超声乳化联合不同方式房角分离手术治疗原发性闭角型青光眼合并白内障的临床研究

发布时间：2018-05-24 00:18

本文选题：超声乳化吸出术 + 房角分离术　；参考：《第三军医大学》2012年硕士论文

【摘要】：目的比较超声乳化白内障吸除术(Phacoemulsification,PHACO)联合两种不同方式的房角粘连分离术(Goniosynechialysis GSL)治疗原发性闭角型青光眼(PrimaryAngle-Closure Glaucoma,PACG)合并白内障的临床效果。研究对象和方法原发性闭角型青光眼合并白内障患者24例(32眼)，术前均在使用不同数量的抗青光眼药物，随机分成A组(撕囊前行房角分离)17例21眼；B组(皮质吸除后行房角分离)7例11眼，均施行白内障超声乳化吸除联合房角粘连分离术,观察两组患者术前、术后1月、3月、6月、12月的视力、眼压、房角开放程度、前房中央深度的变化。结果 A组和B组术前平均最佳矫正视力(Logmar视力)分别为1.13±0.75和0.93±0.50，无统计学意义(p0.05)。术后1月、3月、6月和12月，A组的平均最佳矫正视力为0.57±0.33,0.42±0.24,0.30±0.23,0.35±0.28，B组的为0.68±0.60,0.38±0.15,0.40±0.17,0.33±0.13,and0.37±0.06，术后两组视力均较术前有明显提升，然而两组在同一时间点无显著差异。A组和B组术前平均Goldman眼压分别为35.67±12.31mmHg和31.64±15.06mmHg，术后1月、3月、6月和12月，两组的眼压均明显下降，但两组同一时间点数据之间无统计学意义。A组和B组术前的平均中央前房深度为：1.56±0.37mm和1.72±0.35mm。而在术后1月、3月、6月、12月，两组中央前房深度均较术前有明显加深，但两组平均中央前房深度在各个观察时间点间无统计学差异。术后1年，两组的手术完全成功率非别为86.0%和90.0%，两组的部分成功率分别为9.5%和10.0%，两组失败率分别为A组4.8%，B组无失败病例。A组术前使用抗青光眼药物种类为2.05±0.74，1眼房角分离术后仍需行小梁切除术，2眼房角分离术后仍需抗青光眼药物治疗才能将眼压控制在正常范围。B组术前使用抗青光眼药物种类为2.18±0.87种，1眼术后仍需抗青光眼药物治疗才能将眼压控制在正常范围。在术后各个时间观察点，A组房角在术后各个时间点开放较充分，而B组有4眼术后复查时发现房角狭窄。结论对于闭角型青光眼合并白内障患者，不同方式行房角分离手术均能显著提高患者的视力、降低眼压和加深前房，但根据术后房角开放程度，A组手术方式较B组能取得更好的手术效果。
[Abstract]:Purpose To compare the clinical effect of phacoemulsification- PHACO combined with two different methods of angle adhesions separation (Goniosynechialysis GSL) in the treatment of primary angle-closure glaucoma with primary Angle-Closure Glaucoma PACG. Research objects and methods Twenty-four patients with primary angle-closure glaucoma complicated with cataract were treated with different amount of antiglaucoma drugs before operation. They were randomly divided into group A (17 cases 21 eyes with anterior chamber angle separation) and group B (7 cases 11 eyes with angle separation after cortical aspiration). All patients were treated with phacoemulsification combined with separation of atrial angle adhesion. The changes of visual acuity, intraocular pressure, angle opening degree and anterior chamber central depth were observed before operation, 1 month, 3 months, 6 months and 12 months after operation. Result The mean preoperative best corrected visual acuity (BCVA) of group A and group B were 1.13 卤0.75 and 0.93 卤0.50, respectively. The average corrected visual acuity of group A was 0.57 卤0.33 卤0.42 卤0.24 卤0.30 卤0.23 卤0.35 卤0.28 in 1 month, 3 months, 6 months and 12 months after operation. The visual acuity of group B was 0.68 卤0.600.38 卤0.150.40 卤0.17 卤0.33 卤0.13 and 0.37 卤0.06, respectively. However, there was no significant difference between the two groups at the same time. The preoperative mean intraocular pressure of group A and group B was 35.67 卤12.31mmHg and 31.64 卤15.06 mmHg, respectively. The IOP of group A and group B decreased significantly at 1 month, 3 months, 6 months and 12 months after operation. However, there was no statistical significance between the two groups at the same time point. The mean anterior chamber depth before operation in group A and group B was 1. 56 卤0.37mm and 1. 72 卤0. 35mm. However, the depth of the central anterior chamber in the two groups was significantly deeper than that before operation in 1 month, 3 months, 6 months and 12 months after operation, but there was no significant difference in the mean central anterior chamber depth between the two groups at different observation time points. One year after surgery, The total success rate of operation was 86.0% and 90.0% in both groups, and the partial success rate was 9.5% and 10.0 in both groups, respectively. The failure rate of two groups was 4.8B group without failure cases. Group A was treated with anti-glaucoma drugs before operation 2.05 卤0.74m 1 eye after atrial angle separation. Still need trabeculectomy 2 eyes after angle separation still need antiglaucoma drug treatment to control IOP in normal range. Group B before the use of anti-glaucoma drugs 2.18 卤0.87 kinds of glaucoma drugs still need to be treated after 1 eye Can control IOP in normal range. The angle of atrium in group A was more open at each time point after operation, while in group B, 4 eyes were found to have stenosis after operation. Conclusion For angle-closure glaucoma patients with cataract, different methods of angle separation surgery can significantly improve the visual acuity, reduce intraocular pressure and deepen the anterior chamber. But according to the degree of atrial angle opening, group A can get better results than group B.
【学位授予单位】：第三军医大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R779.66

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