青光眼白内障联合手术的历史及现状

青光眼白内障联合手术是指不同方式白内障摘除与不同方式抗青光眼手术的联合。目前狭义上主要指超声乳化白内障吸除联合滤过性手术尤其是小梁切除术。白内障手术从囊内摘除、囊外摘除到目前的透明角膜切口超声乳化白内障吸除折叠式人工晶状体植入甚至飞秒激光白内障手术；小梁切除术目前主要是巩膜瓣牢固缝线、抗代谢药物（尤其是丝裂霉素）应用和巩膜瓣缝线调控性拆除。目前联合手术适应证尚缺乏统一标准，有学者主张对于房角粘连≥180、降眼压药物≥3种、有白内障手术指证、矫正视力〈0．5者，可选择小梁切除联合超声乳化白内障手术。未来的联合手术将纳入非穿透小梁手术、黏小管切开术、房水引流物植入术（包括I-sent、EXPRESS阀）以及内窥镜下睫状体光凝术等.

The history and future of combined surgery in glaucoma and cataract

Combined cataract and glaucoma surgery refers to the combination of different types of cataract extraction operations and glaucoma operations. At present, it mainly refers to the phacoemulsifica- tion combined with filtering surgery especially trabeculectomy. Cataract surgeries include from intracapsular cataract extraction （ICCE）, extracapsular cataract extraction （ECCE）, to the transparent corneal incision phacoemulsification with foldable intraocular lens implantation even if femtosecond laser cataract surgery. The techniques of trabeculectomy include scleral flap firmly sutured, anti - metabolism drugs （ especially mi- tomycin） application and the controlled demolition of scleral flap sutures. Nowadays there are no unified standards of indication for combined surgery. Some authors have suggested that patients with goniosynechia t〉 180~, numbers of anti -glaucoma drugs /〉3, existing indication of cataract surgery, corrected visual a- cuity 〈 10/20, can be chosen for combined surgery. In the future, non -penetrating trabecular operation, viscocanalostomy and shunt procedures （ including I - sent, EXPRESS） and endoscopic cyclophotocoagula- tion will be incorporated into field of combined surgeries.