玻璃体手术中应用曲安奈德的并发症研究

发布时间：2018-02-27 19:13

本文关键词： 曲安奈德玻璃体切除手术并发症　出处：《郑州大学》2010年硕士论文　论文类型：学位论文

【摘要】： 目的通过观察行玻璃体视网膜手术中注射曲安奈德前后的眼压及其他眼部改变,探讨玻璃体腔内注射曲安奈德术后并发症和疗效,评价小剂量曲安奈德的安全性。资料和方法自2008年9月～2009年9月,选择不同原因造成的需行玻璃体切除手术,术中玻璃体腔内注射不同剂量曲安奈德的116例患者。男65例,女51例。年龄在17岁～71岁之间,平均年龄35岁。116例患者均行闭合式玻璃体切除手术,其中手术过程中单纯用曲安奈德染色的5眼,常规行玻璃体切除手术注入曲安奈德2mg者21眼,注入曲安奈德4mg25眼；常规行玻璃体染色并注入硅油者6眼,注入曲安奈德2mg者23眼,注入4mg者36眼。在无菌条件下行闭合式玻璃体切除术,手术过程注射不同剂量的洗涤过的曲安奈德。术中联合晶状体切除、视网膜前膜剥离或切除、视网膜激光光凝术、硅油填充。术前经过眼压计多次准确测量眼压并排除高眼压；房角镜、UBM检查排除房角粘连；裂隙灯、检眼镜检查,必要时行B超、眼底彩照及眼底荧光血管造影(fundus fluorescein angiography, FFA)、光学相干断层扫描(optical coherence tomography,OCT)等检查记录术前的眼部情况。排除高眼压病史以及青光眼家族史。排除全身和玻璃体腔内应用糖皮质激素的禁忌症。术后观察患者1天、3天、1周、1个月、2个月、3个月左右的眼压、炎症反应、晶状体、视网膜以及视力等眼部情况,以了解曲安奈德玻璃体内注射的并发症及疗效,并针对出现的并发症选择合适的治疗方案。结果在本组的116例中,在随访过程中观察到有37例,出现眼压升高＞5mmHg,占39%；有16例出现眼压升高10mmHg,占14%,16例眼压最高时均高于21mmHg。其中有6例在22mmHg～30mmHg之间,有5例在30mmHg～40mmHg之间,有5例眼压最高在40mmHg以上,1例眼压最高达到59mmHg.单纯行玻璃体染色辅助玻璃体切除术眼压未见升高；行玻璃体切除并注入曲安奈德2mg的21眼,2只眼出现眼压升高5mmHg,1只眼眼压升高高于10mmHg；行玻璃体切除并注入曲安奈德4mg的25只眼中,9只眼出现眼压升高5mmHg,4只眼眼压升高10mmHg；行玻璃体切除硅油填充术并注入曲安奈德2mg的23眼中,6只眼出现眼压升高5mmHg,其中2只眼眼压升高10mmHg；行玻璃体切除硅油填充并注入曲安奈德4mg的36只眼中,有20只眼出现眼压升高＞5mmHg,9只眼压升高10mmHg。在本组研究中的37例中,有17例合并高度近视,占眼压升高总数的46%。曲安奈德的在玻璃体腔内的消失时间为5天～3个月,与曲安奈德的注射剂量、是否合并硅油填充等方面有关。结论 1玻璃体手术中注射2mg小剂量曲安奈德相对于注射4mg曲安奈德,术后出现的高眼压、并发性白内障等并发症的发生率低,相对安全。 2玻璃体手术中注射2mg曲安奈德能够有效的抑制PVR,减少术后炎症反应,出现的眼压升高通过药物基本上能够控制。 3合并高度近视应用曲安奈德术后高眼压的发生率高。硅油填充会延长曲安奈德的排出时间和高眼压的持续时间。在应用过程中注意在不影响疗效时,适当减少曲安奈德的用量,尽量减少不良反应的发生。
[Abstract]:objective
To observe the intraocular pressure and other ocular changes before and after injection of Cu Ann Ned in vitreoretinal surgery, to explore the complications and efficacy of intravitreal injection of Cu Ann Ned, and to evaluate the safety of small dose of Cu Ann Ned.
Information and methods
From September 2008 to September 2009, select the different causes for vitreous body resection, 116 cases with different doses of intravitreal injection of Cu Ann Ned cases. 65 cases were male, 51 were female. The age of 17 to 71 years old, the average age of 35 years old.116 patients underwent closed vitreous surgery. The operation process of pure Cu Ann Ned staining in 5 eyes underwent resection of vitreous body into Cu Ann Ned 2mg in 21 eyes, with Cu Ann Ned 4mg25 eyes; routine staining and injection of silicone oil into the vitreous body in 6 eyes, 23 eyes with Cu Ann Ned 2mg, in 4mg in 36 eyes. In the sterile condition downward closed vitreous body resection. The washing operation process of injection of different doses of Cu Ann Ned. Resection combined with lens implantation, epiretinal membrane peeling or excision, laser photocoagulation and silicone oil tamponade. Preoperative IOP after repeated measurement The intraocular pressure and the exclusion of high intraocular pressure; goniscope and UBM exclude goniosynechia; slit lamp ophthalmoscopy, if necessary, ultrasound, fundus and fundus fluorescein angiography (fundus fluorescein angiography, FFA), optical coherence tomography (optical coherence tomography, OCT) examination were recorded before the eye. Out of high intraocular pressure medical history and family history of glaucoma. Exclusion of contraindications corticosteroids systemic and intravitreal. Postoperative patients were observed for 1 days, 3 days, 1 weeks, 1 months, 2 months, 3 months about intraocular pressure, inflammatory reaction, lens, retina and visual acuity eye conditions, in order to understand the complications and the effect of intravitreal injection of Cu Ann Ned, and choose the appropriate treatment for complications.
Result
In this group of 116 cases, during follow-up were observed in 37 cases, elevation of intraocular pressure occurred in 5mmHg, accounting for 39%; 16 cases of elevated intraocular pressure 10mmHg, accounting for 14%, 16 cases with the highest intraocular pressure was higher than that of 21mmHg. including 6 cases in 22mmHg ~ 30mmHg, there are 5 cases in 30mmHg ~ 40mmHg there are 5 cases, IOP is the highest in more than 40mmHg, 1 cases of intraocular pressure up to 59mmHg. underwent resection of vitreous body dyeing auxiliary vitreous body no increase in intraocular pressure; vitreous body resection and injection of Cu Ann Ned 2mg in 21 eyes, 2 eyes showed elevated intraocular pressure 5mmHg, 1 eyes IOP higher than 10mmHg; for Cu Ann Ned 4mg and injected into the vitreous body resection in 25 eyes appeared in 9 eyes, 4 eyes IOP 5mmHg, 10mmHg elevated intraocular pressure; vitreous body resection for silicone oil tamponade into Cu Ann Ned 2mg in 23 eyes, 6 eyes showed elevated intraocular pressure 5mmHg, including 2 eyes IOP 10mmHg for glass; 36 eyes for silicone oil into Cu Ann Ned 4mg, has appeared in 20 eyes IOP > 5mmHg, pressure 10mmHg. in 9 eyes in the study group of 37 cases, 17 cases with a high degree of myopia, accounting for lost time in the vitreous cavity increased intraocular pressure 46%. of the total number of Cu Ann Ned's 5 days to for 3 months, and the dose of Cu Ann Ned, whether combined with silicone oil filling and so on.
conclusion
1 in vitreous surgery, the incidence of complications such as intraocular hypertension, complicated cataract and postoperative complications such as intraocular pressure (2mg), Cu Ann Ned and Cu Ann Ned 4mg were relatively low and relatively safe.
2 the injection of 2mg triamcinolone in vitreous surgery can effectively inhibit PVR and reduce the postoperative inflammatory response. The increase of intraocular pressure (IOP) is basically controlled by drugs.
3 patients with high myopia using Cu Ann Ned postoperative high intraocular pressure. The high incidence of silicone oil will extend Cu Ann Ned's discharge time and the duration of high intraocular pressure. In the application process in the curative effects, appropriate to reduce the dosage of Cu Ann Ned, as far as possible to reduce the occurrence of adverse reactions.

【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R779.6

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