Ex-PRESS引流钉植入术治疗青光眼的短期疗效观察

发布时间：2018-03-16 18:12

本文选题：青光眼　切入点：Ex-PRESS　出处：《南昌大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的:观察Ex-PRESS引流钉植入术在青光眼的治疗中的短期疗效及并探讨其安全性。方法:1研究对象为我院原发性开角型青光眼患者,其中行Ex-PRESS引流钉植入术为15例23眼(引流钉组),行小梁切除术为16例26眼(小梁切除组),分别收集两组术后1天、3天、1周、2周、1月、2月、3月、6月的视力、眼压、并发症、使用降眼压药物的情况以及手术成功率,对其结果进行比较分析。手术成功标准为眼压较术前下降20%或眼压位于5mm Hg与20mm Hg之间。2研究对象为我院行Ex-PRESS引流钉植入术的特殊类型青光眼患者(18例20眼),收集术后1天、3天、1周、2周、1月、2月、3月、6月的视力、眼压、并发症以及使用降眼压药物的情况,将结果与术前比较,分析其手术效果。纳为本研究的特殊类型青光眼包括先天性青光眼,色素性青光眼,新生血管性青光眼,假性剥脱综合征,葡萄膜炎继发性青光眼,激素性青光眼,抗青光眼手术失败的青光眼,外伤性青光眼以及人工晶体植入术后青光眼;手术成功标准为眼压较术前下降20%或眼压处于5mm Hg与20mm Hg之间。结果:1引流钉组术后视力与术前相比,术后1天、3天、1周、2周具有显著性差异(p0.05),比术前降低,1月视力恢复,与术前比较无统计学差异(p0.05);小梁切除组术后视力与术前相比,术后1天、3天、1周、2周、1月具有显著性差异(p0.05),明显比术前视力降低,2月视力恢复,与术前相比无统计学意义(p0.05);引流钉组与小梁切除组两组视力术后各个时间点相比无统计学差异(p0.05)。引流钉组与小梁切除组术后眼压与术前相比,1天、3天、1周、2周、1月、2月、3月、6月眼压具有显著性差异(p0.05),明显比术前眼压降低。引流钉组与小梁切除组术后眼压两组相比,各个时间点皆无显著性差异(p0.05)。术后6月两组成功率相比无显著性差异(p0.05)。引流钉组出现并发症的为3眼(浅前房1眼,引流钉入口虹膜堵塞1眼,暂时性高眼压1眼),小梁切除组并发症为12眼(浅前房6眼,前房积血4眼,暂时性高眼压1眼,滤过泡渗漏1眼)。两组并发症比较,具有统计学意义(p0.05),引流钉组并发症较小梁切除组少。2引流钉治疗特殊类型青光眼术后视力与术前相比,术后1天、3天、1周、2周、1月与术前相比具有统计学差异(p0.05),视力下降,2月视力恢复,与术前相比无统计学差异(p0.05);术后眼压与比术前相比明显降低,具有统计学差异(p0.05);术后并发症发生共6眼(33%),包括浅前房合并脉络膜脱离1眼,浅前房3眼,后弹力层脱离1眼,前房积血1眼。手术完全成功17眼(85%),条件成功1眼(5%),术后眼压失控2眼(10%)。结论:对于原发性开角型青光眼及其他特殊类型青光眼的治疗,Ex-PRESS引流钉植入术短期降眼压的效果显著;并且在治疗原发性开角型青光眼方面,Ex-PRESS引流钉植入术与小梁切除术术后降眼压效果、视力、手术成功率无显著性差异,但Ex-PRESS引流钉植入术后视力恢复较快,且并发症发生较小梁切除术少。
[Abstract]:Objective: to observe the short-term efficacy and safety of Ex-PRESS drainage nail implantation in the treatment of glaucoma. Ex-PRESS drainage nail implantation was performed in 15 cases (23 eyes) (drainage nail group) and trabeculectomy group (16 cases 26 eyes) (trabeculectomy group). The visual acuity, intraocular pressure and complications were collected from two groups respectively. The use of IOP drugs and the success rate of the operation, The results were compared and analyzed. The successful standard of operation was that IOP decreased by 20% or IOP was located between 5mm Hg and 20mm Hg. 18 cases (20 eyes) of glaucoma with special type glaucoma underwent Ex-PRESS drainage nail implantation were treated with intraocular pressure reduction or intraocular pressure (IOP) between 5 mm Hg and 20 mm Hg. Visual acuity was observed 1 day, 3 days, 1 week, 2 weeks, January, February, March, March, Intraocular pressure (IOP), complications and the use of intraocular pressure lowering drugs (IOP) were compared with those before surgery. The special types of glaucoma in this study included congenital glaucoma, pigmented glaucoma, neovascularization glaucoma. Pseudoexfoliation syndrome, secondary uveitis glaucoma, hormone glaucoma, glaucoma with failed glaucoma surgery, traumatic glaucoma and glaucoma after intraocular lens implantation; The successful standard of operation was that the intraocular pressure was 20% lower than that before operation or the intraocular pressure was between 5 mm Hg and 20 mm Hg. Results compared with preoperative visual acuity, the postoperative visual acuity of the group treated with 1: 1 drainage nail was significantly different from that of preoperative 1 day and 1 week and 2 weeks after operation, which was lower than that before operation, and the visual acuity recovered in January. The visual acuity of trabeculectomy group was significantly lower than that of preoperative visual acuity, and the visual acuity of trabeculectomy group was significantly lower than that of preoperative visual acuity in February, and the visual acuity of trabeculectomy group was significantly lower than that of pre-operation group, and the visual acuity of trabeculectomy group was significantly lower than that of preoperative visual acuity. There was no significant difference in postoperative visual acuity between the drainage nail group and trabeculectomy group (p 0.05). The intraocular pressure of drainage nail group and trabeculectomy group was significantly higher than that of preoperative group (P 0.05). The intraocular pressure of drainage nail group and trabeculectomy group was 1 day after operation. On February, March, June, IOP was significantly lower than that of preoperative IOP. The intraocular pressure in the drainage nail group and trabeculectomy group was significantly lower than that in the trabeculectomy group, and the intraocular pressure was significantly lower in the drainage nail group than in the trabeculectomy group. There was no significant difference at all time points (p0.05). There was no significant difference in the success rate between the two groups on June. Complications occurred in 3 eyes in the drainage nail group (1 eye in the shallow anterior chamber, 1 eye in the inlet of the drainage nail, 1 eye in the iris obstruction at the entrance of the drainage nail), and there was no significant difference in the success rate between the two groups on June. The complications of trabeculectomy group were 12 eyes (6 eyes with shallow anterior chamber, 4 eyes with hyphema, 1 eye with temporary high intraocular pressure and 1 eye with bleb leakage). The complications in the drainage nail group were less than that in the trabeculectomy group, and the postoperative visual acuity of the drainage nail group in the treatment of special type glaucoma was lower than that in the preoperative group. On January, the visual acuity decreased, the visual acuity recovered in February, and there was no significant difference between preoperative and postoperative intraocular pressure (IOP). The complications occurred in 6 eyes, including 1 eye of shallow anterior chamber with choroidal detachment, 3 eyes of shallow anterior chamber and 1 eye of posterior elastic layer detachment. Hyphema in 1 eye, complete success in 17 eyes (85 eyes), successful operation in 1 eye (5 eyes), postoperative intraocular pressure loss in 2 eyes (10 eyes). Conclusion: for primary open angle glaucoma and other special types of glaucoma, the effect of short-term reduction of IOP by Ex-PRESS drainage nail implantation is remarkable. In the treatment of primary open-angle glaucoma, there was no significant difference in the effect of intraocular pressure reduction, visual acuity and success rate between Ex-PRESS drainage nail implantation and trabeculectomy, but the visual acuity recovered quickly after Ex-PRESS drainage nail implantation. The complications were less than trabeculectomy.
【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R779.6

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