577nm波长与532nm波长ALPI联合YAG-LPI治疗原发性急性闭角型青光眼的临床研究

发布时间：2018-03-21 07:52

  本文选题：激光　切入点：青光眼　出处：《延安大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:本研究主要通过577nm与532nm两种波长的激光周边虹膜成形术(Laser peripheral iridoplasty,ALPI)联合YAG激光周边虹膜切除术(Laser peripheral iridotomy,LPI)治疗原发性急性闭角型青光眼,评价其差异性、临床疗效及安全性,为今后激光治疗原发性急性闭角型青光眼提供数据支持。方法:随机选取2015年9月至2017年2月在延安大学附属医院治疗的原发性急性闭角型青光眼患者28例30只眼,其中15只眼行577nm波长激光周边虹膜成形术联合YAG激光周边虹膜切除术(A组),15只眼行532nm波长激光周边虹膜成形术联合YAG激光周边虹膜切除术(B组)。所有治疗均征得患者及家属同意,并在治疗前签署知情同意书。使用天津索维活体超声生物显微镜(UBM)测得术前、术后3d、术后3mo相关参数:ACD(前房深度)、AOD500(500μm处房角开放距离)、ACA500(500μm处房角开放距离对应的前房角)、IT3(周边虹膜厚度)。使用德国海德堡角膜共焦显微镜测得术前及术后3d角膜内皮计数。用日本TOPCON非接触眼压计监测术前、术后1h、术后1d、术后1wk、术后1mo、术后3mo眼压。观察术后并发症,滴眼液使用情况。使用全自动电脑视野检查分析系统(TEC-3F)分析患眼术后3d与术后3mo视野。以上所有操作及检查均由专人完成,所有数据均采用SPSS 20.0软件进行分析。其中眼压与UBM相关参数等时间依赖性变量间比较用重复测量资料的方差分析,进一步分析组内两个时间点间变化采用配对t检验,组内治疗前后角膜内皮计数的变化、组内术后视野变化采用配对t检验,而组间内皮损失对比、组间视野变化对比用独立样本t检验。结果:1.眼压:2组患者在术前、术后1h,术后1d,术后1mo,术后3mo的眼压运用重复测量资料的方差分析得出:各组内不同时间段眼压变化有统计学意义(P0.05),总体呈下降趋势;而2组间眼压变化差异无统计学意义(p0.05)。2.角膜内皮计数:测得2组患者在术前、术后3d的角膜内皮计数。组内治疗前后角膜内皮计数变化采用配对t检验得出:各组内术前术后角膜内皮计数差异无统计学意义(p0.05);两组间角膜内皮损失比较采用独立样本t检验得出:2组间角膜内皮损失量差异无统计学意义(p0.05)。3.ubm相关参数:3.1测得2组患者在术前、术后3d、术后3mo的acd、aod500、aca500、it3,运用重复测量资料的方差分析得出:(1)各组内不同时间段acd值变化均有统计学意义(p0.05),而2组间acd值变化差异均无统计学意义(p0.05)。(2)各组内不同时间段aod500值变化均有统计学意义(p0.05),而2组间aod500值变化差异均无统计学意义(p0.05)。(3)各组内不同时间段aca500值变化均有统计学意义(p0.05),而2组间aca500值变化差异均无统计学意义(p0.05)。(4)各组内不同时间段it3值变化均有统计学意义(p0.05),而2组间it值变化差异均无统计学意义(p0.05)。3.2a组:(1)acd术后3d较术前明显增大,有统计学意义(p0.05);术后3mo较术后3d变化无统计学意义(p0.05)。(2)aod500术后3d较术前明显增大,有统计学意义(p0.05);术后3mo较术后3d变化没有统计学意义(p0.05)。(3)aca500术后3d较术前明显增大,有统计学意义(p0.05);术后3mo较术后3d变化没有统计学意义(p0.05)。(4)it3术后3d较术前减小,有统计学意义(p0.05);术后3mo较术后3d增大,有统计学意义(p0.05);术后3mo较术前减小,其中三个象限(鼻侧、上方、下方)无统计学意义(p0.05),一个象限(颞侧)有统计学意义(p0.05)。3.3b组:(1)acd术后3d较术前明显增大,有统计学意义(p0.05)),术后3mo较术后3d变化无统计学意义(p0.05)。(2)aod500术后3d较术前明显增大,有统计学意义(p0.05),术后3mo较术后3d变化没有统计学意义(p0.05)。(3)aca500术后3d较术前明显增大,有统计学意义(p0.05),术后3mo较术后3d变化没有统计学意义(p0.05)。(4)it3术后3d较术前减小,有统计学意义(p0.05),术后3mo较术后3d增大,有统计学意义(p0.05),术后3mo较术前减小,有统计学意义(P0.05)。4.观察两组术后3mo较术后3d视野无差异。5.本次研究30只眼均无严重并发症,术后1h前房炎症细胞分级为0.5+。6.术后根据情况逐次停用降眼压滴眼液,入选30只眼,除1只眼(A组)术后因停用降眼压滴眼液后眼压升高,后又加用降眼压滴眼液得以控制,余均能于术后1wk停药。结论:1.577nm波长与532nm波长激光周边虹膜成形术联合YAG激光周边虹膜切除术治疗原发性急性闭角型青光眼在疗效、安全性方面无差异。2.577nm波长与532nm波长激光周边虹膜成形术联合YAG激光周边虹膜切除术治疗原发性急性闭角型青光眼,能有效加深患者的前房深度、房角开放度,前房开放距离,从而减少临床用药,控制眼压,保护视功能。3.577nm波长与532nm波长激光周边虹膜成形术联合YAG激光周边虹膜切除术治疗原发性急性闭角型青光眼前后角膜内皮计数无显著减少,术后无严重并发症,安全性较高。
[Abstract]:Objective: This study mainly through 577nm and 532nm laser peripheral iridectomy two wavelength plasty (Laser peripheral iridoplasty, ALPI) combined with YAG laser peripheral iridectomy (Laser peripheral, iridotomy, LPI) for the treatment of primary acute angle closure glaucoma, evaluation of the differences, the clinical efficacy and safety, for the future of laser treatment provide data support of primary acute angle closure glaucoma. Methods: randomly selected from September 2015 to February 2017 in Affiliated Hospital of Yan'an University for treatment of primary acute angle closure glaucoma and 28 eyes of 30 cases, of which 15 eyes underwent 577nm laser peripheral iridoplasty combined with YAG laser peripheral iridectomy (A group), 15 eyes 532nm the wavelength of laser peripheral iridoplasty combined with YAG laser iridectomy (group B) were treated. All patients and their family members consent, and signed informed consent before treatment. Sovi in vivo ultrasound biomicroscopy (UBM) in Tianjin was measured before surgery, postoperative 3D, postoperative 3Mo related parameters: ACD (anterior chamber depth), AOD500 (500 m angle opening distance (500 m), ACA500 at the anterior chamber angle opening distance corresponding angle), IT3 (peripheral iris the thickness of 3D). Corneal endothelial cell counting using Germany Heidelberg corneal confocal microscope measured before and after the surgery. With Japanese TOPCON non-contact tonometer monitoring before surgery, postoperative 1H, postoperative 1D, postoperative 1wk, postoperative 1Mo, postoperative intraocular pressure 3Mo. Postoperative complications, the use of eye drops. The use of automatic analysis system of computer vision inspection (TEC-3F) of eyes with postoperative 3D with 3Mo vision. All of the above operations and check by hand to complete, all the data were analyzed with SPSS 20 software. The IOP and UBM parameters related to time dependent variables were compared using repeated measurement data analysis of variance further, Analysis of two time points within the group were compared by paired t test before and after treatment, changes of corneal endothelial counts within the group, group of postoperative vision were compared by paired t test, and between groups of endothelial loss comparison, comparison between the two groups in perspective with the independent sample t test. Results: 1. hypertension patients in the 2 groups before operation after the operation, 1H, 1D after surgery, postoperative 1Mo, postoperative intraocular pressure using the 3Mo variance of repeated measurement data analysis: there were significant changes of intraocular pressure within each group at different time (P0.05), the overall downward trend; while the difference of intraocular pressure between the 2 groups was statistically significant (P0.05).2. corneal endothelial cell counting measured: 2 groups of patients before surgery, corneal endothelial cell counting 3D after surgery. The treatment group before and after the change of corneal endothelial cell counting using a paired t test showed that within each group of differences in corneal endothelium before and after surgery was not statistically significant between the two groups (P0.05); corneal endothelial loss compared with independent 鏍锋湰t妫，

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