Kosmin A S, Wishart P K, Ridges P J
St. Paul's Eye Unit (8Z LINK), Royal Liverpool University Hospital, United Kingdom.
J Cataract Refract Surg. 1997 Jan-Feb;23(1):97-105. doi: 10.1016/s0886-3350(97)80158-7.
To compare the outcome of phacotrabeculectomy with silicone or poly(methyl methacrylate) (PMMA) intraocular lens (IOL) implantation over the first year.
Glaucoma Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom.
Two consecutive groups of 30 eyes each had phacotrabeculectomy with implantation of a foldable, plate-haptic silicone IOL (3.2 mm wide incision) or a PMMA IOL (5.2 mm wide incision) with a loosely or tightly sewn scleral flap, respectively. Early postoperative results and outcomes up to a mean of 1 year postoperatively in both groups were compared.
In the early postoperative period, eyes in the silicone IOL group had a lower incidence of postoperative intraocular pressure (IOP) spikes (more than 30 mm Hg) than those in the PMMA IOL group (two and six cases, respectively) but also showed an increase (eight and three cases, respectively) in incidence of ocular hypotony (less than 8 mm Hg). There was also an increased incidence, although not statistically significant, of early postoperative complications in the silicone group; for example, fibrinous reaction in the anterior chamber (26.6 versus 10.0%; P = .18), shallow anterior chamber (16.6 versus 3.3%, P = .20), and choroidal detachment (16.6 versus 3.3%, P = .20). These complications, often associated with ocular hypotony, resolved quickly without serious sequelae. One year after surgery, IOP control (less than 22 mm Hg) was attained without medication in 80.0% in the silicone group and 76.7% in the PMMA group (P = 1.00), and corrected visual acuity of 20/40 or better was attained in 70.0% in the silicone group and 73.3% in the PMMA group (P = 1.00).
The loosely sutured flap in the silicone group resulted in fewer early pressure spikes but at a cost of an increase in early postoperative hypotony with its associated complications. One year after surgery, there was no significant difference between the two groups in IOP control or visual acuity, showing that both procedures were effective in the surgical management of patients with cataract and glaucoma.
比较白内障超声乳化小梁切除术联合植入硅胶或聚甲基丙烯酸甲酯（PMMA）人工晶状体（IOL）在术后第一年的效果。
英国利物浦皇家利物浦大学医院青光眼科。
连续两组，每组30只眼，分别行白内障超声乳化小梁切除术，一组植入可折叠、平板襻硅胶人工晶状体（切口宽3.2mm），另一组植入PMMA人工晶状体（切口宽5.2mm），巩膜瓣分别采用宽松或紧密缝合。比较两组术后早期结果及术后平均1年的效果。
术后早期，硅胶人工晶状体组术后眼压（IOP）峰值（超过30mmHg）的发生率低于PMMA人工晶状体组（分别为2例和6例），但低眼压（低于8mmHg）的发生率有所增加（分别为8例和3例）。硅胶组术后早期并发症的发生率也有所增加，尽管无统计学意义；例如，前房纤维蛋白反应（26.6%对10.0%；P = 0.18）、浅前房（16.6%对3.3%，P = 0.20）和脉络膜脱离（16.6%对3.3%，P = 0.20）。这些并发症常与低眼压相关，可迅速缓解，无严重后遗症。术后1年，硅胶组80.0%的患者无需药物治疗眼压得到控制（低于22mmHg），PMMA组为76.7%（P = 1.00）；硅胶组70.0%的患者矫正视力达到20/40或更好，PMMA组为73.3%（P = 1.00）。
硅胶组巩膜瓣宽松缝合导致早期眼压峰值较少，但代价是术后早期低眼压及其相关并发症增加。术后1年，两组在眼压控制或视力方面无显著差异，表明两种手术方法对白内障合并青光眼患者的手术治疗均有效。
