手法小切口白内障术联合小梁切除治疗POAG合并白内障

摘要

AIM: Cataract surgery techniques have improved a lot over the years. The present study was designed to propose a novel and surgically easy technique of 'in the tunnel' trabeculectomy with lesser incidence of complications in the management of cataract with primary open angle glaucoma (POAG). METHODS: One hundred and three patients were included in a prospective, nonrandomized clinical study. 108 eyes of 103 patients with POAG and cataract were performed manual small incision cataract surgery (MSICS) combined with 'in the tunnel' trabeculectomy. The outcome of the surgery was evaluated in terms of the anatomical appearance of the bleb and its functional result over a period of 6 months.RESULTS: The mean intraocular pressure (IOP) on the first postoperative day was 11.4±3.1mmHg in the tunnel incision group (P=0.012). On the second postoperative day the mean IOP was 10.3±3.5mmHg (P =0.065). Shallow anterior chamber and iridocorneal touch occurred significantly less in the tunnel incision group. CONCLUSION: "Scleral tunnel incision"-trabeculectomy (STIT) appears to be steady lowering IOP during the first 6 months postoperatively. It is also relatively safe and has fewer early complications related to excessive aqueous outflow than conventional trabeculectomy (CT).%目的:白内障手术技术在近年已经得到了很大提高.本文提出了一项创新且操作简便的隧道内小梁切除术,并发症少,用于治疗白内障合并原发性开角型青光眼(primary open angle glaucoma,POAG).方法:对于纳入该前瞻性、非随机性临床研究的103例108眼白内障合并POAG患者行手法小切口白内障手术(manual small incision cataract surgery,MSICS)联合隧道内小梁切除术.随访6mo,依据气泡的解剖学外形及其功能对手术疗效进行评估.结果:术后第1d,隧道内切口组的平均眼压(intraocular pressure,IOP)为11.4±3.1mmHg(P=0.012),术后第2d的平均IOP为10.3±3.5mmHg (P=0.065).隧道内切口组的浅前房和虹膜角膜接触明显减少.结论:巩膜隧道切口小梁切除术("scleral tunnel incision"-trabeculectomy,STIT)的眼压在术后6mo平稳降低.STIT相对安全,类似过多房水外流的早期并发症比传统小梁切除术(conventional trabeculectomy,CT)少.