二极管激光（波长810nm）睫状体光凝术（TDLC）治疗中晚期青光眼的临床研究

发布时间：2018-02-15 12:57

本文关键词： 青光眼眼内压二极管激光睫状体光凝　出处：《天津医科大学》2010年硕士论文　论文类型：学位论文

【摘要】： 目的分析使用二极管激光睫状体光凝术(TDLC)治疗不同类型中晚期青光眼时影响术后眼内压的相关因素；探讨使用二极管激光睫状体光凝术更有效控制中晚期青光眼术后眼内压的方法。方法第一部分：回顾性临床病例研究。中晚期青光眼病例共84例84只眼进行TDLC治疗,分别记录患者的年龄、性别、青光眼的类别、激光斑点数,术前、术后眼压,术前、术后视力,并发症的情况,采用偏相关分析的方法分析影响TDLC术后眼压的相关因素；采用两变量相关分析的方法分析术前术后眼压差和激光斑点数的关系。第二部分：前瞻性研究。根据第一部分的研究结果,提出根据患者不同的术前眼压分组,在激光功率和持续时间不变的情况下,给予不同的激光点数。第一组,术前眼压为22-30 mmHg,术中给予激光点数为50点；第二组,术前眼压31-50 mmHg,术中给予激光点数为70点；第三组,术前眼压51-70 mmHg,术中给予激光点数为90点。观察每个病例的术后视力、术后眼压、并发症情况,并与回顾性青光眼病例作对比,观察疗效。随访该方法术后1天、7天、14天、术后30天、60天、90天及180天的眼压,观察其中期效果。结果第一部分：TDLC术后眼压与青光眼类型的关系,将性别、年龄、激光点数、术前眼压作为控制变量,分析青光眼类型与术后眼压的关系。偏相关系数r=0.2934,P=0.023。同样方法,术后眼压和术前眼压的关系,偏相关系数r=0.6123,P=0.000；术后眼压与性别的关系,偏相关系数r=-0.0092,P=0.945；术后眼压与年龄的关系,偏相关系数r=-0.1053,P=0.427。术前术后眼压差与激光治疗点数的相关分析显示r=0.279；P=0.036。第二部分：术后第一天手术成功率为37.04%,较回顾性青光眼病例的成功率26.19%提高,术后6个月的手术成功率最终上升为92.5%。随着时间的推移,术后眼压逐渐下降,并越来越接近正常值。观察期间,没有严重的并发症发生,没有出现视力下降。结论 1. TDLC治疗各种类型中晚期青光眼安全、有效且简便快捷。 2.对于中国人,TDLC治疗中晚期青光眼的术后眼内压和青光眼的类型和术前眼压相关,而与患者年龄、性别无关。术前术后眼压差与激光斑点数呈正相关。 3.根据术前眼压高低,在激光功率和持续时间不变的情况下,给予不同的激光斑点数,该方法治疗中晚期青光眼时是安全的,可行的,能有效的控制术后眼压,且不会增加并发症的发生和降低术后视力。 4.随着时间的推移,TDLC术后眼压在半年内逐渐且平稳地下降至正常范围。
[Abstract]:Objective to analyze the related factors of intraocular pressure (IOP) in the treatment of different types of advanced glaucoma with diode laser ciliary body photocoagulation (TDLC). To study the method of intraocular pressure control by diode laser ciliary body photocoagulation. Methods the first part: retrospective clinical case study. 84 eyes of 84 patients with advanced glaucoma were treated with TDLC. The age, sex, type of glaucoma, number of laser spots, intraocular pressure before and after operation were recorded, respectively. The postoperative visual acuity and complications were analyzed by partial correlation analysis and two variable correlation analysis were used to analyze the relationship between preoperative and postoperative IOP and the number of laser spots. Part two: prospective study. According to the results of the first part of the study, according to the patients with different preoperative intraocular pressure groups, under the condition of constant laser power and duration, different laser points were given. The intraocular pressure was 22-30 mm Hg before operation, and the laser points were 50 points during the operation. In the second group, the intraoperative intraocular pressure was 31-50 mm Hg, and the laser number was 70 points during the operation. In the third group, the intraoperative intraocular pressure was 51-70 mm Hg, and the intraoperative laser points were 90 points. The postoperative visual acuity of each case was observed. The intraocular pressure and complications were compared with those of the patients with retrospective glaucoma and the curative effect was observed. The intraocular pressure was observed at 1 day, 7 days, 14 days, 30 days, 60 days, 90 days and 180 days after operation, and the medium-term effect was observed. Results in the first part, the relationship between intraocular pressure (IOP) and glaucoma type after TDLC was analyzed. Sex, age, laser points and intraocular pressure before operation were used as control variables to analyze the relationship between IOP and IOP. The relationship between postoperative intraocular pressure and preoperative intraocular pressure, partial correlation coefficient (r = 0.6123), postoperative intraocular pressure (IOP) and sex (r = 0.0092) P ~ (0.945), and postoperative intraocular pressure (IOP) and age (r = -0.1053) P ~ (0.427). The correlation analysis between preoperative and postoperative IOP difference and laser treatment points showed that the IOP was 0.279 and P0.036.The relationship between IOP and postoperative intraocular pressure (IOP) and preoperative intraocular pressure (IOP) was 0. 6123P0. 000, and that between IOP and gender was 0. 0092P0. 945. The second part: the successful rate of operation on the first day of operation was 37.04, which was higher than that of retrospective glaucoma in 26.19%, and the successful rate of operation in 6 months after operation was 92.5. With the passage of time, the intraocular pressure decreased gradually. During the observation period, there were no serious complications and no loss of vision. Conclusion. 1. TDLC is safe, effective and convenient in the treatment of various types of middle and late glaucoma. 2. The intraocular pressure (IOP) and the type of glaucoma were related to the preoperative IOP, but not to the age and sex of the patients, but the IOP difference was positively correlated with the number of laser spots. 3.According to the preoperative intraocular pressure and the constant laser power and duration, different laser spots were given. This method is safe and feasible in the treatment of intermediate and advanced glaucoma, and can effectively control postoperative intraocular pressure. And does not increase the occurrence of complications and reduce postoperative visual acuity. 4. Intraocular pressure gradually and steadily decreased to normal range within half a year after TDLC.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R779.63

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