两种不同三联手术方法治疗白内障合并青光眼的临床观察

目的观察两种不同i联手术方法治疗白内障合并青光眼的临床效果。方法2009年10月～2012年12月诊治青光眼合并白内障患者78例（91眼），随机数字表法分为白内障超声乳化＋人工晶状体植入＋小梁切除术（超声乳化i联术）组38例（43眼），小切口白内障囊外摘除＋人工晶体植入＋小梁切除术（小切口囊外j联术）组40例（48眼），对照两组患者术后并发症、术后1个月视力、眼压及滤过泡情况。结果两组三联手术均朱出现角膜失代偿、前房出血、低眼胝、后囊破裂、玻璃体脱出、睫状环阻塞性青光眼、脉络膜视网膜脱离等并发症，超声乳化三联术组术后早期发生角膜后弹力层皱褶7眼，前房纤维性渗出5眼，小切口囊外三联术组分别为8例、6例，两组比较无统计学意义。两组滤过泡多为Ⅱ型弥漫扁平型，均具有良好的控制眼压和恢复视力的作川。，结论超声乳化三联术和小切口囊外三联术均是治疗青光眼合并白内障安全、有效、经济的手术方式，对纤济闲难或高龄硬核不宜超声乳化的白内障患者施行小切口囊外三联术治疗是比较理想的手术方式，值得在基层医院开展。

Clinical observation of two different triple operation method in the treatment of cataract combined with glaucoma

Objective To observe the clinical effect of two different triple operation methods in the treatment of cataract combined with glaucoma. Methods Patients who had undertaken treatment of cataract combined with glauco- ma from Oct.2009 to Dec.2012 were divided randomly into two groups. Among all these 78 eases （91 eyes）, 38 cases （43 eyes） undertook the phacoemulsification and intraocular lens implantation combined with trabeculectomy （ultra- sonic emulsification triple surgery）. While the rest 40 cases （48 eyes） implemented the small incision extracapsular cataract extraction and intraocular lens implantation combined with trabeculectomy （small incision extracapsular triple surgery）. Then complications of these two groups as well as the vision acuity 1 month after operation, the intraocular pressure and the filtering blebs after operation were compared. Results Both of the two groups could not observe the following complications such as of corneal decompensation, anterior chamber hemorrhage, hypotension ,posterior cap- sule rupture, prolapse of vitreous,ciliary block glaucoma, retinal and ehoroid detachment and etc. In Phaeo group, 7 eyes of Descemet＇s membrane folds appeared shortly after operation, meanwhile 5 eyes of anterior chamber fibrous exudation were observed. While the number of such complications appeared in the small incision extracapsular cataract extraction triple surgery group were 8 cases, 6 cases. After statistical analysis, no significant differences were observed. Filtering blebs （type l] ） in both of two groups were flat and diffuse, which possessed ideal control of in- traocular pressure and good recovery function of the vision acuity. Conclusion Both ultrasonic emulsification triple surgery and small incision extracapsular triple surgery are safe,effective and economic operation modes.For those gerontic sufferers or poverty-striken patients who are not suitable for the Ultrasonic emulsification triple surgery, the small incision extracapsular triple surgery may be the ideal choice to be taken in the local hospital.