闭角型青光眼合并白内障患者应用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的效果观察

目的分析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疗效。方法对39例(42眼)闭角型青光眼合并白内障患者实施超声乳化白内障吸除人工晶状体植入联合小梁切除手术。随访6个月,评价治疗的效果。结果42眼的眼压均恢复至正常范围。40眼(93.02%)视力较术前显著改善,2眼维持视力不变。滤过泡I型19眼、Ⅱ型21眼、Ⅲ型2眼。出现浅前房3眼,经注入无菌空气后前房形成。1眼术后出现前房少许出血,经止血、制动对症处理后出血完全吸收。未发生晶状体后囊破裂、角膜失代偿、恶性青光眼等严重并发症。结论对合并白内障的闭角型青光眼患者予以超声乳化白内障吸除联合小梁切除术,控制眼压可靠且能加深前房及改善视力,安全性高。     

青光眼小梁切除术后白内障超声乳化显微手术的临床观察

目的 探讨青光眼小梁切除术后白内障手术的方法及手术对滤过泡的影响.方法 对抗青光眼小梁切除术后白内障126例(166眼),采用颞侧巩膜隧道切口,进行超声乳化白内障吸除及折叠式人工晶状体植入手术.术后观察视力、眼压和滤泡等情况.结果 随访3个月～2年,患者视力较手术前均有不同程度提高,视力≥0.5者占72.6%,眼压与术前基本一致,滤泡形态无改变.结论 经颞侧巩膜隧道切口行超声乳化人工晶状体植入术是治疗青光眼小梁切除术后白内障的有效方法.     

急性闭角型青光眼合并白内障行窦小梁切除术联合超声乳化白内障吸除术的疗效观察

目的:观察窦小巢切除术联合白内障超声乳化吸除术、人工晶体植入术(三联术),对治疗青光眼合并白内障患者的疗效.方法:对41人41眼急性闭角型青光眼合并白内障患者进行手术治疗,采用改良窦小梁切除术联合白内障超声乳化吸除术、人工晶体植入术.术后随访1-10个月.结果:术前眼压16～36mmHg,平均26mmHg,术后随访最终眼压12～21mmHg,平均眼压17mmHg,手术前后眼压变化有显著性差异.术后视力<0.1者5眼,此5例患者均有眼底视神经萎缩;0.1～0.5者11眼;>0.5者22眼.结论:改良宾小梁切除三联手术治疗青光眼合并白内障患者,具有恢复视力、稳定眼压、减少术后用药,并发症少等效果.     

复合式小梁切除术与超声乳化白内障吸除术分期手术临床探讨

目的 通过对复合式小梁切除术、超声乳化白内障吸除术与可折叠式人工晶状体植入术分期手术治疗的回顾性分析，探讨青光眼合并白内障的手术方式选择。方法 收集2000年至2002年期间行复合式小梁切除术，而后再行超声乳化白内障吸除术与可折叠式人工晶状体植入术54例58只眼，对2种手术前后的白内障，视力及眼压进行比较，并对2种手术间隔时间的相关因素进行分析。结果 复合式小梁切除术后品状体混浊程度加重、视力下降，经超声乳化白内障吸除术与可折叠式人工晶体植入术后视力基本回复。短期内白内障手术未影响小梁切除术后的眼压。抗青光眼手术与白内障手术间的间隔时间与患者年龄及青光眼术前眼压无相关性（P〉0．05）。原发性闭角型青光眼的手术间隔时间短于原发性开角型青比眼，差异有统计学意义（P〈0．05）。结论 对于原发性闭角型青光眼，存选择下术治疗方式时须考虑白内障的影响。对于低视力患者，当需要进行滤过性手术时，复合式小梁切除术与超声乳化白内障吸除术的联合治疗可能优于分期手术治疗。     

超声乳化治疗青光眼合并白内障临床观察

目的:观察超声乳化白内障摘除人工晶状体植入联合虹膜周边切除术或小梁切除术治疗青光眼合并白内障的疗效。方法:采用单纯表麻下超声乳化白内障摘除人工晶状体植入治疗白内障继发青光眼不伴房角损害9眼(术式Ⅰ);表麻下超声乳化白内障摘除人工晶状体植入加周边虹膜切除术治疗病人14眼(术式Ⅱ);球周麻醉超声乳化白内障摘除人工晶状体植入加小梁切除术治疗病人13眼(术式Ⅲ);术后随访3个月～2年。结果:术前平均视力0.06,术后平均视力0.5;术前平均眼压(27.63±2.31)mmHg,(1mmHg=0.133KPa),术后平均眼压(15.62±1.76)mmHg。结论:上述三种术式治疗青光眼合并白内障,具有恢复有用视力,控制眼压满意的理想效果。     

超声乳化人工晶体植入联合隧道内小梁切除术

目的探讨青光眼白内障联合手术的最佳方式。方法对86例青光眼合并白内障患者施行超声乳化及人工晶体植入联合隧道内小梁切除。结果术前视力<0.1者70例,0.1~0.3者16例。术后视力<0.1者15例,0.1~0.5者37例,>0.5者34例。术前眼压最高60mm Hg以上,最低24mm Hg,术后75眼压降至正常范围,10例术后经局部滴药水后降至正常。1例出现恶性青光眼。所有术眼均形成功能性滤过泡。并发症主要是角膜水肿与虹膜炎,术后随访半年~2年,10例视力下降,4例眼压升高。结论白内障超声乳化人工晶体植入联合隧道内小梁切除术是目前治疗青光眼合并白内障的良好方法。     

三联术治疗高龄闭角型青光眼合并白内障的临床疗效观察

目的 将白内障超声乳化吸除、人工晶状体（IOL）植入联合小梁切除术用于高龄闭角型青光眼（ACG）合并白内障中,探究其临床效果。方法 选取2017年1月至2021年12月本院收治的64例（64眼）患者,以手术方案分组,对照组32例（32眼）行单纯小梁切除术,观察组32例（32眼）在此基础上行超声乳化吸除IOL植入术,比较两组手术结果。结果 术前两组眼压、视力相比无显著差异（P>0.05）,术后观察组眼压较对照组低,视力较对照组高（P<0.05）;术前与术后,两组视网膜神经纤维层厚、视野缺损相比均无显著差异（P>0.05）;观察组术后并发症发生率为3.13%,较对照组21.88%低（P<0.05）。结论 白内障超声乳化吸除IOL植入术联合小梁切除术用于高龄ACG合并白内障患者中,可有效改善其眼压及视力,减少术后并发症,且对角膜内皮损伤较小,安全性较高,值得应用。     

青光眼滤过术后小切口非超声乳化白内障手术临床观察

目的探讨抗青光眼滤过术后白内障患者的手术方法和效果。方法对自2003年1月~2005年12月26例32眼抗青光眼滤过术后白内障囊外摘除及人工晶体植入方法进行了回顾。颞侧角膜缘后1.5mm巩膜反眉形隧道切口6mm,水分离及水分层,圈匙托核,后房人工晶状体植入。结果32眼术后视力均有提高,术中术后无严重并发症,术后眼压正常。结论经过颞侧巩膜小切口非超声乳化白内障手术治疗青光眼滤过术的白内障效果良好,无严重并发症,未损伤滤过泡及滤过区,术后眼压正常。     

超声乳化人工晶体植入联合房角分离术治疗闭角型青光眼合并白内障

目的:观察超声乳化人工晶体植入联合房角分离术治疗团角型青光眼合并白内障的临床效果。方法:超声乳化人工晶体植入联合房角分离术治疗团角型青光眼合并白内障20例(22眼)。其中急性闭角型青光眼16例,慢性闭角型青光眼6例,所有手术由同一医师完成,均采用超声乳化人工晶体植入联合房角分离术,观察手术前后视力、眼压、前房深度及房角形态的变化。结果:术后随房3～24个月,视力均较术前明显提高(P<0.05),术后眼压较术前显著性降低。术后1个月前房角镜检查房角均较术前开放角度明显增加,虹膜平坦,周边膨隆消失。结论:采用超声乳化人工晶体植入术联合房角分离术可有效治疗合并白内障的闭角型青光眼。     

双切口小梁切除联合超声乳化显微手术治疗青光眼合并白内障

目的　探讨双切口小梁切除联合超声乳化白内障显微手术治疗青光眼合并白内障的临床疗效。　方法　施行双切口小梁切除联合超声乳化白内障吸除术 46例 ( 4 8眼 ) ,术后随访 6～ 3 6个月 ,分析术后眼压、视力等情况。　结果　术前眼压 15 2 8～ 3 2 17mmHg ,术后随访最终眼压 7 10～ 2 0 5 5mmHg ,两者差异有显著性 (t=8 92 ,P <0 0 0 1) ;术前视力眼前光感～ 0 3 ,术后视力大于 0 2者 41眼 ,较术前明显好转 ,经配对 χ2 检验 ,差异有显著性 χ2 =14 0 3 ,P <0 0 0 1)。　结论　双切口小梁切除联合超声乳化白内障显微手术治疗青光眼合并白内障 ,能达到恢复有用视力及降低眼压等效果。     

Intraocular pressure following ECCE and IOL implantation in patients with glaucoma

Patients with glaucoma may suffer optic nerve head damage due to elevated intraocular pressure (IOP) after any intraocular procedure. We retrospectively reviewed the IOP data in 82 consecutive patients (103 eyes) with glaucoma after extracapsular cataract extraction (ECCE) and posterior chamber intraocular lens (PC-IOL) implantation. Nine eyes had previous trabeculectomy and three eyes required combined trabeculectomy with ECCE and PC-IOL. The average follow-up period is 1.5 years (range 0.5 to 6 years). The postoperative IOP rise of 8 mm Hg over baseline or above 23 mm Hg was observed in 45 eyes (49.5%). Two eyes needed argon laser trabeculoplasty and one required trabeculectomy to control postoperative IOP elevation. Most of the patients required the same or lesser number of medications for IOP control after surgery. Results suggest that ECCE with PC-IOL may be a relatively safe procedure in cataract patients with preexisting glaucoma.     

Glaucoma triple procedures: efficacy of intraocular pressure control and visual outcome

Sixty-three glaucoma triple surgeries [combined trabeculectomy, extracapsular cataract extraction (ECCE), and posterior-chamber intraocular lens (PC-IOL) implantation] were reviewed. Intraocular pressure (IOP) was controlled satisfactorily in all cases; 25% required additional glaucoma therapy but fewer glaucoma medications. Eighty-six percent achieved 6/12 or better visual acuity. Postoperative IOP and visual acuity results were similar to those achieved by trabeculectomy or ECCE/PC-IOL, respectively. Cumulative years of preoperative glaucoma therapy had an adverse effect on postoperative IOP control.     

超声乳化白内障吸除联合人工晶体植入术治疗闭角型青光眼的临床疗效观察

目的观察超声乳化白内障吸除联合折叠式人工晶体植入术治疗急性闭角型青光眼合并白内障患者的临床疗效。方法收集2002年7月至2005年9月于中山眼科中心青光眼病区收治的急性闭角型青光眼合并白内障31例(31眼),患者均接受超声乳化白内障吸除联合折叠式人工晶体植入术,术后随访3个月。结果术后最佳矫正视力,较术前显著提高(P<0·05);患者术后3个月眼压平均为(15·3±3·2)mmHg,较术前用药前后眼压相比均显著下降(P<0·05);超声生物显微镜检查发现术后前房深度较术前均显著增加,平均为(3·01±0·47)mm(P<0·05);术后患者房角均较术前增宽,房角粘连关闭象限不同程度开放。结论超声乳化白内障吸除联合折叠式人工晶体植入术可有效降低眼压、提高视力,为急性闭角型青光眼同时合并白内障患者安全有效的治疗途径。     

Trabeculectomy, ECCE with PC-IOL implant, and vitrectomy after malignant glaucoma

A patient with narrow-angle glaucoma developed a post peripheral iridectomy malignant glaucoma in both eyes. The intraocular pressure (IOP) in both eyes was controlled with mydriatics, cycloplegics, and Diamox for 2 years. Subsequently the patient developed a dense cataract and uncontrollable IOP in her left eye. An extracapsular cataract extraction, posterior chamber lens implant, and trabeculectomy were combined with an anterior vitrectomy. The IOP in both eyes has been controlled for 3 years postoperatively.     

Intraocular pressure following ECCE, phacoemulsification, and PC-IOL implantation

Abnormal intraocular pressure (IOP), either transient or permanent, may follow extracapsular cataract extraction (ECCE) with phacoemulsification (PE) and posterior chamber intraocular lens (PC-IOL) implantation. We retrospectively studied IOP measurements at different intervals post ECCE and PE in 242 eyes of 211 patients: 105 males, 106 females, 198 Caucasians and 13 blacks. Elevated IOP (greater than 23 mm Hg) was observed in 20 eyes (8.2%). Only two patients (0.8%) had persistent (greater than 3 months) IOP elevation and needed antiglaucoma therapy. Six more eyes (2.5%), however, developed glaucoma after 1 year. Hence, the incidence of secondary pseudophakic glaucoma at the conclusion of this study was 3.3%. No patient required laser or other mechanical surgery for IOP control. ECCE and PE with PC-IOL does not appear to adversely affect IOP. Patients, however, must be followed closely, as some may develop glaucoma months after surgery.     

Intercapsular cataract extraction with implantation of the Galand disc lens: a retrospective analysis in patients with and without glaucoma

We studied the results of intercapsular cataract extraction and implantation of the rigid Galand disc intraocular lens (IOL) in 164 cataract patients with and without glaucoma. Eighty-eight percent of the glaucomatous eyes and 98% of the eyes without glaucoma had a postoperative visual acuity of 20/40 or better after best-case analysis. Intercapsular bag placement appeared satisfactory in all but two cases, in which the IOL was slightly tilted. Cataract extraction favorably affected glaucoma control, especially in patients with angle-closure glaucoma (7.3 mm Hg intraocular pressure [IOP] reduction) and in those with primary open-angle glaucoma (2.6 mm Hg IOP reduction). The complications encountered, cystoid macular edema and hyphema, occurred in 1% and 0.5% respectively, and were not more frequent in the glaucoma subgroup. Posterior capsular opacification (30%) and inflammatory complications such as posterior synechiae (7.6%) and prepupillary fibrin (6%) were more often noted in the glaucomatous eyes. Pupillary capture or significant IOL decentration did not occur. We conclude that a circular type of IOL is the best currently available lens for use in glaucoma patients.     

手法小切口白内障手术治疗糖尿病性白内障的疗效分析

目的分析手法小切口白内障摘除联合人工晶状体植入术治疗糖尿病性白内障的疗效。方法对68例（96眼）糖尿病合并白内障的患者行小切口白内障摘除及人工晶状体植入术的临床资料进行回顾性分析。统计术后1、30d的视力,术后视力与糖尿病病程的关系以及术后并发症。结果术后第1天裸眼视力〉0.5者69眼（71.88%）,0.3～0.5者18眼（18.75%）,0.1～0.25者6眼（6.25%）,〈0.1者3眼（3.13%）;术后第30天裸眼视力〉0.5者74眼（77.08）,0.3～0.5者16眼（16.67%）,0.1～0.25者4眼（4.17%）,〈0.1者2眼（2.08%）。术后并发症主要有角膜水肿、前房纤维素性渗出、虹膜粘连、继发青光眼。结论手法小切口白内障摘除联合人工晶状体植入术治疗糖尿病性白内障是安全有效的,术后视力的恢复与糖尿病病程及糖尿病视网膜病变有关。     

联合手术治疗伴玻璃体积血的新生血管性青光眼

目的观察玻璃体切除联合术治疗伴玻璃体积血的新生血管性青光眼的疗效。方法对11例伴玻璃体积血的新生血管性青光眼均行玻璃体切除联合小梁切除术,术中行眼内全视网膜光凝,部分患者摘除混浊晶状体。随访8～12个月,观察术后眼压、视力、虹膜新生血管及并发症情况。结果本组病例术后平均眼压（15.6±5.3）mmHg,与术前（45.6±8.7）mmHg相比,差异有统计学意义（P〈0.05）。9例（81.8）患者术后视力有所提高或不变,大部分虹膜新生血管术后2周内消退,术后无严重并发症,随访期内无眼球萎缩发生。结论玻璃体切除联合小梁切除术是治疗伴玻璃体积血的新生血管性青光眼有效、可行的方法。     

前部玻璃体切割联合房角分离术对白内障术后恶性青光眼的疗效观察

目的观察前部玻璃体切割联合房角分离术对白内障术后恶性青光眼的治疗效果。方法对2011年7月至2015年6月间因白内障摘除联合人工晶体植入术后继发恶性青光眼行药物和YAG激光治疗无效的20例(20只眼)患者,在安阳市眼科医院接受前部玻璃体切割联合房角分离手术治疗,随访3个月~1 a,观察记录20例患者手术后的最佳矫正视力、眼压、前房深度及视网膜、脉络膜状态等情况,并对数据进行统计学分析。结果术后3个月,20例(20只眼)患者最佳矫正视力、眼压、前房深度分别为(0.58±0.25)、(15.26±2.97)mm Hg、(3.28±0.42)mm,与术前比较差异均有统计学意义(P0.05)。术后第1天6只眼出现睫状体脱离,3只眼出现睫状体脱离合并脉络膜渗出性脱离。给予地塞米松针5 mg球旁注射,20%甘露醇注射液250 m L静滴,术后2周内9例患者睫状体及脉络膜脱离消失。结论前部玻璃体切割+后囊切开+房角分离术可有效解除白内障术后恶性青光眼患者的睫状环阻滞、房水流出道阻塞,促进患者前房形成和房水流出,明显改善患者症状和提高视功能。