俞臻　杨卫华

[摘要] 目的 观察青光眼滤过手术后白内障患者行透明角膜微切口白内障超声乳化术的临床效果。方法 回顾性分析我院2015年1月～2016年6月收治的青光眼小梁切除术后白内障患者32例（48眼），行颞上象限角膜遂道微切口白内障超声乳化联合人工晶状体植入术，随访3～6个月，观察视力、前房深度、眼压等情况。结果 患者32例（48眼）术后视力恢复较满意，48眼术后随访矫正视力为0.3～0.8，较术前均有不同程度提高，差异有统计学意义（P<0.05）。术后眼压稳定，平均眼压（14.13±3.42）mmHg（1 mmHg=0.133 kPa）。术后前房深度（3.4±0.6）mm，高于术前（2.5±0.4）mm，差异有统计学意义（P<0.05）。结论 微切口超声乳化联合人工晶体植入术治疗青光眼小梁切除术后并发性白内障效果良好，可提高视力，同时保持滤过泡功能，眼压维持正常。

[关键词] 青光眼；白内障；超声乳化；人工晶状体

[中图分类号] R779.6 [文献标识码] B [文章编号] 1673-9701（2017）19-0069-03

[Abstract] Objective To observe the clinical effect of transparent corneal micro-incision cataract phacoemulsification in patients with cataract after glaucoma filtering surgery. Methods A total of 32 cases（48 eyes） of patients with cataract after glaucoma trabeculectomy treated in our hospital from January 2015 to June 2016 were retrospectively analyzed. The patients underwent temporal upper quadrant corneal tunnel micro-incision cataract phacoemulsification combined with intraocular lens implantation，and then were followed up for 3-6 months. The vision， anterior chamber depth， intraocular pressure and so on were observed. Results The vision recovery of 32 patients （48 eyes） was satisfactory after eye surgery. The corrected visual acuity of 48 eyes was 0.3-0.8 during postoperative follow-up， which was significantly improved than before surgery. The difference between before and after treatment was statistically significant（P<0.05）. Postoperative intraocular pressure was stable， with the average intraocular pressure of（14.13±3.42） mmHg（1 mmHg=0.133 kPa）. The postoperative anterior chamber depth was （3.4±0.6） mm， higher than before surgery （2.5±0.4） mm， and the difference was statistically significant（P<0.05）. Conclusion Micro-incision phacoemulsification combined with intraocular lens implantation for the treatment of concurrent cataract after glaucoma trabeculectomy has good effect， which can improve vision and maintain the function of filter bleb， and can also keep intraocular pressure normal.

[Key words] Glaucoma； Cataract； Phacoemulsification； Intraocular lens

白內障是由各种原因引起的晶状体代谢紊乱，从而引起晶状体蛋白质变性出现混浊。青光眼常需要手术治疗，由于手术原因，极易导致术后晶状体代谢紊乱，因此青光眼术后常发生白内障。相对于普通的老年性白内障，青光眼术后并发白内障出现的时间更早，核更硬，有前房浅、瞳孔小、虹膜后粘连、瞳孔变形等复杂的特点，同时晶体悬韧带更脆弱，角膜内皮更易受损，使行白内障超声乳化手术的风险大大增加[1]。以往采用常规切口治疗，不仅对眼球损伤较大，而且在娩核时由于虹膜常有粘连或弹性差，核不易娩出，并且可能出现出血、虹膜撕裂、脱出、后囊破裂等并发症。术后手术源性散光也大，视力恢复较差。随着生物医学的发展，各种治疗青光眼术后白内障的方法不断出现，超声乳化术正是其中的代表。本文总结我科2015年1月～2016年6月对32例（48眼）抗青光眼术后并发白内障的患者行透明角膜微切口超声乳化联合人工晶体植入手术，并对手术方法进行探讨。……