超声乳化白内障吸除、人工晶体植入联合房角分离术治疗原发性闭角型青光眼的临床观察

发布时间：2018-02-25 09:47

本文关键词： 闭角型青光眼白内障超声乳化房角分离　出处：《河北医科大学》2010年硕士论文　论文类型：学位论文

【摘要】： 目的:对比超声乳化白内障吸除人工晶状体植入联合小梁切除术(以下简称三联)、超声乳化白内障吸除人工晶状体植入术(以下简称单纯超乳)及超声乳化白内障吸除人工晶状体植入联合房角分离术(以下简称超乳联合房角分离)对闭角型青光眼合并白内障的治疗效果,以期为手术治疗原发性闭角型青光眼(primary angle-closure glaucoma,PACG)合并白内障提供临床指导。方法: 1试验分组:根据房角粘连情况将患眼分为A(房角粘连关闭≤l80°),B(180°房角粘连关闭≤270°),C(房角粘连关闭270°)三组,每组随机分为两个手术组。 2手术选择:A组共72眼,随机分为两组,分别采用单纯超乳、超乳联合房角分离。B组共106眼,C组60眼,均分别随机分为两组,分别采用三联、超乳联合房角分离。 3术前及术后随访视力、眼压、裂隙灯、眼底、房角、视野。结果: 1视力:238眼中14眼视力无变化或下降,超乳+房角分离中仅2眼视力无提高,无一例视力下降。 2眼压:三组中两个亚组之间的术前眼压差异无统计学意义术后:A组:房角分离组眼压明显低于单纯超乳组(P0.01),不同时相之间眼压无差别(P0.05)。B组:房角分离组与三联组眼压存在差别(P0.05),不同时相之间眼压存在差别(P0.01)。一周时,三联组眼压最低,后有升高趋势;而房角分离组一周时眼压高于三联组,其后稍有降低,1个月后眼压趋于稳定并低于三联组,差异具有统计学意义(P0.01)。C组:房角分离组平均眼压稍低于三联组眼压,差异无统计意义(P0.05)。 3房角变化房角分离的119眼术后1月房角镜检查房角均不同程度开放,周边虹膜前粘连基本消失。角镜检查未发现再次粘连及关闭。对照组术后前房角较术前部分增宽,虹膜根部较术前平坦,部分患者房角重新开放,周边虹膜前粘连的范围变小。但变化不及房角分离组明显。随访期内,三联组中有4眼虹膜周切口前粘连。 4视野房角分离患者中视野复查资料完整的47眼:A组、B组术后视野平均光敏度(MS)较术前显著性增高( P 0.01),视野指数MD绝对值较术前下降,有统计学意义( P 0.05)。C组术后MS较术前有下降趋势,但无差异( P 0.05 ) ;术后视野指数MD绝对值较术前提高,但无统计学差异( P 0.05 )。结论: 1对于PACG合并白内障患者,房角粘连关闭≤l80°的,仅行单纯超乳、人工晶体植入就可控制眼压;180°房角粘连关闭≤270°,超乳合并房角分离优于三联,并发症少、眼压控制更佳;房角粘连关闭270°的患者,超乳合并房角分离与三联眼压控制无差异。 2对于房角粘连关闭≥270°的慢性闭角型青光眼,眼压控制较急闭型青光眼差。虽然术前房角粘连关闭所在象限术后房角重新开放,但20%慢闭眼的眼压仍未得到有效控制。 3 PACG合并白内障患者早期行手术治疗,术后视野光敏度提高,暗点变浅,视野好转。晚期再行手术治疗,眼压可趋于稳定,但视野可能仍有恶化趋势.
[Abstract]:Objective: To compare the phacoemulsification and intraocular lens implantation combined with trabeculectomy (hereinafter referred to as triple), phacoemulsification and intraocular lens implantation (hereinafter referred to as ultra pure milk) and phacoemulsification and intraocular lens implantation combined with goniosynechialysis (hereinafter referred to as the phacoemulsification combined with goniosynechialysis) to close angle closure glaucoma with cataract treatment, in order for the surgical treatment of primary angle closure glaucoma (primary angle-closure glaucoma, PACG) with cataract and to provide clinical guidance.
Method:
1 test group: according to goniosynechia eyes will be divided into A (goniosynechia off less than L80 degrees), B (adhesion 180 degrees angle closure is smaller than 270 DEG), C (goniosynechia closed 270 degrees) three groups, each group were randomly divided into two groups.
2 operation selection: group A, 72 eyes, were randomly divided into two groups. They were divided into two groups by single emulsion, super emulsification combined with corner separation,.B group, 106 eyes, group C 60 eyes. They were randomly divided into two groups.
3 preoperative and postoperative follow-up of visual acuity, intraocular pressure, slit lamp, fundus, room angle, and visual field.
Result:
1 visual acuity: there was no change or decline in 14 eyes in 238 eyes. Only 2 eyes had no improvement in visual acuity in hyper emulsion + atrial angle separation, and no case of visual acuity was decreased.
2 intraocular pressure: there was no significant difference of three groups in two groups between preoperative IOP differences: group A: goniosynechiolysis IOP was obviously lower than that of phaco group (P0.01), no difference between different phases of intraocular pressure (P0.05) group.B: goniosynechiolysis group and triple group differences (intraocular pressure P0.05), different phase differences between the intraocular pressure (P0.01). One week after the lowest IOP, triple, has a rising trend; and goniosynechiolysis group a week when intraocular pressure was higher than the triple group, then decreased slightly, 1 months after the IOP was stable and lower than the triple group, the difference has statistical significance (P0.01).C group: goniosynechiolysis group mean IOP was slightly lower than the triple group, intraocular pressure, the difference was not statistically significant (P0.05).
3 atrial angle change
The corner separation in 119 eyes after 1 months gonioscopy examination angle were open, peripheral anterior synechia of iris disappeared. Angle was not found again adhesion and closed.
In the control group, the anterior chamber angle was widened partially after operation, the iris root was more flat than before operation, the angle of the anterior chamber was re opened in some patients, and the extent of the anterior synechia area around the periphery was smaller. However, the change of the anterior chamber angle was smaller than that in the angle separation group. During the follow-up period, there were 4 eyes with anterior synechia in the triple group.
4 field of vision
Goniosynechiolysis 47 eye view review with complete data: A group, B group, postoperative vision meansensitivity (MS) was significantly higher than that before operation (P 0.01), the absolute value of vision index MD decreased, with statistical significance (P 0.05).C group MS after operation than before operation a downward trend, but no significant difference (P 0.05); postoperative vision index of the absolute value of MD were improved, but the difference was not statistically significant (P 0.05).
Conclusion:
1 PACG for patients with cataract, goniosynechia off less than L80 degrees, only underwent phacoemulsification, intraocular lens implantation can control intraocular pressure; 180 degrees goniosynechia close less than or equal to 270 degrees, with super milk goniosynechiolysis is better than triple, less complications, better control of intraocular pressure; goniosynechia closed 270 degree patients super milk with goniosynechiolysis, and triple IOP control no difference.
2 for goniosynechia closed more than 270 degrees of chronic angle closure glaucoma, intraocular pressure control is more acute closed glaucoma. Although the adhesion in the anterior chamber angles of the quadrant angle after re open, not closed but 20% slow intraocular pressure was controlled effectively.
3 PACG patients with early cataract patients underwent surgical treatment, postoperative vision sensitivity enhancement, vision improved. Scotoma becomes shallow, late and underwent surgery, intraocular pressure can be stabilized, but the view may still have a deteriorating trend.

【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R779.66

【引证文献】