【摘要】 目的 探讨同轴1.8 mm微切口白内障超声乳化吸除超薄IOL植入联合小梁切除术治疗青光眼合并白内障的临床疗效和安全性，并与传统同轴3.0 mm小切口超声乳化吸除IOL植入联合小梁切除术进行比较。方法 回顾性病例对照研究。分析2011年10月至2013年10月在内蒙古自治区眼科行超声乳化白内障手术的青光眼合并白内障患者68例（68眼），根据切口大小不同分为2组。小切口组：传统同轴3.0 mm小切口超声乳化吸除植入折叠IOL联合小梁切除术34例。微切口组：同轴1.8 mm微切口白内障超声乳化吸除超薄IOL植入联合小梁切除术34例。术后随访1周、1个月和3个月。检查并记录视力、角膜内皮细胞密度、手术源性散光、眼压、滤过泡的形成和并发症的情况。采用独立样本t检验、重复测量的方差分析和χ2检验对数据进行分析。结果 术后1周，微切口组UCVA优于小切口组（χ2=7.114，P<0.05）。术后1个月和3个月，2组BCVA差异有统计学意义（χ2=8.053、10.532，P＜0.05）。术后1周、1个月、3个月微切口组角膜内皮细胞密度大于小切口组（t=10.254、7.291、9.334，P＜0.05）。术后3个时间点2组的手术源性散光差异有统计学意义（t=9.112、0.732、16.014，P<0.05）。术后2组的眼压均有下降，与术前比较，差异有统计学意义（F=55.934、69.063，P＜0.01）。术后各时间点2组间眼压差异无统计学意义。2组术后滤过泡比较，差异无统计学意义（χ2=0.031，P>0.05）。2组术中均未出现虹膜损伤、后囊膜破裂、前房出血等并发症。结论 同轴1.8 mm微切口白内障超声乳化吸除超薄IOL植入联合小梁切除术与传统同轴3.0 mm小切口超声乳化吸除折叠IOL植入联合小梁切除术相比，能有效减少手术源性散光，是一种有效、安全、便捷的治疗白内障合并青光眼的联合手术。
【关键词】 超声乳化白内障吸除术； 微切口； 青光眼； 小梁切除术
DOI：10.3760/cma.j.issn.1674-845X.2014.08.006
基金项目：内蒙古自治区科技厅科研基金（20130409）
作者单位：010017 呼和浩特，内蒙古自治区眼科（崔巍、路强）；014010 内蒙古包头（刘志英）
通信作者：刘志英，Email：wojiaoanni2008@126.com
Clinical observation of 1.8 mm microincision coaxial phacoemulsification with ultra-thin intraocular lens implantion combined with trabeculectomy
Cui Wei*， Liu Zhiying， Lu Qiang. * Department of Ophthalmology， Inner Mongolia Autonomous Region Hospital， Hohhot 010017， China
Corresponding author：Liu Zhiying，Email：wojiaoanni2008@126.com
【Abstract】 Objective To compare the outcomes of 1.8 mm coaxial microincision phacoemulsification-trabeculectomy with ultra-thin IOL implants compared to 3.0 mm small incision phacoemulsification-trabeculectomy with foldable IOL implantion. Methods In a prospective controlled study， 68 cases of glaucoma and cataract were selected at the Inner Mongolia Autonomous Region People′s Hospital between October 2011 and October 2013. All patients were randomly divided into two groups. In the small incision group， 34 patients underwent 3.0 mm coaxial microincision phacoemulsification-trabeculectomy with foldable IOL implantation； for the microincision group， 34 patients underwent 1.8 mm small incision phacoemulsification-trabeculectomy with ultra-thin IOL implantation. All cases were followed up at 1 week， 1 month and 3 months. Visual acuity， corneal endothelial cell density， surgically induced astigmatism， intraocular pressure， filtering bleb and complications were evaluated. A t-test， repeat measured ANOVA and Pearson′s chi-square test were used to determine statistical differences between the two samples. Results At 1 week postoperatively， visual acuity tended to be better in the microincision group and the difference was significant （χ2=7.114， P<0.05）. At 1 month and 3 months postoperatively， the difference in corrected visual acuity between the 2 groups was statistically significant （χ2=8.053， 10.532， P＜0.05）. At 1 week postoperatively， there was a significant difference in corneal endothelial cell density between the 2 groups （t=10.254， P＜0.05）. This was also true at 1 and 3 months （t=7.291， 9.334， P＜0.05）. At 1 week， 1 month and 3 months postoperatively， there was a significant difference in surgically induced astigmatism between the 2 groups （t=9.112， 10.732， 16.014， P<0.05）. IOP decreased after surgery （F=55.934， 69.063， P＜0.01） but there was no significant difference between the 2 groups. There was also no significant difference in blebs between the 2 groups （χ2=0.031， P>0.05）. No iris injury， posterior capsule rupture or anterior chamber bleeding was found in either group. Conclusion 1.8 mm coaxial microincision phacoemulsification-trabeculectomy with ultra-thin IOL implants can effectively reduce surgically induced astigmatism and is effective， safe， and convenient for treating glaucoma and cataract.
【Key words】 Phacoemulsification； Microincision； Glaucoma； Trabeculectomy
