原位滤过道再通术与再次小梁切除术的疗效对比

发布时间：2018-02-09 17:17

本文关键词： 原位滤过道再通术滤过泡瘢痕化眼压失控　出处：《吉林大学》2011年硕士论文　论文类型：学位论文

【摘要】：目的：观察原位滤过道再通术与再次小梁切除术治疗抗青光眼术后眼压失控的临床疗效。资料和方法：以12例(13只眼)小梁切除术后滤过道瘢痕化的青光眼患者为实验组(A组),同期入院的19例(22只眼)小梁切除术后滤过道瘢痕化的青光眼患者为对照组(B组)。用裂隙灯、前房角镜观察周边虹膜切除孔及球结膜滤过泡的情况,两组患者首次手术失败的原因均为滤过道外阻塞。局部或全身应用降眼压药物,两组患者术前眼压均在40mmHg以下。对A组患者行原位滤过道再通术,B组患者再次行小梁切除术。首次小梁切除术与原位滤过道再通术以及再次小梁切除术均由同一术者完成。术后定期监测患者的眼压情况,采用Kronfeld分型标准记录滤过泡的形态及功能。Kaplan-Meier法对比分析A、B两组滤过泡的生存时间。结果：(1)术后眼压：术后第7天,A组眼压由术前的28.15±7.54(15～40) mmHg降至13.77±4.71(10～24)mmHg; B组眼压由术前的25.36±8.89(16-40) mmHg降至15.05±4.36(9～28)mmHg。末次随访时,A组眼压为17.38±10.50(12～50)mmHg;B组眼压为16.00±11.08(11～50)mmHg。原位再通组与再次小梁切除组术后眼压的差别无统计学意义(P0.05)。(2)术后滤过泡形态及功能：术后第7天,两组滤泡形态弥漫扁平或微隆起,泡壁适中并有少量血管分布,滤过功能均良好。末次随访时,A组：功能型滤过泡10例11只眼,无功能型滤过泡2例2只眼；B组：功能型滤过泡17例20只眼,无功能型滤过泡2例2只眼。Kaplan-Meier生存分析结果表明,两组滤过泡生存时间的差别无统计学意义(P0.05)。(3)两组患者均无脉络膜上腔出血、角膜内皮失代偿、白内障以及黄斑囊样水肿等术中和术后并发症的发生。结论：(1)与再次小梁切除术相比,原位滤过道再通术同样可以有效控制眼压,且滤过泡形态、功能均良好。(2)原位滤过道再通术具有眼部正常组织破坏少、术后瘢痕面积小,并发症少,远期疗效稳定等优点,不失为治疗抗青光眼术后眼压失控的有效术式之一。(3)首次小梁切除术与原位滤过道再通术应由同一术者完成,这样二次手术才更安全、更具有实际意义。
[Abstract]:Objective: to observe the clinical effect of orthotopic filtration and trabeculectomy in the treatment of intraocular pressure loss after glaucoma surgery. Materials and methods: 12 cases (13 eyes) of trabeculectomy and 19 cases (22 eyes) of glaucoma treated by trabeculectomy were treated as experimental group A and 19 cases with scarring glaucoma after trabeculectomy. Group B: slit lamp, Anterior chamber angle endoscopy was used to observe the peripheral iris excision foramen and bulbar conjunctiva filtration bleb. The reason of the first operation failure in both groups was the obstruction of the extraductal tract, local or systemic application of intraocular pressure lowering drugs. The preoperative IOP of both groups was below 40mmHg. The patients in group A were treated with in situ filtering and recanalization. The patients in group B underwent trabeculectomy again. The first trabeculectomy, in situ filtration recanalization and re-trabeculectomy were performed by the same method. The patient's intraocular pressure was monitored regularly after operation. The morphology and function of bleb were recorded by Kronfeld typing standard. Kaplan-Meier method was used to compare and analyze the survival time of two groups. Results intraocular pressure (IOP) in group A decreased from 28.15 卤7.541540 mmHg to 13.77 卤4.71U 1024mm Hgon on the 7th day after operation, and IOP in group B decreased from 25.36 卤8.89516-40 mmHg to 15.05 卤4.36928mm Hg.Intraocular pressure in group A was 17.38 卤10.50,1250mm Hgg at the last follow-up. Intraocular pressure in group B was 16.00 卤11.081150mm Hg.Intraocular pressure in group B was 16.00 卤11.081150mm Hg.Ocular pressure in group A was 15.05 卤4.36928mm Hg.After the last follow-up, IOP was 17.38 卤10.50mm Hgg in group B and 16.00 卤11.081150mm Hgg in group B. There was no significant difference in posterior intraocular pressure (P 0.05).) the morphology and function of filtering bleb: on the 7th day after operation, there was no significant difference in posterior intraocular pressure (P < 0.05). The follicles in both groups were diffusely flat or slightly bulged, with moderate wall and a small amount of vasculature, with good filtering function. In group A, 10 cases (11 eyes) with functional bleb were followed up at the last follow-up, 11 eyes of 10 cases were functional bleb, 11 eyes of 10 cases were treated with functional bleb. The results of Kaplan-Meier survival analysis showed that 17 cases (20 eyes) were functional blebs, 2 cases (2 eyes) without functional blebs, and 2 eyes (2 eyes) without functional blebs. There were no intraoperative and postoperative complications such as suprachoroidal hemorrhage, corneal endothelial decompensation, cataract and macular cystic edema. Conclusion compared with the second trabeculectomy, in situ filtering and recanalization can also effectively control intraocular pressure, and the function of filtering bleb is good. 2) in situ filtering, the normal tissue damage is less and the scar area is small after operation. The advantages of less complications and stable long-term curative effect are one of the effective methods for the treatment of intraocular pressure loss after glaucoma surgery.) the first trabeculectomy and the in-situ filtration and passage recanalization should be performed by the same person. Only in this way can the second operation be more safe. More practical significance.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R779.6

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