青光眼術後隧道切口摘除白内障31眼

目的述用隧道切口施行青光眼術後白内障摘除的方法和優點.方法以滤枕位置情况選以9點或10點時鐘位為中心的結膜切開,止血;做角膜緣後2mm反眉形半層切口做隧道于透明角膜内1.5mm進入前房,注入粘彈劑後檢查瞳孔小于3mm不能散開者做瞳孔緣放射形剪開;伴虹膜後粘連者在注射粘彈劑的同時用粘彈劑針頭平掃式分離或用囊膜剪剪開.撕囊或開罐式破囊;水分離,粘彈劑針頭挠核使核脱位,將粘彈劑注射于核後,擴大切口至6～7mm,圈匙進入核後套出晶體核,注吸皮質至眼内透明,視手術前計劃植人人工晶體或不植,從側切口向前房内注入注吸液關閉隧道切口,結膜切口區結膜下注射慶大霉素2萬U,地塞米鬆2mg使結膜水腫向前推移覆蓋隧道外口.結果手術31眼,術中注吸皮質時後囊破裂1眼,為3.22%.手術後眼壓無升高.結論對于青光眼手術後白内障患者應用避開滤枕做9～10點位隧道切口完成白内障手術,其優點為不損傷滤枕,術後不影響眼壓,與傳統術式相比手術簡單,隧道切口和結膜切口皆不縫合,减少了手術後散光發生和减少了手術程序,可以在臨床推磨應用.

Cataract extraction after trabeculectomy through a scleral tunnel incision in 31eyes

Objective To study the methods and advantages of cataract extraction after trabeculectomy through a scleral tunnel incision. Methods 31 eyes after trabeculectomy incised the conjuctiva at 9 or 10 clock according to the filtering bleb. All operations used scleral tunnel incision. The tunnel incision was away from the limbal about 2 mm and entered the limbal 1.5 mm. We checked the pupil after injecting the iviz into anterior chamber. The pupil was cut out if diameter of pupil was shorter than 3 mm. Dessected the adhesion of iris with blunt syringe needle or scissors if there was adhesion behind the iris. Anterior capsulectomy, hydradessection, removal of nucleus, removal of cortex were performed in proper order. A part of cases implanted PC-IOL. BSS was injected into anterior chamber to close tunnel incision. Conjuctiva incision was closed by injected gentamicin and dexamethasone under conjuctiva. Results Postoperatively, intraocular pressure of 31 cases did not rise. The complication was posterior casule rupture in 1 case (3.22%), in the operation. Conclusion The case of cataract extraction after trabeculectomy should select 9 or 10 clock limbal for scleral tunnel incision. The advantages include that it does not damage the filtering bleb, does not raise the intraocular pressure, and simplifies operation steps and because of suture-free no astigmatism occurs after operation. So it can be widely used in clinical practice.