Wyse T, Meyer M, Ruderman J M, Krupin T, Talluto D, Hernandez R, Rosenberg L F
Glaucoma Service, Department of Ophthalmology, Northwestern University Medical School, Chicago, Illinois 60611, USA.
Am J Ophthalmol. 1998 Mar;125(3):334-9. doi: 10.1016/s0002-9394(99)80143-3.
To compare the results of combined trabeculectomy and phacoemulsification surgery with intraocular lens implant by means of a one-site vs a two-site approach.
Glaucomatous patients with a coexisting cataract were randomly assigned to undergo either a one-site or two-site combined procedure. One-site surgery was performed with a limbus-based conjunctival flap and scleral tunnel at the 12-o'clock position. Two-site surgery was performed with a limbus-based conjunctival flap for the trabeculectomy in the superior nasal quadrant and a temporal clear cornea incision for phacoemulsification. Mitomycin C (0.4 mg/ml for 2 minutes) was applied to the scleral surface at the trabeculectomy site for both approaches. All patients received intraocular lens implants at the time of combined surgery.
Thirty-three eyes of 33 patients were included in this study. Preoperative intraocular pressure and number of glaucoma medications were similar in the two groups. Corrected visual acuity improved similarly in both groups. Intraocular pressure decreased in both groups at last follow-up but was not significantly different (P = .129) between the one-site and two-site groups. At last follow-up, the one-site group required significantly more (P = .030) medications than did the two-site group.
Combined trabeculectomy and phacoemulsification surgery in which one-site and two-site techniques were used yielded similar improvements in corrected visual acuity and intraocular pressure reduction. However, the one-site group required more medication to maintain intraocular pressure control than did the two-site group.
通过单切口与双切口方法比较小梁切除术联合白内障超声乳化吸除及人工晶状体植入术的效果。
将合并白内障的青光眼患者随机分为接受单切口或双切口联合手术。单切口手术在12点位置制作以角膜缘为基底的结膜瓣和巩膜隧道。双切口手术在鼻上象限制作以角膜缘为基底的结膜瓣用于小梁切除术，在颞侧透明角膜做切口用于白内障超声乳化吸除。两种方法均在小梁切除部位的巩膜表面应用丝裂霉素C（0.4mg/ml，2分钟）。所有患者在联合手术时植入人工晶状体。
本研究纳入了33例患者的33只眼。两组患者术前眼压和青光眼用药数量相似。两组矫正视力改善情况相似。最后一次随访时两组眼压均下降，但单切口组和双切口组之间差异无统计学意义（P = 0.129）。最后一次随访时，单切口组所需药物显著多于双切口组（P = 0.030）。
采用单切口和双切口技术的小梁切除术联合白内障超声乳化吸除术在矫正视力改善和眼压降低方面效果相似。然而，单切口组比双切口组需要更多药物来维持眼压控制。
