TSCP激光治疗参数与患者眼压及睫状体形态变化的相关性研究

发布时间：2018-08-25 12:12

【摘要】：目的：探讨经巩膜睫状体光凝术（TSCP）激光治疗参数与术后眼压及睫状体形态变化的关系，从而指导临床对经巩膜睫状体光凝术光凝射击点数和爆破点数的选择。方法：回顾分析从2010年8月至2011年11月，我院青光眼科收治的诊断为难治性青光眼，并行睫状体光凝术的患者共65例，选取其中定期复诊的患者41例共41眼进行统计分析。分别用眼压计和超声生物显微镜（UBM）测量手术前及手术后3个月的眼压、眼前段的参数，总结分析经巩膜睫状体光凝术激光治疗参数与术后眼压改变及睫状体形态变化的相关性。结果： 1.本研究共纳入41例共41只眼，术前眼压平均值为58.91±3.62mmHg，术后3个月眼压平均值为27.27±16.02mmHg，眼压下降值为31.64±16.33mmHg。术后3个月眼压明显低于术前的眼压，且具有统计学意义（P0.05）。其中，多次抗青光眼术后眼压失控患者眼压下降值最小，为17.50±5.44mmHg，明显低于其他类型难治性青光眼患者，且具有统计学意义（P0.05）。术前与术后3个月UBM检查参数比较：术前睫状突数量(CPN)、巩膜睫状体夹角（θ）、α角与术后3个月相比，差异具有统计学意义（P0.05）。 2.眼压下降的程度与睫状突形态改变的相关性：巩膜睫状体夹角（θ）改变与眼压下降呈正相关性r=0.925（P0.05）；A角改变与眼压下降呈正相关性r=0.848（P0.05）；α角改变与眼压下降呈正相关性r=0.949（P0.05）；睫状突数量（CPN）改变与眼压下降呈正相关性r=0.687（P0.05）。睫状突厚度（CPT）改变与眼压下降没有线性相关。 3.眼压下降的程度与激光治疗参数间的相关性：眼压下降的程度与射击点数呈正相关性r=0.656（P0.05）；眼压下降的程度与爆破点数呈正相关性r=0.554（P0.05）。结论： 1.经巩膜睫状体光凝术是治疗难治性青光眼的有效方法，且相对方便安全经济。对不同类型的难治性青光眼疗效不同，原发性闭角型青光眼绝对期效果最好，，多次抗青光眼术后眼压失控患者治疗效果明显差于其他难治性青光眼患者。 2.经巩膜睫状体光凝术后眼压下降的程度与睫状体形态变化的程度呈正相关性，睫状体形态变化的程度越大，眼压下降的程度越大。 3.经巩膜睫状体光凝术后眼压下降的程度与射击点数、爆破点数呈正相关性，随着射击点数、爆破点数的增加，眼压下降的程度越大。 4.行经巩膜睫状体光凝术时，应根据患者术前的眼压水平来选择射击点数和爆破点数，术前眼压越高，术中越应增加光凝点数和爆破点数。
[Abstract]:Objective: to investigate the relationship between the parameters of (TSCP) laser therapy and postoperative intraocular pressure (IOP) and ciliary body morphology in scleral ciliary body photocoagulation, so as to guide the selection of firing points and blasting points for scleral ciliary body photocoagulation. Methods: from August 2010 to November 2011, 65 patients with refractory glaucoma and ciliary body photocoagulation were analyzed retrospectively. Among them, 41 eyes were selected for regular follow-up. Intraocular pressure (IOP) and anterior segment parameters were measured by intraocular pressure meter (IOP) and ultrasound biomicroscopy (UBM) before and 3 months after operation, and the correlation between the parameters of transscleral ciliary photocoagulation and the changes of intraocular pressure and ciliary body morphology were analyzed. Results: 1. The intraocular pressure was 58.91 卤3.62mmHg before operation, 27.27 卤16.02mmHg at 3 months after operation and 31.64 卤16.33mmHg. IOP 3 months after operation was significantly lower than preoperative IOP (P0.05). Among them, the intraocular pressure of the patients with out-of-control intraocular pressure after multiple anti-glaucoma surgery was the smallest, 17.50 卤5.44 mmHg, which was significantly lower than that of other types of refractory glaucoma patients, and had statistical significance (P0.05). Comparison of UBM parameters between preoperative and postoperative 3 months: preoperative ciliary process number (CPN), scleral ciliary body angle (胃), 伪 angle compared with postoperative 3 months, the difference was statistically significant (P0.05). The relationship between the degree of intraocular pressure decrease and the change of ciliary process: the change of scleral ciliary body angle (胃) was positively correlated with the decrease of intraocular pressure, the change of angle A was positively correlated with the decrease of intraocular pressure (P0.05), the change of 伪 angle was positively correlated with the decrease of intraocular pressure (P 0.05), the change of 伪 angle was positively correlated with the decrease of intraocular pressure (P 0.05), and the change of angle A was positively correlated with the decrease of intraocular pressure. The number of ciliary process (CPN) was positively correlated with the decrease of intraocular pressure (P 0.05). There was no linear correlation between (CPT) change of ciliary process thickness and intraocular pressure decrease. The degree of IOP drop was positively correlated with firing points (P 0.05), and the degree of IOP drop was positively correlated with blasting points (P 0.05). Conclusion: 1. Transscleral ciliary photocoagulation is an effective method for the treatment of refractory glaucoma, and is relatively convenient, safe and economical. For different types of refractory glaucoma, the effect of primary angle-closure glaucoma in absolute period is the best, and the effect of IOP control after multiple anti-glaucoma surgery is significantly worse than that of other refractory glaucoma patients. 2. After transscleral ciliary body photocoagulation, the degree of intraocular pressure decrease was positively correlated with the degree of ciliary body morphological change. The greater the degree of ciliary body morphology change, the greater the degree of intraocular pressure decrease. After scleral ciliary body photocoagulation, the degree of intraocular pressure decrease was positively correlated with the number of firing points and the number of blasting points. With the increase of firing points, the degree of intraocular pressure decrease was greater. 4. In transscleral ciliary body photocoagulation, shooting points and blasting points should be selected according to the preoperative IOP level. The higher the IOP before operation, the higher the number of photocoagulation points and blasting points should be increased.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R779.63

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