葡萄膜炎临床特点及影响玻璃体切除术临床疗效因素分析

发布时间：2018-03-10 00:17

本文选题：葡萄膜炎　切入点：临床特点　出处：《新疆医科大学》2011年硕士论文　论文类型：学位论文

【摘要】：目的：探讨葡萄膜炎的临床特点及玻璃体切除术治疗葡萄膜炎临床疗效的影响因素。方法：对2004年1月～2009年12月在兰州军区乌鲁木齐总医院眼科住院治疗的各类葡萄膜炎患者共184例216眼的临床资料进行回顾性分析。观察葡萄膜炎患者的性别、年龄、病因、病程、解剖分类、复发次数、治疗方法、治疗前后视力和眼部体征的变化、并发症的发生情况。用统计学方法对治疗前后视力、眼部体征的变化及并发症的发生情况进行统计学分析。根据治疗前后视力、眼部体征的变化及并发症发生情况判定临床疗效。对48例54眼行玻璃体切除术的葡萄膜炎患者,综合比较不同的性别、年龄、病因、病程、解剖分类、复发次数对其玻璃体切除术临床疗效的影响,用统计学方法对各种分组的临床疗效的差异性进行统计学分析。结果：本组各种葡萄膜炎患者共184例216眼,男性142例164眼,女性42例52眼。以21-40岁患者居多(100例占54.3%)。病因：其中以特发性葡萄膜炎为主(103例占56.0%)其次为外伤性葡萄膜炎(23例占12.5%)。病程：急性葡萄膜炎155眼(71.8%)；慢性葡萄膜炎61眼(28.2%)。解剖分类：以前葡萄膜炎为主(136眼占63.0%)；其次为全葡萄膜炎(61眼占28.2%)。复发次数：住院时既往复发次数：0次共163眼(75.5%),0-2次者共20眼(9.2%),3-4次者共28眼(13.0%),5次及以上者共5眼(2.3%)。治疗：采取单纯药物治疗共154眼(71.3)%,药物联合手术治疗共62眼(28.7%),其中行玻璃体切除术者共54眼。并发症：治疗前无并发症共81眼(37.5%),有并发症135眼(62.5%)；治疗后无并发症共144眼(66.7%),有并发症共72眼33.3%)。本组216眼痊愈共53眼(24.5%),显效83眼(38.5%),有效69眼(31.9%),无效11眼(5.1%),治愈率24.5%,总有效率94.9%。54眼葡萄膜炎行玻璃体切除术后痊愈2眼(3.7%),显效14眼(25.9%),有效30眼(55.6%),无效8眼(14.8%),治愈率3.7%,总有效率85.2%。本组病例治疗前后视力相比有差别,其差别有统计学意义(P0.01)；本组病例治疗前、后眼部体征相比有差别,其差别有统计学意义(P0.01)。本组病例治疗前后的并发症发生情况相比有差别,其差别有统计学意义(P0.01)；不同性别、年龄、病因、病程的患者行玻璃体切除术后临床疗效无明显差别,其差别无统计学意义(P0.05)不同解剖分类的患者行玻璃体切除术后临床疗效有差别,其差别有统计学意义(P0.05)；不同复发次数的患者行玻璃体切除术后临床疗效有差别,其差别有统计学意义(P0.01)。结论：葡萄膜炎仍是眼科常见致盲性疾病,好发于青壮年,男性多于女性,病因多样化,发病机制复杂,以特发性葡萄膜炎为主,以急性葡萄膜炎和前葡萄膜炎分布居多。目前仍以药物治疗为主,但针对一部分单纯药物治疗无效且反复发作、迁延不愈的葡萄膜炎行玻璃体切除术也有一定的临床疗效,其不同的解剖分类、复发次数将影响玻璃体切除术后的临床疗效。
[Abstract]:Objective: to investigate the clinical characteristics of uveitis and the factors influencing the clinical efficacy of vitrectomy in the treatment of uveitis. Methods: from January 2004 to December 2009 in Urumqi General Hospital of Lanzhou military region, various types of ophthalmological treatment were studied. The clinical data of 216 eyes of 184 patients with uveitis were retrospectively analyzed. Age, etiology, course of disease, anatomical classification, number of recurrence, treatment, changes of visual acuity and ocular signs before and after treatment, occurrence of complications. The changes of ocular signs and the occurrence of complications were analyzed statistically. According to the changes of visual acuity, ocular signs and complications before and after treatment, the clinical efficacy was evaluated. 48 cases (54 eyes) of uveitis underwent vitrectomy. The effects of sex, age, etiology, course of disease, anatomic classification and recurrence frequency on the clinical efficacy of vitrectomy were compared. Results: there were 184 cases (216 eyes) with various uveitis, 142 cases (164 eyes) were male, 42 cases (52 eyes) were female. 100 cases (54.3%) were mostly from 21 to 40 years old. Etiology: 103 cases (56.0%) were mainly idiopathic uveitis) the next was traumatic uveitis (23 cases) 12.5%. Course of disease: 155 eyes with acute uveitis, 71.8% with chronic uveitis; 61 cases with chronic uveitis. Anatomical classification: 136 eyes (63.0 eyes) were mainly uveitis before, followed by 61 eyes (28.2m) with total uveitis. Recurrence times: the number of previous recurrence in the hospital was 0 times (163 eyes) 75.5o 0 times (20 eyes) with 9.23-4 times (28 eyes) 13.00 times and above (5 times). Treatment: 154 eyes were treated with drugs alone, 62 eyes were treated with combined drug surgery, 54 eyes were treated with vitrectomy. Complications: 81 eyes had no complications before treatment, 135 eyes had complications. A total of 144 eyes (66.7 eyes) had complications and 72 eyes (33.3 eyes) had complications. In this group, 216 eyes (53 eyes) were cured, 53 eyes (24. 5%) were cured, 83 eyes (38. 5%) were effective, 69 eyes (31. 995%) were effective, 11 eyes (11 eyes) were not effective, the cure rate was 24.55.The total effective rate was 94.9.54 eyes, 2 eyes were cured after vitrectomy, and 14 eyes showed remarkable effect. The curative rate was 3.7and the total effective rate was 85.2. The visual acuity of this group of patients was different before and after treatment. There were significant differences in the occurrence of complications before and after treatment in this group of patients (P 0.01) and before and after treatment (P 0.01), and there were significant differences in the occurrence of complications before and after treatment (P 0.01). There was no significant difference in the clinical effect after vitrectomy in patients with age, etiology and course of disease, but there was no significant difference in the clinical efficacy of vitrectomy in patients with different anatomical classification (P 0.05). The difference was statistically significant (P 0.05), the clinical efficacy of patients with different recurrence times after vitrectomy was different, and the difference was statistically significant (P 0.01). Conclusion: uveitis is still a common blinding disease in ophthalmology, which usually occurs in young adults. Male is more than female, the etiology is diverse, the pathogenesis is complicated, mainly idiopathic uveitis, acute uveitis and anterior uveitis are mostly distributed. But there are some clinical effects of vitrectomy for some patients with chronic uveitis. Different anatomical classification and recurrence times will affect the clinical effect after vitrectomy.
【学位授予单位】：新疆医科大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R779.6

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