白内障摘除联合房角分离术在疑难闭角型青光眼应用的临床观察

发布时间：2018-12-11 08:04

【摘要】：目的:白内障超声乳化摘除+人工晶体植入联合机械性房角分离术在小梁切除术后眼压失控的疑难闭角型青光眼治疗中的临床疗效观察。方法:本研究为回顾性、自身对照研究。患者选择:收集自2015年4月至2016年8月间在沈阳何氏眼科医院确诊的资料完整的小梁切除术后眼压失控的疑难闭角型青光眼合并白内障患者共12例(14只眼),其中男性2例(2只眼),女性10例(12只眼),年龄56岁-85岁,平均(69.58±8.58)岁。所有患者均符合闭角型青光眼的诊断标准,术前术眼曾有过小梁切除术史,有不同程度的视神经损害和视野缺损,房角镜查周边房角粘连270度,UBM查房角不同程度关闭或狭窄,前房浅。眼压21mm Hg或者应用降眼压药物后21mm Hg。无手术禁忌症,无其他眼部疾病。其中术前视力最低矫正视力为HM/50cm,最好矫正视力为0.4,伴有不同程度的晶状体混浊。所有病例均由同一术者使用同一台机器进行超声乳化白内障摘除术联合人工晶体植入术,术中同时行机械性房角分离术,瞳孔直径大于5mm患者同时行瞳孔成型术。观察对比术前、术后1天、7天、1个月、3个月和6个月眼压;术前、手术1个月后视力,术前、术后1个月后房角开放范围(度),中央前房深度。同时记录观察患者术中、术后并发症发生情况。术前14只眼眼压平均值为(23.3±4.1),术后第1天、1周、1个月、3个月、6个月14只眼眼压平均值分别为(17.2±4.6)(17.9±2.1)、(16.8±1.4)、(15.7±1.8)、(15.8±1.5),分别应用配对t检验,p值均0.05,与术前比较差异有显著性,具有统计学意义。1个月后查房角镜房角粘连范围均明显减小,且UBM示中央前房深度与术前相比明显加深,差异显著(P0.05),有统计学意义。14只眼(100%)术后一个月矫正视力均有不同程度提高;术前、术后1个月最佳矫正视力差异有显著性(Wilcoxon符号秩和检验;Z=-5.43,P0.05),具有统计学意义。仅有1例出现前房积血,有2例出现术后角膜水肿,经对症处理后均好转。随访6个月,未发现严重并发症,眼压均在正常范围以内。结果:结论:白内障超声乳化摘除+人工晶体植入联合机械性房角分离术对小梁切除术后眼压失控的疑难闭角型青光眼患者的疗效明显,术后眼压控制良好,视力得到恢复,前房深度加深,房角开放程度扩大,且并发症较少。为抗青术后眼压失控的闭角型青光眼患者提供了新的治疗思路,值得在临床推广。
[Abstract]:Objective: to observe the clinical effect of phacoemulsification and intraocular lens implantation combined with mechanical atrial angle separation in the treatment of difficult angle closure glaucoma with out of control intraocular pressure after trabeculectomy. Methods: this study was a retrospective, self-controlled study. Patient selection: from April 2015 to August 2016, a total of 12 patients (14 eyes) with complicated angle closure glaucoma complicated with cataract after trabeculectomy and trabeculectomy were collected. Male 2 cases (2 eyes), female 10 cases (12 eyes), age 56 to 85 years old, mean (69.58 卤8.58) years old. All the patients were in accordance with the diagnostic criteria of angle closure glaucoma. The eyes had a history of trabeculectomy and had different degrees of optic nerve damage and visual field defect. The conglutination of peripheral angle was 270degrees by angle endoscopy, and the angle of UBM rounds was closed or narrowed in varying degrees. The anterior chamber is shallow. Intraocular pressure 21mm Hg or 21mm Hg. after intraocular pressure lowering No contraindication, no other eye diseases. The lowest corrected visual acuity before operation was HM/50cm, and the best corrected visual acuity was 0.4, with different degree of lens opacity. All cases were performed phacoemulsification cataract extraction and intraocular lens implantation by the same machine. Mechanical atrial angle separation was performed simultaneously. Pupil diameter was larger than that of 5mm. Intraocular pressure (IOP) was observed 1 day, 7 days, 1 month, 3 months and 6 months before operation, visual acuity 1 month after operation, open range of anterior chamber angle (degree) and depth of central anterior chamber before operation and 1 month after operation. The complications during and after operation were also recorded. The mean IOP of 14 eyes was (23.3 卤4.1) before operation, and the mean IOP of 14 eyes was (17.2 卤4.6) (17.9 卤2.1), (16.8 卤1.4) on the first day, 1 week, 1 month, 3 months and 6 months after operation. (15. 7 卤1. 8), (卤15. 8 卤1. 5), using paired t test, p value was 0. 05, there was significant difference between before and after 1 month, the range of angle adhesion was obviously reduced. UBM showed that the depth of central anterior chamber was significantly deeper than that before operation (P0.05), there was statistical significance. 14 eyes (100%) 1 month after surgery corrected visual acuity improved in varying degrees. There was significant difference in the best corrected visual acuity before and after 1 month (Wilcoxon sign rank sum test; ZHS-5.43P 0.05), which was statistically significant. Only 1 case had hyphema and 2 cases had corneal edema. Follow-up for 6 months showed no serious complications and intraocular pressure was within normal range. Results: phacoemulsification and intraocular lens implantation combined with mechanical atrial angle separation were effective for patients with uncontrollable IOP after trabeculectomy. IOP was well controlled and visual acuity was recovered. The depth of anterior chamber was deeper, the degree of angle opening was enlarged, and the complications were less. It provides a new way of treatment for angle-closure glaucoma patients who have lost control of intraocular pressure after anti-cyanosis, and is worth popularizing in clinic.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R779.6

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