不同手术方式治疗青光眼术后硬核白内障的临床疗效观察

目的对不同手术方法治疗青光眼术后硬核白内障的临床疗效和安全性进行观察和分析。方法选取2009年9月-2013年4月曲靖市第二人民医院收治的青光眼手术后硬核白内障患者100例作为研究对象，按不同治疗方法分为观察组和对照组，其中观察组54例（75眼），对照组46例（61眼）。观察组患者应用巩膜隧道小切口超声劈核后手法娩出核进行治疗，对照组患者应用透明角膜切口超声乳化碎核进行治疗。对所有患者随访3～6个月，观察和记录患者手术前、后视力，前房深度，眼压和角膜内皮细胞平均计数的变化及不良反应。结果2组患者视力均较治疗前显著改善（P〈0．05），但2组间差异无统计学意义（P〉0．05）；2组患者前房深度分级显著优于治疗前（P〈0．05），且治疗后观察组患者的前房深度分级显著优于对照组（P〈0．05）；2组患者治疗后的眼压与治疗前的差异无统计学意义（P〉0．05），2组间的差异也无统计学意义（P〉0．05）；观察组患者角膜内皮细胞密度下降不显著（P〉0．05），而对照组则下降显著（P〈0．05），观察组患者治疗后的角膜内皮细胞密度显著高于对照组（P〈0．05）；2组患者术后的不良反应发生率分别为21．33％（16／75）和21．31％（13／61），经对症治疗后均得到控制和恢复，2组患者不良反应情况差异无统计学意义（P〉0．05）。结论应用巩膜隧道小切口超声劈核后手法娩出核治疗青光眼术后硬核白内障，可有效改善患者视力和前房深度，安全性较高，且在改善前房深度和减少角膜细胞损伤方面优于超声乳化碎核术，值得临床推广应用。

Effect observation of different operation mode on treatment of hard nucleus cataract after glaucoma surgery

Objectives To observe and analyze the efficacy and safety of the different operation methods in the treatment of hard nucleus cataract after glaucoma surgery. Methods 100 patients with hard nucleus cataract after glaucoma operation were selected. According to the different treatment methods, the patients were divided into the observation group （n = 54, 75 eyes） and the control group （ n = 46, 61 eyes）. The observation group was treated with manual nuclear delivery after ultrasonic chopping nucleus through small scleral tunnel incision, while the control group was treated with the phacoemuisification through clarity corneal incision. All the patients were followed up for 3 to 6 months. Changes of visual acuity, the depth of anterior chamber, intraocular pressure and corneal endothelial cell counting before and after operation as well as the adverse reactions were observed and compared. Results Compared with visual acuity before treatment, the visual acuity of the patients in both groups improved significantly after treatment （ P 〈 0.05 ）. The anterior chamber depth grades of patients in both groups were significantly higher than those before treatment （P〈 0.05）, and after treatment, the anterior chamber depth grade of the patients in the observation group was significantly better than that in the control group （P 〈 0.05）. There was no significant difference of intraocular pressure before： and after the treatment in both groups （P 〉0.05）. The corneal endothelial cell density of the patients in the observation group decreased （P 〉0.05）, while that in the control group decreased significantly （P 〈 0.05）. The corneal endothelial cell density of the patients in the observation group after the corneal endothelium was significantly higher than that in the control group （P 〈 0.05）. The incidence rates of adverse reaction in the two groups were 21.33 % （16/75） and 21.31% （ 13/61 ） respectively, and the symptom were controlled and cured after the symptomatic treatment. Conclusion Application of manual nuclear delivery after ultrasonic chopping nucleus through small scleral tunnel incision for the patients with hard nucleus cataract after glaucoma surgery can effectively improve the visual acuity and anterior chamber depth of the patients. It is safe and better than ultrasonic emulsification nucleus surgery in the aspects of improving anterior chamber depth and reducing the injury to corneal cells. It is worthy of clinical application.