Dickens M A, Cashwell L F
Department of Ophthalmology, Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, NC, USA.
Ophthalmic Surg Lasers. 1996 Jan;27(1):9-14.
For patients with advanced glaucoma, care must be taken in the management of cataract to prevent loss of long-term intraocular pressure (IOP) control. The authors evaluated the effect of extracapsular cataract extraction (ECCE) with posterior chamber intraocular lens (PC IOL) implantation via the inferotemporal limbal approach on the function of an established glaucoma filtering bleb.
Twenty-three eyes of 21 patients with a minimum of 48 months of follow-up (range 48 to 97 months) were retrospectively evaluated. IOP, bleb status, visual field, and visual acuity were compared before and after operation.
Average IOP increased from 8.7 mm Hg preoperatively to 12.2 mm Hg at last follow-up. Six blebs (26.1%) decreased in size, 11 (47.8%) did not change, 4 (17.4%) increased in size, and 2 (8.7%) were lost and required refiltration. At last follow-up, 23 eyes had an IOP of less than 20 mm Hg and did not show progression of glaucoma damage by optic disc or visual field evaluation. Six eyes required resumption of medical therapy and 2 eyes required refiltration for adequate control.
ECCE with PC IOL implantation via the inferotemporal limbal approach in the presence of an established filtering bleb is effective in the long-term management of the glaucomatous eye with cataract.
对于晚期青光眼患者，在白内障治疗过程中必须小心谨慎，以防止长期眼压（IOP）控制的丧失。作者评估了经颞下周边角膜缘入路行白内障囊外摘除术（ECCE）联合后房型人工晶状体（PC IOL）植入对已建立的青光眼滤过泡功能的影响。
对21例患者的23只眼进行回顾性评估，随访时间至少48个月（范围48至97个月）。比较手术前后的眼压、滤过泡状态、视野和视力。
平均眼压从术前的8.7 mmHg升至最后一次随访时的12.2 mmHg。6个滤过泡（26.1%）变小，11个（47.8%）无变化，4个（17.4%）变大，2个（8.7%）消失并需要再次滤过。在最后一次随访时，23只眼的眼压低于20 mmHg，经视盘或视野评估未显示青光眼损害进展。6只眼需要恢复药物治疗，2只眼需要再次滤过来实现充分控制。
对于已有滤过泡的青光眼患者，经颞下周边角膜缘入路行ECCE联合PC IOL植入对青光眼合并白内障的长期治疗有效。
