超声乳化联合引流钉植入治疗白内障伴原发性闭角型青光眼

发布时间：2018-05-10 07:24

  本文选题：Ex-PRESS + 青光眼引流钉　； 参考：《浙江大学》2015年博士论文

【摘要】：目的： 探讨Ex-PRESS青光眼引流钉植入联合白内障超声乳化吸除术,用于合并白内障的原发性闭角型青光眼的手术治疗的安全性和有效性,以及白内障吸除后的原发性闭角型青光眼的前房结构是否符合Ex-PRESS引流钉植入的要求。 方法： 本研究是连续的非随机的前瞻性临床病例对照研究,2013年9月至2014年9月,入组了浙江大学医学院附属第二医院眼科中心的收治的青光眼病人,其中试验组原发性闭角型青光眼合并白内障患者20人25眼,行Ex-PRESS引流钉植入联合白内障超声乳化吸除及囊袋内人工晶体植入术；对照原发性开角型青光眼的患者18人21眼,行单纯Ex-PRESS引流钉植入术的前后房结构。术前及术后1天、7天,和1、3、6个月收集术眼数据,包括眼压(IOP)、最佳矫正视力(BCVA)、以及中央前房深度(ACD)、房角开放距离(AOD500)、小梁虹膜角(TIA)、小梁睫状体距离(TCPD)、引流钉管腔长轴与角膜内皮夹角(ACA)等前后房结构数据和并发症情况等。手术成功的标准为：6mmHg≤眼压≤21mmHg,并且视力下降不超过两行(Snellen表),如使用抗青光眼药物辅助则为部分成功,未使用药物控制则为完全成功。 结果： 试验组6个月时手术成功率为92%,其中完全成功率分别为88%,平均眼压在术后各个时期都显著低于术前(P0.001),在6个月时平均眼压分别为15.7+3.5mmHg。试验组由于行白内障吸除术,术后最佳矫正视力(logMAR)较术前有显著性提高(P0.001)。在术后第1天试验组和对照组分别有3眼(12%)眼压低于6mmHg,术后7天均自行恢复正常,并且均未对手术效果造成长期影响。在接受了联合白内障超声乳化吸除术的Ex-PRESS引流钉植入术后中央前房深度、房角开放距离、小梁虹膜角、小梁睫状体距离均大于术前(P0.001),并且与POAG行单纯Ex-PRESS引流钉植入术后前房结构没有显著性差异(P0.05),且引流钉管腔长轴与角膜内皮夹角也无组间差异(P0.05)。 结论： 白内障超声乳化吸除术后,前房加深,房角开放,达到了Ex-PRESS引流钉植入手术的前房深度要求。在联合白内障超声乳化吸除术的前提下,Ex-PRESS青光眼引流钉用于合并白内障闭角型青光眼的手术是安全而有效的。这是Ex-PRESS引流钉植入术扩大适应症的有力证据。
[Abstract]:Objective: To investigate the safety and efficacy of Ex-PRESS glaucoma drainage nail implantation combined with phacoemulsification for primary angle-closure glaucoma complicated with cataract. And whether the anterior chamber structure of primary angle-closure glaucoma after cataract aspiration meets the requirement of Ex-PRESS drainage nail implantation. Methods: This study was a series of nonrandomized prospective clinical case-control studies. From September 2013 to September 2014, glaucoma patients were admitted to the Center of Ophthalmology of the second affiliated Hospital of Zhejiang University School of Medicine. In the experimental group, 25 eyes of 20 patients with primary angle-closure glaucoma complicated with cataract were treated with Ex-PRESS drainage nail implantation, phacoemulsification and intraocular lens implantation in the capsule, and 18 patients with 21 eyes with primary open-angle glaucoma. The anterior and posterior chamber structure of simple Ex-PRESS drainage nail implantation was performed. Preoperative and postoperative data were collected 1 day, 7 days, and 1 month, 6 months after operation. The results included IOP, BCV AV, ACD, AOD500, TIAA, TCPD, ACD, and complications, such as anterior chamber depth, anterior chamber angle, trabecular iris angle, trabecular ciliary body distance (TCPD), long axis of drainage nail and cornea endothelium angle (ACAA), and so on. The standard of successful operation was: 1: 6mmHg 鈮，

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