白内障超声乳化吸除术、后房型人工晶状体植入术联合丝裂霉素C小梁切除术

Combined phacoemulsification, posterior chamber intraocular lens implantation, and trabeculectomy with mitomycin C.

作者信息

Munden P M, Alward W L

机构信息

Department of Ophthalmology, University of Iowa Hospitals and Clinics, Iowa City 52242.

出版信息

Am J Ophthalmol. 1995 Jan;119(1):20-9. doi: 10.1016/s0002-9394(14)73809-7.

DOI:10.1016/s0002-9394(14)73809-7

PMID:7825686

Abstract

PURPOSE

We evaluated the effectiveness of combined phacoemulsification, posterior chamber intraocular lens implantation, and trabeculectomy with mitomycin C in patients with coexisting cataract and glaucoma.

METHODS

We conducted a retrospective review of the records of 21 consecutive patients who had combined phacoemulsification, posterior chamber intraocular lens implantation, and trabeculectomy with mitomycin C. Patients were selected for the combined procedure on the basis of the degree to which intraocular pressure was controlled, toleration of medical therapy, degree of glaucomatous optic nerve damage, and extent of visual impairment because of cataract. Nine (43%) of the 21 patients had previous incisional surgery and were at high risk of surgical failure. All patients had at least six months' follow-up. Sixteen (76%) of 21 patients had at least one year of follow-up.

RESULTS

The mean preoperative intraocular pressure was 20.8 +/- 5.0 mm Hg (range, 13 to 35 mm Hg), which decreased to a mean postoperative intraocular pressure of 15.1 +/- 3.1 mm Hg (range, 9 to 21 mm Hg) as measured at last follow-up (P = .0002). The intraocular pressure was controlled between 6 and 21 mm Hg) in all patients at last follow-up. Seventeen (81%) of 21 patients had a best-corrected visual acuity of 20/40 or better at last follow-up. No patient had a decrease in visual acuity after surgery. Fifteen (71%) of 21 patients were using no antiglaucoma medications at last follow-up. Four of the remaining six patients were using one medication, and two were using two medications. A hyphema (less than 1.0 mm) was seen in seven (33%) of 21 patients and was the most common postoperative complication. No patient had a postoperative wound or bleb leak or a shallow anterior chamber. No patient developed symptomatic hypotony.

CONCLUSIONS

The glaucoma triple procedure with adjunctive mitomycin C appears to be a safe and effective surgical technique for treating selected patients with coexisting cataract and glaucoma.

摘要

目的

我们评估了白内障超声乳化吸除术、后房型人工晶状体植入术联合丝裂霉素C小梁切除术治疗白内障合并青光眼患者的有效性。

方法

我们对21例连续接受白内障超声乳化吸除术、后房型人工晶状体植入术联合丝裂霉素C小梁切除术的患者的记录进行了回顾性分析。根据眼压控制程度、药物治疗耐受性、青光眼性视神经损伤程度以及白内障所致视力损害程度选择患者进行联合手术。21例患者中有9例（43%）曾接受过切口手术，手术失败风险较高。所有患者均至少随访6个月。21例患者中有16例（76%）至少随访1年。

结果

术前平均眼压为20.8±5.0 mmHg（范围13至35 mmHg），最后一次随访时测得术后平均眼压降至15.1±3.1 mmHg（范围9至21 mmHg）（P = 0.0002）。最后一次随访时所有患者眼压均控制在6至21 mmHg之间。21例患者中有17例（81%）最后一次随访时最佳矫正视力达到20/40或更好。术后无患者视力下降。21例患者中有15例（71%）最后一次随访时未使用抗青光眼药物。其余6例患者中有4例使用一种药物，2例使用两种药物。21例患者中有7例（33%）出现前房积血（小于1.0 mm），这是最常见的术后并发症。无患者出现术后伤口或滤过泡渗漏或前房变浅。无患者出现有症状的低眼压。