巩膜瓣可调整缝线的小梁切除术对角膜散光的影响
发布时间：2018-09-01 12:28
【摘要】：背景青光眼是由于病理性眼压增高而引起视神经萎缩、视野缺损,最终可以导致失明的全球第二位致盲性眼病,全球患病率高达3.54%[1],其病因尚不明确。传统青光眼小梁切除术是常用的外引流手术方式,但易出现术后早期低眼压、浅前房、恶性青光眼等手术并发症。联合巩膜瓣可调整缝线的小梁切除术有利于早期形成前房,良好地控制眼压,大大降低浅前房等术后并发症。但巩膜可调整缝线是否会引起角膜散光,术后何时屈光度到达稳定状态,是眼科学者所关注的问题。目的探讨巩膜瓣可调整缝线的小梁切除术对角膜散光的影响及术后屈光度稳定的时间。方法收集2014年6月至2016年7月于新乡医学院第一附属医院眼科收治的57例原发性青光眼患者,将其分为两组,实验组为联合可调整缝线的小梁切除术患者33例40眼,对照组为常规小梁切除术患者24例30眼,检查记录术前、术后第1天、术后1周(可调整缝线拆除前)、可调整缝线拆除后第1天、1月、3月的角膜地形图、角膜曲率及眼压情况。结果1.实验组角膜散光术后第1天(4.35±1.29D)、术后1周(3.80±1.31D)、拆线后第1天(3.23±1.19D)与术前(1.48±0.79D)相比,差异有显著统计学意义(P0.01),术后1月(1.50±0.71D)、3月(1.36±0.61D)与术前相比,差异无统计学意义(P0.05);对照组角膜散光术后第1天(1.78±0.33D)、术后1周(1.42±0.32D)与术前(1.12±0.36D)相比,差异有显著统计学意义(P0.01),术后1月(1.25±0.31D)、3月(1.09±0.34D)与术前相比,差异无统计学意义(P0.05)。2.实验组角膜散光术后第1天(4.35±1.29D)、术后1周(3.80±1.31D)与对照组(1.78±0.33D、1.42±0.32D)相比,差异具有显著统计学意义(P0.01);术后1月(1.50±0.71D)、3月(1.36±0.61D)与对照组(1.25±0.31D、1.09±0.34D)相比,差异无统计学意义(P0.05)。3.实验组角膜散光术后1月(1.50±0.71D)与3月(1.36±0.61D)相比,差异无统计学意义(P0.05);对照组角膜散光术后1月(1.25±0.31D)与3月(1.09±0.34D)相比,差异无统计学意义(P0.05)。结论1.巩膜瓣可调整缝线拆除前明显增加角膜散光度数。2.可调整缝线拆除后角膜散光度数减少,术后3月趋于稳定,术后3月时角膜散光以循规性散光为主。
[Abstract]:Background Glaucomatous glaucoma is the second leading cause of blindness caused by optic atrophy and visual field defect due to increased pathological IOP. The global prevalence rate of glaucoma is as high as 3.54% [1]. The etiology of glaucoma is still unclear. Trabeculectomy is a common external drainage operation, but it is easy to occur early postoperative complications such as low intraocular pressure, shallow anterior chamber, malignant glaucoma and so on. Trabeculectomy combined with adjustable suture of scleral flap is beneficial to early formation of anterior chamber, good control of intraocular pressure and reduction of postoperative complications such as shallow anterior chamber. However, whether the scleral adjustable suture will cause corneal astigmatism and when the diopter will reach a stable state after surgery is an issue of concern to ophthalmologists. Objective to investigate the effect of trabeculectomy with adjustable suture of scleral flap on corneal astigmatism and the time of postoperative diopter stability. Methods from June 2014 to July 2016, 57 patients with primary glaucoma were divided into two groups: 33 cases (40 eyes) of trabeculectomy combined with adjustable suture, and 57 cases of primary glaucoma treated in the first affiliated Hospital of Xinxiang Medical College from June 2014 to July 2016. The control group consisted of 24 patients (30 eyes) with conventional trabeculectomy. The corneal topography, corneal curvature and intraocular pressure were recorded before operation, 1 day after operation, 1 week after operation (before the removal of adjustable suture), 1 day, 1 month and 3 months after the removal of suture. Result 1. In the experimental group, there were significant differences between the first day (4.35 卤1.29D), the postoperative week (3.80 卤1.31D), the first day after the removal of the wire (3.23 卤1.19D) and the preoperative period (1.48 卤0.79D) (P 0.01), the postoperative 1 month (1.50 卤0.71D), the third month (1.36 卤0.61D) compared with the preoperative. There was no significant difference between the control group and the control group on the 1st day (1.78 卤0.33D), 1 week (1.42 卤0.32D) and 1.12 卤0.36D, respectively (P 0.01), 1 month after operation (1.25 卤0.31D), 3 months (1.09 卤0.34D) and 1 month after the operation (1.09 卤0.34D), there was no significant difference (P 0.05). There was no significant difference between the experimental group and the control group on the 1st day (4.35 卤1.29D) and the 1st week (3.80 卤1.31D) compared with the control group (1.78 卤0.33Dl 1.42 卤0.32D) (P0.01), but at 1 month (1.50 卤0.71D) and 3 months (1.36 卤0.61D) compared with the control group (1.25 卤0.31D, 1.09 卤0.34D), there was no significant difference (P0.05). There was no significant difference between the experimental group (1.50 卤0.71 D) and the third month (1.36 卤0.61D) (P0.05), but there was no significant difference between the control group (1.25 卤0.31D) and the control group (1.09 卤0.34D) (P0.05). Conclusion 1. The scleral flap can be adjusted to increase the corneal astigmatism by 2. 2 before removing the suture. The degree of corneal astigmatism decreased after removable suture, and tended to be stable at 3 months after operation, and the main astigmatism was regular astigmatism at 3 months after operation.
【学位授予单位】：新乡医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R779.6
本文编号：2217202
[Abstract]:Background Glaucomatous glaucoma is the second leading cause of blindness caused by optic atrophy and visual field defect due to increased pathological IOP. The global prevalence rate of glaucoma is as high as 3.54% [1]. The etiology of glaucoma is still unclear. Trabeculectomy is a common external drainage operation, but it is easy to occur early postoperative complications such as low intraocular pressure, shallow anterior chamber, malignant glaucoma and so on. Trabeculectomy combined with adjustable suture of scleral flap is beneficial to early formation of anterior chamber, good control of intraocular pressure and reduction of postoperative complications such as shallow anterior chamber. However, whether the scleral adjustable suture will cause corneal astigmatism and when the diopter will reach a stable state after surgery is an issue of concern to ophthalmologists. Objective to investigate the effect of trabeculectomy with adjustable suture of scleral flap on corneal astigmatism and the time of postoperative diopter stability. Methods from June 2014 to July 2016, 57 patients with primary glaucoma were divided into two groups: 33 cases (40 eyes) of trabeculectomy combined with adjustable suture, and 57 cases of primary glaucoma treated in the first affiliated Hospital of Xinxiang Medical College from June 2014 to July 2016. The control group consisted of 24 patients (30 eyes) with conventional trabeculectomy. The corneal topography, corneal curvature and intraocular pressure were recorded before operation, 1 day after operation, 1 week after operation (before the removal of adjustable suture), 1 day, 1 month and 3 months after the removal of suture. Result 1. In the experimental group, there were significant differences between the first day (4.35 卤1.29D), the postoperative week (3.80 卤1.31D), the first day after the removal of the wire (3.23 卤1.19D) and the preoperative period (1.48 卤0.79D) (P 0.01), the postoperative 1 month (1.50 卤0.71D), the third month (1.36 卤0.61D) compared with the preoperative. There was no significant difference between the control group and the control group on the 1st day (1.78 卤0.33D), 1 week (1.42 卤0.32D) and 1.12 卤0.36D, respectively (P 0.01), 1 month after operation (1.25 卤0.31D), 3 months (1.09 卤0.34D) and 1 month after the operation (1.09 卤0.34D), there was no significant difference (P 0.05). There was no significant difference between the experimental group and the control group on the 1st day (4.35 卤1.29D) and the 1st week (3.80 卤1.31D) compared with the control group (1.78 卤0.33Dl 1.42 卤0.32D) (P0.01), but at 1 month (1.50 卤0.71D) and 3 months (1.36 卤0.61D) compared with the control group (1.25 卤0.31D, 1.09 卤0.34D), there was no significant difference (P0.05). There was no significant difference between the experimental group (1.50 卤0.71 D) and the third month (1.36 卤0.61D) (P0.05), but there was no significant difference between the control group (1.25 卤0.31D) and the control group (1.09 卤0.34D) (P0.05). Conclusion 1. The scleral flap can be adjusted to increase the corneal astigmatism by 2. 2 before removing the suture. The degree of corneal astigmatism decreased after removable suture, and tended to be stable at 3 months after operation, and the main astigmatism was regular astigmatism at 3 months after operation.
【学位授予单位】：新乡医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R779.6
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