不同手术方式治疗新生血管性青光眼的疗效观察

发布时间：2018-01-03 00:19

本文关键词：不同手术方式治疗新生血管性青光眼的疗效观察　出处：《昆明医科大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的：本文比较Ex-press青光眼引流器植入术和小梁切除术+睫状体冷凝术治疗新生血管性青光眼的疗效,从而探索NVG的最佳治疗方案。方法：选择2012.1-2014.12于昆明医科大学第一附属医院眼科住院治疗的新生血管性青光眼患者,共48例(51只眼),所有患者均给予经睫状体平坦部玻璃体腔注射Lucentis0.1ml(1.0mg)。注药3-5天后,根据不同的手术方式将其分为两组：A组(Ex-press青光眼引流器植入术组)：23例26眼,行Ex-press青光眼引流器植入术；B组(小梁切除术+睫状体冷凝术组)：25例25眼,行小梁切除术+睫状体冷凝术。观察比较两组手术前至术后1周、1月、3月、6月,分别记录两组的平均眼压、视力、使用抗青光眼药物数量、手术成功率(完全成功和部分成功的人数占各组总人数的比例)、并发症情况,并进行两组间比较。结果：1.两组术后1周、1月、3月、6月的平均眼压较术前明显降低,其中A组分别降低29.93mmhg,31mmhg,31.66mmhg,31.62mmhg;B组分别降低22.64mmhg,23.6 mmhg,24.2mmhg,26.16mmhg。差异有统计学意义(P0.001)。2.A组较B组术后1周、1月、3月的平均眼压高,分别高5.46mmhg,5.57mmhg, 5.63mmhg。差异有统计学意义(P0.05)。A组与B组术后6月平均眼压分别为14.73±5.02,18mmhg.36±10.23mmhg,B组较A组高3.63mmhg。差异无统计学意义(P=0.1)。3.两组术后使用降眼压药物的数量分别为0.42±0.95,1.24±1.64,较术前使用的降眼压药物数量明显减少,差异有统计学意义(P0.001)。两组间相比,A组较B组术后使用降眼压药物的数量少0.82种,差异有统计学意义(t=2.1681,P=0.03647)。4.两组成功率分别为88.5%,60.0%。A组较B组手术成功率高,差异有统计学意义(x 2=6.7436,P=0.009)。5.两组术后并发症分别进行对比,总的并发症发生率分别为19.2%,60.0%。B组总的并发症发生率明显高于A组,差异有统计学意义(P=0.006)。其中前房出血的发生率分别为7.7%,32.0%,B组明显高于A组,差异有统计学意义(P=0.02)。两组间浅前房、低眼压、前房渗出、脉络膜脱离、眼球萎缩的发生率比较无统计学差异(P0.05)结论：1.Ex-press青光眼引流器植入术和小梁切除术+睫状体冷凝术对于治疗NVG均有显著效果。2.Ex-press青光眼引流器植入术降眼压效果更好,手术成功率高,且操作简单,术后用药少,术后并发症少,视力维持好,对于有一定视功能的患者是一种较为安全有效的治疗方法。3.小梁切除术+睫状体冷凝术是一种破坏性手术,术后并发症多,但操作简单,可多次进行,只要严格掌握适应症,冷冻量适度,不失为新生血管性青光眼的治疗选择之一。
[Abstract]:Objective: To compare the efficacy of Ex-press glaucoma drainage device implantation and trabeculectomy combined with cyclocryotherapy for neovascular glaucoma, so as to explore the best treatment of NVG. Methods: 2012.1-2014.12 in the First Affiliated Hospital of Kunming Medical University hospital treatment of patients with neovascular glaucoma, 48 cases (51 eyes) and all the patients were treated with pars plana intravitreal injection of Lucentis0.1ml (1.0mg). 3-5 days after injection, according to the different operation mode will be divided into two groups: group A (Ex-press glaucoma drainage device implantation group):23 cases 26 eyes underwent Ex-press glaucoma drainage device implantation; group B (small trabeculectomy + CYCLOCRYOSURGERY group):25 cases 25 eyes underwent trabeculectomy + CYCLOCRYOSURGERY. The two groups were observed and compared before surgery to 1 weeks after surgery, January, March, June, the average intraocular pressure were recorded, two groups of the vision, the With the number of anti glaucoma drugs, surgical success rate (complete success and success ratio of the number of the total number of groups), complications, and compared between the two groups. Results: 1. of the two groups after 1 weeks, January, March, June the average IOP decreased significantly in the A group, respectively. 29.93mmhg, 31mmhg, 31.66mmhg, 31.62mmhg; group B were reduced by 22.64mmhg, 23.6 mmHg, 24.2mmhg, 26.16mmhg. difference was statistically significant (P0.001) in.2.A group than in B group after 1 weeks of operation, in January March, the average intraocular pressure were high, high 5.46mmhg, 5.57mmhg, there were significant differences in 5.63mmhg. (P0.05).A group and B group after June the average IOP was 14.73 + 5.02,18mmhg.36 + 10.23mmhg, B group was higher than A group 3.63mmhg. showed no significant difference (P=0.1).3. two group after use number of hypotensive drugs were 0.42 + 0.95,1.24 + 1.64, compared with the preoperative IOP drug use quantity obviously Reduce, the difference was statistically significant (P0.001). Compared between the two groups, A group than in B group after the IOP drug of the number of 0.82, the difference was statistically significant (t=2.1681, P=0.03647).4. two group success rate was 88.5%, 60.0%.A group compared with B group, the success rate is high, the difference was statistically significant (x 2=6.7436, P=0.009.5.) postoperative complications of two groups were compared. The total complication rate was 19.2%, 60.0%.B group the overall complication rate was significantly higher than A group, the difference was statistically significant (P=0.006). The anterior chamber hemorrhage rate respectively is 7.7%, 32%, B group was significantly higher than that of A group, the difference was statistically significant (P=0.02). Among the two groups of shallow anterior chamber, low intraocular pressure, anterior chamber exudation, choroidal detachment, eyeball atrophy rate had no significant difference (P0.05) conclusion: 1.Ex-press glaucoma drainage device implantation and trabeculectomy + CYCLOCRYOSURGERY for treatment NVG treatment had a significant effect of.2.Ex-press glaucoma drainage device implantation intraocular pressure lowering effect is better, the success rate is high, and has the advantages of simple operation, less postoperative medication, less postoperative complications, maintain good eyesight, for a visual function in some patients is a safe and effective treatment method for.3. trabeculectomy + ciliary body cryotherapy is a destructive operation, postoperative complications, but the operation is simple, can be repeated, as long as the indications, frozen in moderation, one choice is the treatment of neovascular glaucoma.

【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R779.6

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