三种手术方式治疗原发性闭角型青光眼的临床研究

发布时间：2019-01-04 23:49

【摘要】：目的比较研究三种手术方式治疗原发性闭角型青光眼的临床效果及相关影响因素,为临床治疗提供参考。方法回顾性系列病例研究。排除高血压、糖尿病等其他引起眼部病变的疾病,选择2008年2月至2009年1月于我院就诊并诊断为原发性闭角型青光眼患者164例191眼,按青光眼类型分为急性组、慢性组,每组按手术方式又分为单纯小梁切除术、小梁切除联合白内障超声乳化人工晶体植入术、单纯白内障超声乳化摘除联合人工晶状体植入术三种术式。资料包括年龄、性别、病程、视力、眼压、眼底杯盘比、平均缺损、模式标准差、术后(1m、2m、3m、6m、1y、2y、3y)眼压、最佳矫正视力、前房深度、房角变化、(1y、2y、3y)视野改变及术后并发症等。统计学采用Spssl7.0软件,术前与术后眼压、平均视野缺损、平均模式标准差采用配对秩和检验；每种术式急慢组间术后眼压比较采用独立秩和检验；急慢组三种术式间术后眼压采用单因素方差分析及两两比较采用LSD-t检验,并发症及滤过泡形态比较采用卡方检验或Fisher's确切概率法。结果 (1)急慢组三种术式术后眼压较术前均明显下降,差异有统计学意义(Z=2.201,P=0.0281；急性组小梁切除联合白内障超声乳化术术后眼压控制效果更好,差异有统计学意义(较单纯小梁切除术：LSD-t检验：P=0.001；较单纯白内障超声乳化术：LSD-t检验：P=0.028)；慢性组三种术式间术后眼压差异无统计学意义(F=1.136,P=0.343)。 (2)小梁切除联合白内障超声乳化术与单纯白内障超声乳化术术后前房均较术前加深,差异有统计学意义(急性组小梁切除联合白内障超声乳化术：Z=-4.198,P=0.000；单纯白内障超声乳化术：Z=-5.443,P=0.000；慢性组小梁切除联合白内障超声乳化术：Z=-4.902,P=0.000；单纯白内障超声乳化术：Z=-5.012,P=0.000)；平均模式标准差术后较术前改变差异无统计学意义(Z=-1.604,P=-0.109)；视野平均缺损有不同程度的负值增大,但差异无统计学意义(Z=-0.943,P=0.435)。 (3)三种术式术后各种并发症的发生差异无统计学意义(P0.05)；单纯白内障超声乳化术与小梁切除联合白内障超声乳化术术后33眼(26.19%)房角进一步开放,病程0.5天～1.6年,色素沉着O～Ⅱ级,其中4眼(7.14%)单纯白内障摘除术后尽管房角进一步开放,但术后2年行UBM检查房角未关闭,眼压控制欠佳。结论小梁切除联合白内障超声乳化人工晶体植入术对急性闭角型青光眼眼压控制效果更好,与其他手术方式相比,无更多的并发症发生；单纯白内障超声乳化摘除术短期内能有效的控制眼压,对急慢性青光眼眼压控制无差别；重新开放的房角,可能与病程长短无关,而与房角色素沉着相关,且不一定存在滤过功能；眼轴较短而晶状体相对较厚行单纯小梁切除术后可能更易发生浅前房。
[Abstract]:Objective to compare the clinical effects and related factors of three surgical methods in the treatment of primary angle-closure glaucoma, and to provide reference for clinical treatment. Methods A series of retrospective cases were studied. From February 2008 to January 2009, 164 cases (191 eyes) with primary angle-closure glaucoma were selected and divided into acute group and chronic group according to the type of glaucoma. Each group was divided into three groups: trabeculectomy, trabeculectomy combined with phacoemulsification and intraocular lens implantation, phacoemulsification combined with intraocular lens implantation. Data included age, sex, course of disease, visual acuity, intraocular pressure, fundus cup / disc ratio, average defect, model standard deviation, postoperative intraocular pressure (1 m ~ 2 m ~ 3 m ~ 6 m ~ (-1) ~ 1 ~ 2 y ~ 3y), best corrected visual acuity, anterior chamber depth, change of angle of atrium, (1 yth). Visual field changes and postoperative complications. Spssl7.0 software was used in statistics, preoperative and postoperative intraocular pressure (IOP), mean visual field defect, mean model standard deviation were tested by paired rank sum test, and IOP was compared by independent rank sum test between acute and slow operation groups. In the acute and slow group, intraocular pressure was analyzed by univariate ANOVA and LSD-t test, and the complications and bleb morphology were compared by chi-square test or Fisher's exact probability method. Results (1) the IOP in the acute and slow group was significantly lower than that in the pre-operation group (Z = 2.201 / P = 0.0281). The effect of intraocular pressure control after trabeculectomy combined with phacoemulsification in acute group was better than that in simple trabeculectomy (P < 0. 001). Compared with phacoemulsification alone, LSD-t test showed that there was no significant difference in intraocular pressure between the three kinds of operation methods in chronic group (P < 0.01). (2) the anterior chamber of trabeculectomy combined with cataract phacoemulsification and cataract phacoemulsification was deeper than that of pre-operation. The difference was statistically significant (acute group trabeculectomy combined with cataract phacoemulsification: ZJ-4.198 P0.000; Simple phacoemulsification of cataract: Zhi-5.443 phacoemulsification, chronic trabeculectomy combined with phacoemulsification: ZJ-4.902P0. 000; single cataract phacoemulsification: ZJ-5.012 P0. 000); There was no significant difference in the mean model standard deviation after operation compared with that before operation (Z _ (-1.604) P ~ (-0.109), but there was no significant difference (Z _ (-0.943) P _ (0.435). (3) there was no significant difference in the occurrence of postoperative complications among the three types of operations (P0.05); 33 eyes (26.19%) after phacoemulsification of cataract and trabeculectomy combined with phacoemulsification were further open. The course of disease was 0.5 days to 1.6 years. In 4 eyes (7.14%), although the angle of atrium was further opened after cataract extraction, the angle of atrium was not closed by UBM 2 years after operation, and the intraocular pressure was not well controlled. Conclusion Trabeculectomy combined with phacoemulsification and intraocular lens implantation is more effective in controlling IOP in acute angle-closure glaucoma. Phacoemulsification alone can effectively control intraocular pressure in a short period of time, but there is no difference in the control of IOP in acute and chronic glaucoma. The angle of reopening may not be related to the duration of the disease, but to the pigmentation of the angle of the atrium, and may not necessarily have filtering function, and the shallow anterior chamber may occur more easily after simple trabeculectomy with shorter axial axis and thicker lens.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R779.6

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