Jampel Henry D, Friedman David S, Lubomski Lisa H, Kempen John H, Quigley Harry, Congdon Nathan, Levkovitch-Verbin Hani, Robinson Karen A, Bass Eric B
Department of Ophthalmology, Johns Hopkins University, Baltimore, Maryland, USA.
Ophthalmology. 2002 Dec;109(12):2215-24; quiz 2225, 2231. doi: 10.1016/s0161-6420(02)01439-2.
To analyze the literature pertaining to the techniques used in combined cataract and glaucoma surgery, including the technique of cataract extraction, the timing of the surgery (staged procedure versus combined procedure), the anatomic location of the operation, and the use of antifibrosis agents.
Cataract and glaucoma are both common conditions and are often present in the same patient. There is no agreement concerning the optimal surgical management of these disorders when they coexist.
METHODS/LITERATURE REVIEWED: Electronic searches of English language articles published since 1964 were conducted in Pub MED and CENTRAL, the Cochrane Collaboration's database. These were augmented by a hand search of six ophthalmology journals and the reference lists of a sample of studies included in the literature review. Evidence grades (A, strong; B, moderate; C, weak; I, insufficient) were assigned to the evidence that involved a direct comparison of alternative techniques.
The preponderance of evidence from the literature suggests a small (2-4 mmHg) benefit from the use of mitomycin-C (MMC), but not 5-fluorouracil (5-FU), in combined cataract and glaucoma surgery (evidence grade B). Two-site surgery provides slightly lower (1-3 mmHg) intraocular pressure (IOP) than one-site surgery (evidence grade C), and IOP is lowered more (1-3 mmHg) by phacoemulsification than by nuclear expression in combined procedures (evidence grade C). There is insufficient evidence to conclude either that staged or combined procedures give better results or that alternative glaucoma procedures are superior to trabeculectomy in combined procedures.
In the literature on surgical techniques and adjuvants used in the management of coexisting cataract and glaucoma, the strongest evidence of efficacy exists for using MMC, separating the incisions for cataract and glaucoma surgery, and removing the nucleus by phacoemulsification.
分析与白内障合并青光眼手术所采用技术相关的文献，包括白内障摘除技术、手术时机（分期手术与联合手术）、手术的解剖位置以及抗纤维化药物的使用。
白内障和青光眼均为常见病症，且常并存于同一患者。对于这两种疾病并存时的最佳手术治疗方案尚无共识。
方法/文献综述：在PubMed和Cochrane协作网数据库CENTRAL中对自1964年以来发表的英文文章进行电子检索。此外，还手动检索了六种眼科期刊以及文献综述中纳入的部分研究的参考文献列表。对涉及不同技术直接比较的证据赋予证据等级（A，强；B，中等；C，弱；I，不足）。
文献中的大量证据表明，在白内障合并青光眼手术中，使用丝裂霉素-C（MMC）有轻微（2 - 4 mmHg）益处，但使用5-氟尿嘧啶（5-FU）则无此效果（证据等级B）。两点手术比一点手术提供的眼内压（IOP）略低（1 - 3 mmHg）（证据等级C），在联合手术中，超声乳化术降低IOP的幅度比晶状体核挤出术更大（1 - 3 mmHg）（证据等级C）。尚无足够证据得出分期手术或联合手术效果更好的结论，也无法确定在联合手术中其他青光眼手术方法优于小梁切除术。
在关于白内障合并青光眼治疗中所采用手术技术和辅助剂的文献中，使用MMC、将白内障和青光眼手术切口分开以及采用超声乳化术摘除晶状体核的疗效证据最为确凿。
