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目的 述用隧道切口施行青光眼术后白内障摘除的方法和优点。方法 以滤枕位置情况选以9点或10点时钟位为中心的结膜切开,止血;做角膜缘后2mm反眉形半层切口做隧道于透明角膜内1.5mm进入前房,注入粘弹剂后检查瞳孔小于3mm不能散开者做瞳孔缘放射形剪开;伴虹膜后粘连者在注射粘弹剂的同时用粘弹剂针头平扫式分离或用囊膜剪剪开。撕囊或开罐式破囊;水分离,粘弹剂针头挠核使核脱位,将粘弹剂注射于核后,扩大切口至6～7mm,圈匙进入核后套出晶体核,注吸皮质至眼内透明,视手术前计划植入人工晶体或不植,从侧切口向前房内注入注吸液关闭隧道切口,结膜切口区结膜下注射庆大霉素2万U,地塞米松2mg使结膜水肿向前推移覆盖隧道外口。结果 手术31眼,术中注吸皮质时后囊破裂1眼,为3.22％。手术后眼压无升高。结论 对于青光眼手术后白内障患者应用避开滤枕做9～10点位隧道切口完成白内障手术,其优点为不损伤滤枕,术后不影响眼压,与传统术式相比手术简单,隧道切口和结膜切口皆不缝合,减少了手术后散光发生和减少了手术程序,可以在临床推广应用。
Objective To describe the methods and advantages of cataract extraction with glaucoma after tunnel incision. Methods The situation of the filter pillow to choose 9 o’clock or 10 o’clock clock as the center of the conjunctiva incision, hemostasis; do 2mm anti-ophthalmic incision after half-incision tunnel made in the transparent cornea 1.5mm into the anterior chamber, into the viscoelastic After the examination of the pupil dose less than 3mm can not be scattered to do the pupil margin radial cut; with iris posterior adhesions in the injection of viscoelastic at the same time with the viscoelastic needle flat sweep separation or capsule cut open. Capsulorhexis or open cans ruptured the bladder; water separation, viscoelastic needle core to nuclear dislocation, the viscoelastic injected in the nucleus, the expansion of the incision to 6 ~ 7mm, the ring into the nucleus after the set out of the crystal nucleus, the suction Cortex to the eye transparent, depending on the plan before surgery, intraocular lens implantation or implants, injection into the anterior chamber from the side of the injection of liquid injection to close the tunnel incision, conjunctival incision area injection of gentamicin 20,000 U, dexamethasone 2mg of conjunctival edema to move forward cover the tunnel mouth. Results 31 cases of surgery, intraoperative cessation of injection of cortical rupture of the posterior capsule, 3.22%. No intraocular pressure elevation after surgery. Conclusions For cataract patients after glaucoma surgery, cataract surgery should be performed with 9-10 points of tunnel filter avoiding the filter pillow. The advantage of this method is that it does not damage the filter and does not affect the intraocular pressure. Compared with the conventional operation, the operation is simple and the tunnel incision And conjunctival incision are not suture, reducing the incidence of postoperative astigmatism and reduce the surgical procedures, can be popularized in clinical applications.