多联手术治疗药物难控制性青光眼合并白内障的疗效观察(1)
[摘要] 目的探讨药物难以控制眼压的白内障青光眼患者,行超声乳化折叠人工晶体植入,联合术中房角分离、乳化隧道内小梁切除的临床疗效。方法回顾分析2004年9月至09年8月对用药物等难控制眼压的青光眼白内障患者52例52眼,实施白内障超声乳化、折叠人工晶体植入联合房角分离、乳化隧道内小梁切除术后视力恢复及眼压控制效果。结果术后最佳矫正视力较术前提高45眼(86.54%),视力不变7眼(13.46%)。随访38眼中,有21眼(55.26%)眼压达到理想治愈, 12眼(31.58%)达标准治愈, 4眼(10.53%)有效, 1眼(2.63%)无效,总有效率为97.37%。术后前房角有不同程度的增宽,粘连范围明显缩小。结论白内障超声乳化折叠人工晶体植入联合房角分离、乳化隧道内小梁切除术,对药物难以控制眼压的白内障青光眼患者,能迅速控制眼压,恢复视力,良好控制眼压的有效方法。
[关键词] 白内障;青光眼;眼压;多联手术;前房角
[中图分类号]R771 [文献表示码]A [文章编号]
, 百拇医药
Clinical Observation of Multi-surgery for Drug-uncontrollable Glaucoma Combined with Cataract
LI Aizhi,SUN Jinge,Wu Yubo。The Central Hospital of Jiaozhou,Qingdao 266300, Shandong China
[Abstract] Objective To explore the therapeutic effect of phacoemulcification ,intraocular lens(IOL) implantation, anterior chamber separating ,and intratunnel trabeculectomy for drug-uncontrollable glaucoma combined with cataract. Methods Vision recovery and intraocular pressure (IOP) controlled effect of52 cases(52 eyes)of drug-uncontrollable glaucoma combined with cataract , which wereperformed phacoemulcification, folded IOL implantation, anterior chamber separating, and intratunnel trabeculectomy from September 2004 through August 2009, were retrospectively analyzed. ResultsThe best corrected visual acuity(BCVA) was improved in 45 eyes(86.54%),but not changed in 8 eyes(13.46%). In 38 eyes followed up, 21/38(55.26%) got the effect of ideal cure, 12/38(31.58%) were standard cured, and 4/38(10.53%) were effective, but 1/38(2.63%)was ineffective, the total effective rate was 97.37%.Conclusion Combined surgery of phacoemulcification , IOL implantation, anterior chamber separating ,and intratunnel trabeculectomy could control IOP and improve visual acuity rapidly., and was effective for drug-uncontrollable glaucoma combined with cataract.
, 百拇医药
[Key words] Cataract ;Glaucoma ;Intraocular pressure(IOP); Multi-surgery ;Anterior chamber angle
青光眼患者视力恢复的程度与高眼压持续的时间和视神经对眼压的耐受性有关,许多青光眼患者药物保守治疗很难奏效,保存视力的最好方法是尽快降低眼压至正常范围,无疑手术是最佳选择。尤其在青光眼合并白内障的患者,选择手术时机、手术方式和减少手术并发症是获得最佳视力的重要保证,我们从04年9月至09年8月,对用药物等难以控制眼压的青光眼伴白内障患者52例52眼实施了白内障超声乳化、房角分离、人工晶体植入合并乳化隧道内小梁切除术的临床效果进行观察,报道如下:
1资料和方法
1.1 临床资料:回顾性分析2004年9月至2009年8月我院收治的药物不能控制眼压的青光眼合并白内障用患者52例52眼,男12例12眼,女40例40眼;年龄65~89岁,平均74.89岁。术前视力:21眼光感,8眼手动,10眼数指,13眼0.01~0.02;其中急性闭角型青光眼45眼,慢性闭角型青光眼7眼;晶状体混浊情况:皮质性36眼,核性7眼,后囊下性5眼,混合性4眼,晶体核硬度Ⅱ-Ⅳ级;术前房角检查因角膜水肿看不清或粘连均>3/4;眼底47眼看不清,5眼视乳头C/D≥0.7;术前24-76小时药物治疗后眼压33-55mmHg,平均45.25±17.20mmHg,中央前房深度平均2.384mm; 43眼瞳孔≥4mm。其中正规用降眼压药物后,眼压不能控制,高眼压持续≤3天手术眼数为46眼,其余均为4天以上手术患者。术后随访时间3-26月,平均11.6月。
, http://www.100md.com
1.2 手术方法:所有患者术前半小时给予20%甘露醇250ml静脉点滴,不散曈,采用球周麻醉或表面麻醉加局部结膜下麻醉,3点透明角膜缘用15°穿刺刀做辅助切口放出少量房水降低眼压,再做上方穹窿部为基底的球结膜瓣,浅层巩膜电凝止血,以角膜缘为基底做4×4mm厚1/2板层巩膜瓣,至角膜后缘时潜行分离至透明角膜1.5mm,用3.0mm刺穿刀进入前房,注入粘弹剂分离虹膜后粘连、扩大瞳孔加深前房,对瞳孔<4mm先用少量付肾素散瞳,连续环形撕囊,水分离核,常规白内障超声乳化人工晶体植入,乳化晶体核时,要提高灌注瓶的高度,低能量高负压,囊带内原位乳化,尤其是闭角性青光眼,前房浅,术中很容易造成内皮损伤,引起术后内皮功能失代偿。植入人工晶体后卡米可林缩瞳,并自术口或辅助口再次注入粘弹剂分离粘连房角,常规在隧道口内做2.0×1.5mm包括小梁在内的深层巩膜切除,宽基底切除根部虹膜组织,前房水置换,10-0尼龙线缝合巩膜瓣2针,辅助切口注入林格液形成前房,并见有水自巩膜瓣流出,球结膜复位缝合2针,庆大霉素2万U、地塞米松2mg球旁注射,包术眼。术后观察最佳矫正视力,裂隙灯显微镜观察角膜、前房、滤过泡,眼底,非接触眼压计测量眼压。记录术后1天、1周、1月、3月、6月、1年眼压。, 百拇医药(李爱芝 孙金阁 吴雨玻)
[关键词] 白内障;青光眼;眼压;多联手术;前房角
[中图分类号]R771 [文献表示码]A [文章编号]
, 百拇医药
Clinical Observation of Multi-surgery for Drug-uncontrollable Glaucoma Combined with Cataract
LI Aizhi,SUN Jinge,Wu Yubo。The Central Hospital of Jiaozhou,Qingdao 266300, Shandong China
[Abstract] Objective To explore the therapeutic effect of phacoemulcification ,intraocular lens(IOL) implantation, anterior chamber separating ,and intratunnel trabeculectomy for drug-uncontrollable glaucoma combined with cataract. Methods Vision recovery and intraocular pressure (IOP) controlled effect of52 cases(52 eyes)of drug-uncontrollable glaucoma combined with cataract , which wereperformed phacoemulcification, folded IOL implantation, anterior chamber separating, and intratunnel trabeculectomy from September 2004 through August 2009, were retrospectively analyzed. ResultsThe best corrected visual acuity(BCVA) was improved in 45 eyes(86.54%),but not changed in 8 eyes(13.46%). In 38 eyes followed up, 21/38(55.26%) got the effect of ideal cure, 12/38(31.58%) were standard cured, and 4/38(10.53%) were effective, but 1/38(2.63%)was ineffective, the total effective rate was 97.37%.Conclusion Combined surgery of phacoemulcification , IOL implantation, anterior chamber separating ,and intratunnel trabeculectomy could control IOP and improve visual acuity rapidly., and was effective for drug-uncontrollable glaucoma combined with cataract.
, 百拇医药
[Key words] Cataract ;Glaucoma ;Intraocular pressure(IOP); Multi-surgery ;Anterior chamber angle
青光眼患者视力恢复的程度与高眼压持续的时间和视神经对眼压的耐受性有关,许多青光眼患者药物保守治疗很难奏效,保存视力的最好方法是尽快降低眼压至正常范围,无疑手术是最佳选择。尤其在青光眼合并白内障的患者,选择手术时机、手术方式和减少手术并发症是获得最佳视力的重要保证,我们从04年9月至09年8月,对用药物等难以控制眼压的青光眼伴白内障患者52例52眼实施了白内障超声乳化、房角分离、人工晶体植入合并乳化隧道内小梁切除术的临床效果进行观察,报道如下:
1资料和方法
1.1 临床资料:回顾性分析2004年9月至2009年8月我院收治的药物不能控制眼压的青光眼合并白内障用患者52例52眼,男12例12眼,女40例40眼;年龄65~89岁,平均74.89岁。术前视力:21眼光感,8眼手动,10眼数指,13眼0.01~0.02;其中急性闭角型青光眼45眼,慢性闭角型青光眼7眼;晶状体混浊情况:皮质性36眼,核性7眼,后囊下性5眼,混合性4眼,晶体核硬度Ⅱ-Ⅳ级;术前房角检查因角膜水肿看不清或粘连均>3/4;眼底47眼看不清,5眼视乳头C/D≥0.7;术前24-76小时药物治疗后眼压33-55mmHg,平均45.25±17.20mmHg,中央前房深度平均2.384mm; 43眼瞳孔≥4mm。其中正规用降眼压药物后,眼压不能控制,高眼压持续≤3天手术眼数为46眼,其余均为4天以上手术患者。术后随访时间3-26月,平均11.6月。
, http://www.100md.com
1.2 手术方法:所有患者术前半小时给予20%甘露醇250ml静脉点滴,不散曈,采用球周麻醉或表面麻醉加局部结膜下麻醉,3点透明角膜缘用15°穿刺刀做辅助切口放出少量房水降低眼压,再做上方穹窿部为基底的球结膜瓣,浅层巩膜电凝止血,以角膜缘为基底做4×4mm厚1/2板层巩膜瓣,至角膜后缘时潜行分离至透明角膜1.5mm,用3.0mm刺穿刀进入前房,注入粘弹剂分离虹膜后粘连、扩大瞳孔加深前房,对瞳孔<4mm先用少量付肾素散瞳,连续环形撕囊,水分离核,常规白内障超声乳化人工晶体植入,乳化晶体核时,要提高灌注瓶的高度,低能量高负压,囊带内原位乳化,尤其是闭角性青光眼,前房浅,术中很容易造成内皮损伤,引起术后内皮功能失代偿。植入人工晶体后卡米可林缩瞳,并自术口或辅助口再次注入粘弹剂分离粘连房角,常规在隧道口内做2.0×1.5mm包括小梁在内的深层巩膜切除,宽基底切除根部虹膜组织,前房水置换,10-0尼龙线缝合巩膜瓣2针,辅助切口注入林格液形成前房,并见有水自巩膜瓣流出,球结膜复位缝合2针,庆大霉素2万U、地塞米松2mg球旁注射,包术眼。术后观察最佳矫正视力,裂隙灯显微镜观察角膜、前房、滤过泡,眼底,非接触眼压计测量眼压。记录术后1天、1周、1月、3月、6月、1年眼压。, 百拇医药(李爱芝 孙金阁 吴雨玻)