Efficacy Analysis Of Micro-incision Phacoemulsification And Intraocular Lens Implantation Combind With Trabeculectomy In Tunnel

Objective To observe the clinical efficacy and safety of 2.8mm micro-incision phacoemulsification and intraocular lens(IOL) implantation combined with trabeculectomy in tunnel for the treatment of glaucoma and cataract.And compaird with the clinical efficacy of 5.5mm incision-phacoemulsification and polymethylmethacrylate(PMMA) IOL implantation combined with trabeculectomy in tunnel.Methods:Devided 100 cases (112 eyes) with glaucoma and cataract into group A and group B according to the IOL type selected as the patient ' s wish and economics was foldable IOL or PMMA IOL. In group A ,49 cases (52 eyes) underwent 2.8mm micro-incision phacoemulsification and foldable IOL implantation combined with trabeculectomy in tunnel. and 52 cases (60 eyes) underwent 5.5mm incision phacoemulsification and PMMA IOL implantation combined with trabeculectomy in tunnel in group B.Results:After follow-up 3～6 months all the patients achieved satisfaction with the intraocular pressure(IOP) .In group A the mean postoperative intraocular pressure respectively was(11.24±5.32)mmHg(1mmHg=0.133 KPa),(14.26±3.51)mmHg,(14.13±3.42)mmHg at 1 week,1 month, 3～6months . At the same time in group B the mean IOP respectively was(12.12±5.83)mmHg,(14.12±4.11)mmHg,(14.28±3.51)mmHg.There was no significant difference between two groups(t= 0.830,0.192 ,0.197 p= 0.409 ,0.848 ,0.854). The postoperative IOP at 3～6 months in two groups all convindencly reduced than preoprative IOP(p<0.05).Postoperatively , the visual acuities were≥0.6 in 40 eyes(76.9%) in group A and 31 eyes(51.6%) in group B at 1 week, there was significant difference between two groups (χ2=7.657,P=0.006). The mean preoperative astigmatism and mean postoperative astigmatism at 1 month, 3～6months respectively was (1.04±0.44)D, (1.12±0.50)D, (1.08±0.52)D, there was no significant difference in the mean preoperative astigmatism and postoperative astigmatism at 1 month, 3～6 months. The mean astigmatism in group B at the same time with group A respectively was(1.01±0.45)D,(1.33±0.47)D,(0.98±0.51)D,There was significant difference between the mean preoperative astigmatism and postoperative astigmatism at 1 month (q=5.193,P<0.01)and no significant difference between postoperative astigmatism at 3～6months and the mean preoperative astigmatism(q=0.487,P>0.05).The filtering blebs of typeⅠ,Ⅱ(functional) by Kronfeld′s classification presented in 80.7% of 42 eyes and typeⅢ(non- functional) in 19.2% of 10 eyes in group A.And in group B the filtering blebs of typeⅠ,Ⅱ(functional) presented in 78.3% of 47 eyes and typeⅢ(non- functional) in 21.6% of 13 eyes.There was no significant difference between preoperative retinal nerve fiber layer (RNFL) and postoperative RNFL at 3～6 months.The every quadrant RNFL were detected through optical coherence tomography(OCT).Conclusion The combined surgery of trabeculectomy in tunnel and micro-incision phacoemulsification and foldable IOL implantation is a safe and effective surgery for patients with cataract and glaucoma.This combined surgery can improve visual acuity and control IOP with good recovery.