Ruderman J M, Fundingsland B, Meyer M A
Department of Ophthalmology, North-western University Medical School, Chicago, Illinois 60611-1210, USA.
J Cataract Refract Surg. 1996 Oct;22(8):1085-90. doi: 10.1016/s0886-3350(96)80122-2.
To examine the safety and efficacy of primary combined phacoemulsification, posterior chamber intraocular lens (IOL) implantation, and trabeculectomy with mitomycin-C (0.4 mg/ml) in patients with open-angle glaucoma and visually significant cataract.
University-hospital-based glaucoma referral practice.
In this study, data of 43 patients of a single surgeon were retrospectively analyzed. These consecutive patients had combined phacoemulsification, posterior chamber IOL implantation, and trabeculectomy with mitomycin-C.
Thirty-eight patients (88%) had open-angle glaucoma and 5 (12%) pseudoexfoliative glaucoma. Thirty-eight patients (88%) had 12 months of follow-up; all had at least 6 months follow-up. Mean preoperative intraocular pressure (IOP) was 21.6 mm Hg +/- 6.8 (SD) (range 12.0 to 41.0 mm Hg) with 2.5 +/- 1.0 glaucoma medications. At last follow-up, mean IOP had decreased to 14.2 +/- 6.2 mm Hg (range 3.0 to 40.0 mm Hg) with 0.5 +/- 0.5 glaucoma medications. Twenty-one patients (55%) had an IOP of 15 mm Hg or less at 12 months. Best corrected visual acuity was 20/40 or better in 31 of 43 patients (72%) at last follow-up. A filtration bleb was noted in 33 of 40 patients (83%) at their last visit. Postoperative IOP spikes occurred in 17 patients (40%), transient hyphema in 12 (28%), transient wound leaks in 11 (26%), and superficial punctate keratopathy in 11 (26%). Three cases of persistent hypotony (IOP less than 5 mm Hg) and 1 case of epithelial downgrowth were also noted.
Phacoemulsification with IOL implantation and combined trabeculectomy with mitomycin-C produced good visual acuity and excellent IOP control but resulted in some complications. The use of mitomycin-C in combined procedures does not appear to confer a significant benefit.
探讨原发性白内障超声乳化吸除术、后房型人工晶状体（IOL）植入术联合丝裂霉素C（0.4mg/ml）小梁切除术治疗开角型青光眼合并明显白内障患者的安全性和有效性。
以大学医院为基础的青光眼转诊诊疗机构。
本研究对一名外科医生的43例患者的数据进行回顾性分析。这些连续的患者接受了白内障超声乳化吸除术、后房型IOL植入术联合丝裂霉素C小梁切除术。
38例（88%）为开角型青光眼，5例（12%）为假性剥脱性青光眼。38例（88%）患者随访12个月；所有患者至少随访6个月。术前平均眼压（IOP）为21.6mmHg±6.8（标准差）（范围12.0至41.0mmHg），使用2.5±1.0种青光眼药物。在最后一次随访时，平均IOP降至14.2±6.2mmHg（范围3.0至40.0mmHg），使用0.5±0.5种青光眼药物。21例（55%）患者在12个月时IOP为15mmHg或更低。在最后一次随访时，43例患者中有31例（72%）最佳矫正视力达到20/40或更好。40例患者中有33例（83%）在最后一次就诊时发现滤过泡。术后17例（40%）出现IOP峰值，12例（28%）出现短暂性前房积血，11例（26%）出现短暂性伤口渗漏，11例（26%）出现浅层点状角膜炎。还注意到3例持续性低眼压（IOP低于5mmHg）和1例上皮内生。
白内障超声乳化吸除联合IOL植入术及丝裂霉素C小梁切除术可获得良好的视力和出色的眼压控制，但会导致一些并发症。在联合手术中使用丝裂霉素C似乎并未带来显著益处。
