucoma medications (2.9± 0.9 vs 4.1± 0.4,P＜0.01) and the extent of peripheral anterior synechiae (PAS) (2.9±0.5 clock hours vs 4.2± 0.8 clock hours,P ＜0.01) between success and failure cases in PACG group.The pre-IOP (25.3±3.4 mmHg vs 35.4±3.6 mmHg,P＜0.01),the number of antiglaucoma medications (1.2± 0.4 vs 2.8± 0.9,P ＜0.01) were significant different between the success and failure cases in POAG group.Cox stepwise regression analysis found that pre-IOP (P ＜0.05,RR=1.17) and the extent of PAS (P ＜0.01,RR=3.971) in PACG group and the pre-IOP (P＜0.01,RR=1.284) in the POAG group was significant associated with the corresponding survival time after cataract surgery.Conclusions Phacoemulsification with intraocular lens implantation may be an alternative procedure for effective IOP control of the patients with primary glaucoma on early stage coexisting with cataract on considering pre-IOP and the extent of PAS in PACG and pre-IOP in POAG.     

超声乳化治疗特殊类型白内障技术分析

目的：探讨超声乳化术治疗特殊类型白内障的安全性和有效性。

方法：回顾性分析临床资料,研究超声乳化吸出(联合)人工晶状体植入术治疗青光眼术后白内障、小瞳孔白内障、葡萄膜炎并发白内障和外伤后并发白内障等特殊类型白内障的技术要领。

结果：进行治疗的73例84眼特殊类型白内障患者中,单纯行超声乳化术27例28眼,植入后房型人工晶状体52眼,植入前房型人工晶状体4眼; 术后1mo平均眼压12.72±2.63mmHg,脱盲率99%,脱残率96%; 并发症发生率4%。

结论：特殊类型白内障手术难度大,超声乳化术切口小,可保留晶状体后囊膜和植入人工晶状体,是摘除特殊类型白内障的理想术式。     

超声乳化联合小梁切除术治疗闭角型青光眼伴白内障

目的探讨闭角型青光眼伴白内障行超声乳化联合小梁切除术的手术方式及临床效果。方法回顾性分析41例（46眼）闭角型青光眼伴白内障行超声乳化联合小梁切除术的临床资料。结果术后随访12个月,裸眼视力0．3及其以上者为36眼（78．26％）,0．05及其以上脱盲率为100％。术后眼压全部降至正常范围,由术前的（32．5±6．2）mmHg降至术后（14．2±4．6）mmHg（1mmHg=0．133kPa）,术前与术后眼压相比差异有统计学意义（t=7．71,P〈0．01）。角膜内皮细胞密度术前与术后1周、1个月、3个月时相比差异有统计学意义（t=4．29～4．331,P〈0．01）,但术后1周、1个月、3个月之间的差异无统计学意义（t=0．025～0．097,P〉0．05）。结论闭角型青光眼伴白内障行超声乳化联合小梁切除术获得良好疗效,是一种有效的手术方式。     

白内障超声乳化联合前房角成形术治疗原发性闭角型青光眼的疗效观察

目的:评价白内障超声乳化后房型人工晶状体植入联合前房角成形术治疗原发性闭角型青光眼(primary angle-closure glaucoma,PACG)合并白内障的临床疗效。方法:分析1998-01/2008-01在我科住院的PACG患者35例35眼,其中急性PACG28例,慢性PACG7例,均有不同程度的晶状体混浊,行白内障超声乳化后房型人工晶状体植入联合前房角成形术,随访6mo。结果:术后平均眼压14.6±2.3mmHg,比术前用药后眼压23.2±3.6mmHg明显降低,中央前房深度由术前的1.64±0.32mm,增加到术后的3.16±0.53mm,差异均有统计学意义(P<0.05)。术后32眼(91%)最佳矫正视力均有不同程度提高。结论:白内障超声乳化后房型人工晶状体植入联合前房角成形术,可有效治疗PACG合并白内障。     

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。     

Preliminary Observation of One-site Combined Trabeculectomy and Phacoemulsification in the Management of Cataract Patients with Drug-controllable Glaucoma

Purpose: To evaluate the effect of one-site combined phacoemulsification and trabeculectomy in the management of cataract patients with drug-controllable glaucoma. Methods : Twenty-four cases (25 eyes) of cataract patients with glaucoma whose intraocular pressure could be controlled by drugs were observed. All had undergone one-site combined phacoemulsification and trabeculectomy. Intraocular pressure and visual acuity were observed.Results: The follow-up was 1-21 months. Postoperative visual acuity was 0.4-0.6 in 9 eyes, 0.7-0.9 in 7 eyes and 1.0 or better in 9 eyes. Postoperative intraocular pressure was 2.17±0.764kPa (16.28±5.73mmHg), 1.83±0.90kPa (13.74 ± 6. 77mmHg) lower than that before surgery (t= 11.89, P<0.01). Only one eye needed one drug to control intraocular pressure after surgery.Conclusions:One-site combined phacoemulsification and trabeculectomy is a safe, effective and convenient technique for the management of cataract patients with drug-controllable glaucoma. . Eye Science 1999 ;