ALPI联合LPI与小梁切除术在急性PACG中的疗效观察研究
发布时间：2018-08-21 11:56
【摘要】：目的:探讨激光周边虹膜成形术(Laser Peripheral Iridoplasty,ALPI)联合激光周边虹膜切除术(Laser Peripheral Iridotomy,LPI)与传统小梁切除术(trabeculectomy)分别对原发性急性闭角型青光眼(primary acute angle closure glaucoma)首次大发作患眼的术后治疗效果。意义在于通过对比ALPI联合LPI术与小梁切除术,为临床治疗急性PACG寻求一种有效、安全、微创的治疗方法。方法:随机选择2014年9月到2016年9月在延安大学附属医院眼科接受治疗的急性PACG首次大发作60例患者60只眼进行观察;随机分为两组,每组30只眼,A组施行ALPI联合LPI术,B组施行传统小梁切除术,手术均由同一术者操作。分别检测并记录术前及术后1周(w)、术后3个月(m)的视力值、眼压(intraocular pressure,IOP)测量值;检测并记录术前、术后3个月前房深度(anterior chamber depth,ACD)、房角开放距离500(anterior chamber angle,AOD_(500));检测并记录术前及术后3个月视野、杯/盘比(C/D)、盘沿面积、视神经纤维层厚度(retinal never fiber layer,RNFL)。通过SPSS20.0统计学软件对A组、B组行术前、术后1w、术后3个月的视力、IOP进行重复测量资料方差分析的研究;对A组、B组术前、术后3个月ACD、AOD_(500)进行配对t检验;对A、B两组之间ACD、AOD_(500)进行独立样本t检验;对A组、B组的视野、C/D值、盘沿面积、RNFL的值术前、术后3m进展情况进行χ2检验的研究。结果:1.眼压(1)A组术前、术后1周、术后3个月眼压的检测结果如下:术前眼压(15.44±2.28)mm Hg、术后1周眼压(14.13±2.96)mm Hg、术后3个月眼压(15.50±3.50)mm Hg,P=0.00,差异有统计学意义。(2)B组术前、术后1周、术后3个月眼压的检测结果如下:术前眼压(15.00±2.78)mm Hg、术后1周眼压(14.50±7.01)mm Hg、术后3个月眼压(14.81±4.07)mm Hg,P=0.00,差异有统计学意义。(3)A组与B组术后眼压相比较结果为P=0.33,差异无统计学意义。2.视力(1)A组术前、术后1周、术后3个月视力的检测结果如下:术前视力(0.37±0.30)、术后1周视力(0.57±0.26)、术后3个月视力(0.57±0.25),P=0.00,差异有统计学意义。(2)B组术前、术后1周、术后3个月视力的检测结果如下:术前视力(0.36±0.24)、术后1周视力(0.46±0.24)、术后3个月视力(0.45±0.23),P=0.00,差异有统计学意义。(3)A组与B组手术后视力相比较结果为P=0.33,差异无统计学意义。3.超声生物显微镜(Ultrasound biomicroscopy,UBM)测得前房相关参数3.1 ACD(1)A组术前、术后3个月ACD检测结果如下:术前(1733.67±306.56)μm,术后3个月(1835.33±249.59)μm,P=0.01,差异有统计学意义。(2)B组术前、术后3个月ACD检测结果如下:术前(1758.33±134.42)μm,术后3个月(1841.00±144.35)μm,P=0.00,差异有统计学意义。(3)A、B两组之间术后ACD相比较P=0.54,差异无统计学意义。3.2.AOD_(500)(1)A组术前、术后3个月AOD_(500)检测结果如下:术前AOD_(500)(鼻)(98.57±75.89),术后AOD_(500)(鼻)(227.70±114.20),P=0.00,差异有统计学意义;术前AOD_(500)(下)(60.00±53.38),术后AOD_(500)(下)(203.27±118.45),P=0.00,差异有统计学意义;术前AOD_(500)(颞)(85.27±80.13),术后AOD_(500)(颞)(226.27±117.40),P=0.00,差异有统计学意义;术前AOD_(500)(上)(44.27±60.32),术后AOD_(500)(上)(117.67±89.85),P=0.00,差异有统计学意义。(2)B组术前、术后3个月AOD_(500)检测结果如下:术前AOD_(500)(鼻)(101.07±73.88),术后AOD_(500)(鼻)(208.97±104.94),P=0.00,差异有统计学意义;术前AOD_(500)(下)(57.60±53.49),术后AOD_(500)(下)(187.27±111.27),P=0.00,差异有统计学意义;术前AOD_(500)(颞)(81.43±75.75),术后AOD_(500)(颞)(219.23±110.83),P=0.00,差异有统计学意义;术前AOD_(500)(上)(41.60±56.42),术后AOD_(500)(上)(109.10±82.77),P=0.00,差异有统计学意义。(3)A、B两组之间术后AOD_(500)相比较PAOD_(500)(鼻)=0.37;PAOD_(500)(下)=0.58;PAOD_(500)(颞)=0.89;PAOD_(500)(上)=0.80,差异均无统计学意义。4.视野A组视野进展率为0.0%,B组视野进展率为3.3%,两者视野进展率相比较结果P=0.50,差异无统计学意义。5.C/D A组C/D值进展率为0.0%,B组C/D值进展率为3.3%,两者C/D进展率相比较结果P=0.50,差异无统计学意义。6.盘沿面积A组盘沿面积减少进展率为3.3%,B组盘沿面积减少进展率为3.3%,两者进展率相比较结果P=0.75,差异无统计学意义。7.视网膜神经纤维层厚度A组RNFL厚度变薄进展率为3.3%,B组RNFL厚度变薄进展率为3.3%,两者进展率相比较结果P=0.75,差异无统计学意义。结论:两种治疗方法对急性PACG首次大发作患者3个月短、中期疗效如下:1.ALPI联合LPI术以及传统小梁切除术术后眼压均较术前有所下降,术后视力均较术前提高,但两者之间眼压、视力无明显差别;2.ALPI联合LPI术以及传统小梁切除术术后前房ACD、AOD_(500)均较术前增大,但两者之间无明显差异;3.ALPI联合LPI术与传统小梁切除术相比对于术后3个月视野、C/D值、盘沿面积的减小、RNFL变薄进展的控制两者之间无明显差异
[Abstract]:Objective: To evaluate the effect of laser peripheral iridoplasty (ALPI) combined with laser peripheral iridotomy (LPI) and trabeculectomy in the treatment of primary acute angle closure glaucoma (PACG) with the first major attack. Results. The significance of ALPI combined with LPI and trabeculectomy was to find an effective, safe and minimally invasive treatment for acute PACG. Methods: 60 eyes of 60 patients with the first major attack of acute PACG were randomly selected from September 2014 to September 2016. The visual acuity, intraocular pressure (IOP) and anterior chamber depth (A) were measured and recorded before and after 1 week (w) and 3 months (m) respectively. CD, anterior chamber angle 500 (AOD_ (500)); visual field, cup/disc ratio (C/D), disc edge area, retinal never fiber layer (RNFL) were measured and recorded before and after operation for 3 months. Material analysis of variance; paired t test for ACD and AOD_ (500) before and 3 months after operation in group A and group B; independent sample t test for ACD and AOD_ (500) between group A and group B; _2 test for visual field, C/D value, disc edge area, RNFL value before and 3 m after operation in group A and group B. Results: 1. The results of intraocular pressure were as follows: intraocular pressure (IOP) was 15.44 (+ 2.28) mm Hg before operation, 14.13 (+ 2.96) mm Hg one week after operation, and 15.50 (+ 3.50) mm Hg three months after operation, P = 0.00. The difference was statistically significant. (2) IOP of group B was as follows: IOP was 15.00 (+ 2.78) mm Hg before operation, 14.50 (+ 7.01) mm Hg one week after operation. Hg, intraocular pressure 3 months after surgery (14.81 + 4.07) mm Hg, P = 0.00, the difference was statistically significant. (3) Compared with group B, the intraocular pressure of group A was P = 0.33, there was no significant difference. 2. Visual acuity (1) Visual acuity of group A before surgery, 1 week after surgery, 3 months after surgery were as follows: preoperative visual acuity (0.37 + 0.30), 1 week visual acuity (0.57 + 0.26), 3 months after surgery visual acuity (0.57 + 0.26). There were significant differences in visual acuity before operation, one week after operation and three months after operation in group B. The results were as follows: preoperative visual acuity (0.36.24), one week visual acuity (0.46.24), three months visual acuity (0.45.23), P = 0.00. There was no significant difference in visual acuity between group A and group B (P = 0.33). Significance. 3. Ultrasound biomicroscopy (UBM) measurement of anterior chamber related parameters 3.1 ACD (1) A group before surgery, 3 months after surgery ACD detection results were as follows: preoperative (1733.67 65507 34.42 micron, 3 months after surgery (1841.00 + 144.35) micron, P = 0.00, the difference was statistically significant. (3) A, B, ACD postoperative comparison between the two groups P = 0.54, there was no significant difference. 3.2 AOD (500) (1) A group before surgery, 3 months after surgery AOD (500) detection results were as follows: preoperative AOD (500) (nose) (98.57 75.89), postoperative AOD (500) (nose) (227.70 114.20), P = 0.00, the difference was statistically significant. AOD_ (500) (below) (60.00 53.38) before operation, AOD_ (500) (below) (203.27 118.45), P = 0.00 after operation, the difference was statistically significant; AOD_ (500) (temporal) (85.27 80.13) before operation, AOD_ (500) (temporal) (226.27 117.40), P = 0.00 after operation, the difference was statistically significant; AOD_ (500) before operation (above) (44.27 60.32), AOD_ (500) (above) (117.67 89.85), P = 0.00, P = 0.00). The results of AOD_ (500) in group B were as follows: AOD_ (500) (nose) (101.07 73.88) before operation, AOD_ (500) (nose) (208.97 104.94), P = 0.00 after operation; AOD_ (500) (below) (57.60 53.49) before operation, AOD_ (500) (below) (187.27 111.27), P = 0.00 after operation. Preoperative AOD_ (500) (temporal) (81.43 75.75), postoperative AOD_ (500) (temporal) (219.23 110.83), P = 0.00, the difference was statistically significant; preoperative AOD_ (500) (above) (41.60 56.42), postoperative AOD_ (500) (above) (109.10 82.77), P = 0.00, the difference was statistically significant. (3) A, postoperative AOD_ (500) between the two groups compared with PAOD_ (500) (nose) = 0.37; OD (500) (below) = 0.58; The progress rate of visual field in group A was 0.0%, and that in group B was 3.3%. There was no significant difference between the progress rate of visual field in group A and group B (P = 0.50). The progress rate of C/D was 0.0% in group C/D A and 3.3% in group B (P = 0.50). 6. The progressive rate of rim area reduction was 3.3% in group A and 3.3% in group B. The progressive rate of rim area reduction was P = 0.75, with no significant difference. 7. The progressive rate of RNFL thickness thinning was 3.3% in group A and 3.3% in group B, respectively. There was no significant difference between the two treatments (P = 0.75). CONCLUSION: The two treatments were effective for the first major attack of acute PACG within 3 months. The middle-term results were as follows: 1. Intraocular pressure (IOP) decreased after ALPI combined with LPI and trabeculectomy, but the visual acuity improved after trabeculectomy, but there was no significant difference between the two treatments. The ACD and AOD_ (500) of anterior chamber increased after LPI and traditional trabeculectomy, but there was no significant difference between them. 3. Compared with traditional trabeculectomy, ALPI combined with LPI had no significant difference in visual field, C/D value, disc area, and RNFL thinning progression control.
【学位授予单位】：延安大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R779.6
本文编号：2195639
[Abstract]:Objective: To evaluate the effect of laser peripheral iridoplasty (ALPI) combined with laser peripheral iridotomy (LPI) and trabeculectomy in the treatment of primary acute angle closure glaucoma (PACG) with the first major attack. Results. The significance of ALPI combined with LPI and trabeculectomy was to find an effective, safe and minimally invasive treatment for acute PACG. Methods: 60 eyes of 60 patients with the first major attack of acute PACG were randomly selected from September 2014 to September 2016. The visual acuity, intraocular pressure (IOP) and anterior chamber depth (A) were measured and recorded before and after 1 week (w) and 3 months (m) respectively. CD, anterior chamber angle 500 (AOD_ (500)); visual field, cup/disc ratio (C/D), disc edge area, retinal never fiber layer (RNFL) were measured and recorded before and after operation for 3 months. Material analysis of variance; paired t test for ACD and AOD_ (500) before and 3 months after operation in group A and group B; independent sample t test for ACD and AOD_ (500) between group A and group B; _2 test for visual field, C/D value, disc edge area, RNFL value before and 3 m after operation in group A and group B. Results: 1. The results of intraocular pressure were as follows: intraocular pressure (IOP) was 15.44 (+ 2.28) mm Hg before operation, 14.13 (+ 2.96) mm Hg one week after operation, and 15.50 (+ 3.50) mm Hg three months after operation, P = 0.00. The difference was statistically significant. (2) IOP of group B was as follows: IOP was 15.00 (+ 2.78) mm Hg before operation, 14.50 (+ 7.01) mm Hg one week after operation. Hg, intraocular pressure 3 months after surgery (14.81 + 4.07) mm Hg, P = 0.00, the difference was statistically significant. (3) Compared with group B, the intraocular pressure of group A was P = 0.33, there was no significant difference. 2. Visual acuity (1) Visual acuity of group A before surgery, 1 week after surgery, 3 months after surgery were as follows: preoperative visual acuity (0.37 + 0.30), 1 week visual acuity (0.57 + 0.26), 3 months after surgery visual acuity (0.57 + 0.26). There were significant differences in visual acuity before operation, one week after operation and three months after operation in group B. The results were as follows: preoperative visual acuity (0.36.24), one week visual acuity (0.46.24), three months visual acuity (0.45.23), P = 0.00. There was no significant difference in visual acuity between group A and group B (P = 0.33). Significance. 3. Ultrasound biomicroscopy (UBM) measurement of anterior chamber related parameters 3.1 ACD (1) A group before surgery, 3 months after surgery ACD detection results were as follows: preoperative (1733.67 65507 34.42 micron, 3 months after surgery (1841.00 + 144.35) micron, P = 0.00, the difference was statistically significant. (3) A, B, ACD postoperative comparison between the two groups P = 0.54, there was no significant difference. 3.2 AOD (500) (1) A group before surgery, 3 months after surgery AOD (500) detection results were as follows: preoperative AOD (500) (nose) (98.57 75.89), postoperative AOD (500) (nose) (227.70 114.20), P = 0.00, the difference was statistically significant. AOD_ (500) (below) (60.00 53.38) before operation, AOD_ (500) (below) (203.27 118.45), P = 0.00 after operation, the difference was statistically significant; AOD_ (500) (temporal) (85.27 80.13) before operation, AOD_ (500) (temporal) (226.27 117.40), P = 0.00 after operation, the difference was statistically significant; AOD_ (500) before operation (above) (44.27 60.32), AOD_ (500) (above) (117.67 89.85), P = 0.00, P = 0.00). The results of AOD_ (500) in group B were as follows: AOD_ (500) (nose) (101.07 73.88) before operation, AOD_ (500) (nose) (208.97 104.94), P = 0.00 after operation; AOD_ (500) (below) (57.60 53.49) before operation, AOD_ (500) (below) (187.27 111.27), P = 0.00 after operation. Preoperative AOD_ (500) (temporal) (81.43 75.75), postoperative AOD_ (500) (temporal) (219.23 110.83), P = 0.00, the difference was statistically significant; preoperative AOD_ (500) (above) (41.60 56.42), postoperative AOD_ (500) (above) (109.10 82.77), P = 0.00, the difference was statistically significant. (3) A, postoperative AOD_ (500) between the two groups compared with PAOD_ (500) (nose) = 0.37; OD (500) (below) = 0.58; The progress rate of visual field in group A was 0.0%, and that in group B was 3.3%. There was no significant difference between the progress rate of visual field in group A and group B (P = 0.50). The progress rate of C/D was 0.0% in group C/D A and 3.3% in group B (P = 0.50). 6. The progressive rate of rim area reduction was 3.3% in group A and 3.3% in group B. The progressive rate of rim area reduction was P = 0.75, with no significant difference. 7. The progressive rate of RNFL thickness thinning was 3.3% in group A and 3.3% in group B, respectively. There was no significant difference between the two treatments (P = 0.75). CONCLUSION: The two treatments were effective for the first major attack of acute PACG within 3 months. The middle-term results were as follows: 1. Intraocular pressure (IOP) decreased after ALPI combined with LPI and trabeculectomy, but the visual acuity improved after trabeculectomy, but there was no significant difference between the two treatments. The ACD and AOD_ (500) of anterior chamber increased after LPI and traditional trabeculectomy, but there was no significant difference between them. 3. Compared with traditional trabeculectomy, ALPI combined with LPI had no significant difference in visual field, C/D value, disc area, and RNFL thinning progression control.
【学位授予单位】：延安大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R779.6
【参考文献】
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