抗青光眼滤过术后白内障摘除术对眼内压长期影响的临床观察

目的探讨抗青光眼滤过术后白内障摘除术对眼内压的长期影响。方法对抗青光眼滤过术后白内障患者69例69眼随机分为三组,分别采用颞侧角巩膜缘切口白内障囊外摘除及人工晶状体植入术(简称ECCE组)(18例18眼)、颞侧角巩膜缘隧道切口超声乳化白内障吸除及人工晶体植入术(简称角巩膜缘超声乳化组)(25例25眼)和上方透明角膜切口超声乳化白内障吸除及折叠式人工晶体植入术(简称透明角膜超声乳化组)(26例26眼),术后平均随访26个月,分别观察眼压和视力并进行比较。结果ECCE组、角巩膜缘超声乳化组、透明角膜超声乳化组术后最后一次随访时平均眼压升高分别为2.75mmHg,1.82mmHg和1.68mmHg,与术前比较,差异均无统计学意义(>0.05);视力改善分别为12眼(70.6%)、23眼(92.0%)和24眼(92.3%);ECCE组与角巩膜缘超声乳化组和透明角膜超声乳化组比较,术后效果低于两种超声乳化组,差异有统计学意义(<0.05),两种超声乳化组间比较,差异无统计学意义(>O.05)。结论抗青光眼滤过术后三种白内障摘除术术后眼压均可有效控制,视力改善,超声乳化白内障吸除术尤其是经透明角膜切口折叠式人工晶体植入术术后长期对眼压影响小,视力恢复快,是目前此类白内障手术的最佳术式。

A clinical investigation of the effect of cataract surgery on intraocular pressure after filtering surgery

Objective To investigate the effect of cataract surgery in eyes on intraocular pressure(IOP)after filtering surgery.Methods 69 eyes subjected to cataract surgery after filtering surgery were put into three random groups,IOP and visual acuity were observed and compared and the mean follow-up after cataract surgery was 26 months.Among them,18 eyes had temporal corneoscleral extracapsular cataract extraction(ECCE) and intraocular lens (IOL) implantation,25 eyes had temporal corneoscleral phacoemulsification and IOL implantation (corneoscleral phacoemulsification)and 26 eyes had superior clear corneal phacoemulsification (clear corneal phacoemulsification).Results At the end of follow-up,the increase in the mean postoperative IOP of the three groups was respectively 2.75mmHg,1.82mmHg and 1.68mmHg.The difference was not statistically significant( >O.05).The postoperative visual acuity improved was respectively 12 eyes(70.6%),23 eyes(92.0%) and 24 eyes(92.3%). Corneoscleral phacoemulsification or clear corneal phacoemulsification was better than ECCE and the difference was statistically significant( <0.05).However,there was no statistical significance between corneoscleral phacoemulsification and clear corneal phacoemulsification ( >O.05). Conclusions The patients by ECCE and corneoscleral phacoemulsification or clear corneal phacoemulsification in eyes with filtering blebs after trabeculectomy can control IOP and rehabilitate their visual acuity.The best surgery is clear corneal phacoemulsification with foldable IOL implantation which does not adversely affect long-telm IOP control and the patients obtain the best visual acuity.