超声乳化术联合23 G前部玻璃体切除术治疗白内障继发青光眼

摘要

Objective To investigate the clinical efficacy of single channel 23G minimally invasive anterior vitrec-tomy combined with phacoemulsification and foldable lens implantation in the treatment of secondary glaucoma due to intu-mescent cataract.Methods Totally 29 eyes of secondary glaucoma due to intumescent cataract with uncontrolled intraocu-lar pressure ( IOP) after 3 to 5 days of medication treatment were studied.These patients were treated with single channel 23G minimally invasive anterior vitrectomy in order to lower the IOP.Phacoemulsification and foldable intraocular lens im-plantation followed vitrectomy.After 6 months to 1 year, pre-and postoperative visual acuity, anterior chamber depth and angle opening degree were analyzed.Results All surgeries were successfully completed.There was no serious complica-tion observed during and after surgery.Best corrected visual acuity improved in 26 eyes (89.6%):it was 0.1~0.8 in 27 eyes and <0.1 in 2 eyes.IOP was 35.8~47.5 mmHg before the surgery, and reduced to 13.5~28.9 mmHg after the surgery.IOP was controlled within the normal range in 3 eyes by medication ( P <0.01).Anterior chamber depth was 1.193 ±0.265 mm before the surgery, and increased to 3.082 ±0.345 mm after the surgery.This change was significant ( P <0.01).Anterior chamber angle was widened or partially opened in all patients after the surgery.Conclusion Phacoe-mulsification and foldable lens implantation combined with 23G minimally invasive anterior vitrectomy is an effective method to treat secondary glaucoma due to intumescent cataract.%目的：探讨应用23G微创单通道前部玻璃体切除后行超声乳化并人工晶状体植入治疗膨胀期白内障继发青光眼的手术特点和效果。方法分析药物治疗3～5 d眼压未能控制正常的29例（29只眼）膨胀期白内障继发青光眼的患者，先行23G微创单通道前部玻璃体切除，然后行超声乳化并人工晶状体植入治疗膨胀期白内障继发青光眼。术后随访6个月至1年，对比术前术后视力、眼压、前房深度和房角开放范围。结果手术均顺利，所有患者均未发生严重并发症，术后最佳矫正视力明显提高26只眼（89．6％），其中0．1～0．8者27只眼，＜0.1者2只眼。术前眼压（35．8～47．5）mmHg，术后眼压（13．5～28．9）mmHg。26只眼术后眼压控制在正常范围，3只眼经药物治疗均可达到正常范围（ P ＜0．01）。术前前房深度平均为（1．193±0．265）mm，术后平均为（3．082±0．345） mm，前房深度较术前明显加深，术前术后对比差异有统计学意义（ P ＜0．01）。所有患者术前狭窄的房角术后均增宽，房角检查见关闭的房角部分开放。结论白内障超声乳化并人工晶状体植入联合23G微创前部玻璃体切除治疗膨胀期白内障继发青光眼更安全、有效。