睫状体平坦部滤过术治疗难治性青光眼的临床研究

发布时间：2018-04-15 17:49

本文选题：难治性青光眼 + 睫状体平坦部滤过术　；参考：《中国中医科学院》2010年硕士论文

【摘要】： 目的：通过临床观察,系统评价睫状体平坦部滤过术治疗难治性青光眼的有效性及安全性,观察该手术的降压效果及对眼部各组织的病理影响,为临床研究治疗难治性青光眼提供新的依据。方法：搜集2005年4月至2009年12月我院确诊为难治性青光眼并实施睫状体平坦部滤过手术的住院患者68例73只眼,其中男46例50眼,女22例23眼；右眼42只眼,左眼31只眼；年龄10—82岁,平均52.6岁；新生血管性青光眼34眼,抗青光眼术后眼压失控8眼,开角型青光眼5眼,闭角型青光眼14眼,继发性青光眼9眼,青睫综合征1眼,先天性青光眼2眼。术前眼压：19.6—65mmHg,平均41.1mmHgo术前视力：无光感44眼,光感至手动6眼,指数／眼前到0.1患者18眼, 0.1以上5只眼。所有病例均采用睫状体平坦部滤过术联合丝裂霉素棉片结膜瓣及巩膜瓣下留置的方法治疗。手术步骤：①做以穹窿部为基底的结膜瓣,避开以前手术位置。⑦做巩膜瓣,其游离缘距角膜缘6mm,宽4mm,高3mm。③角膜缘后约4mm做深层巩膜切除及睫状体平部切除或切开,切除溢出玻璃体。④复位巩膜瓣,可调节缝线缝合巩膜瓣。⑤间断缝合结膜瓣。术后随访观察眼压、视力、疼痛症状、术后并发症。随访时间为术后一天到术后四年。结果： 1.术后眼压：术后一天：9只眼因角膜水肿测不出,6只眼眼压在26.5mmHg-40.3mmHg之间,58只眼眼压在0.6mmHg-20.59mmHg。术后一周：5只眼压未测出,3只眼压在21.1mmHg-42mmHg,65只眼眼压在2.2mmHg—20.5mmHg。术后两周随访72只眼：2只眼眼压未测出,2只眼眼压在21mmHg-28.7mmHg,68只眼眼压在3.7-18.2mmHg。术后1个月随访67只眼：其中2只眼眼压不在正常范围,分别为24.8mmHg、29.6mmHg,65只眼眼压在0.6mmHg-18.2mmHg。术后3个月随访67眼：3只眼眼压不在正常范围,眼压在23.3-40mmHg之间,64只眼在4.1-19.7mmHg。术后半年随访64眼：1眼眼压为21.5mmHg,63只眼眼压在2.9mmHg-19.8mmHg。术后1年随访53眼：1只眼眼压为22.1mmHg,余52眼眼压在6.4mmHg-19.3mmHg。完全成功率为92%,条件成功率为98%。术后一年半随访46眼：眼压在5.9mmHg-17.6mmHg。完全成功率为88%,条件成功率为98%。术后两年随访33眼：眼压在6.1mmHg-18.9mmHg。完全成功率为88%,条件成功率为100%。术后三年随访21眼：眼压在8.9mmHg-19.3mmHg。完全成功率为85%,条件成功率为100%。术后四年随访9眼：眼压在11.5mmHg-19.7mmHg。 2.术后视力：至本课题随访结束,73只眼中,42只无光感眼仍未变化；其余31眼中4只眼视力轻微下降,17眼视力提高,10只不变。视力提高率为23.5%,视力稳定率为71%,视力下降率为5.5%。 3.术后眼部情况：术后前房均不同程度加深。手术早期,滤泡呈隆起弥散状态,随着时间延长,滤过泡趋于平坦。前房浮游物及渗出者15眼,8例于术后3天消失,7例术后5天消失。前房积血11只眼,术后3天吸收6眼,术后1周吸收4只眼,1眼于术后11天吸收。新生血管性青光眼34眼,虹膜新生血管术后一天消退10只眼,术后3天消退7只眼,术后5天消退5眼,术后8天消退3眼,术后11天、14天各消退1只眼,术后30天消退2只眼,血管变细3只眼,不变2只眼。视网膜浅脱离3只眼,术后1个月恢复；局部脉络膜脱离2只眼,分别术后1月、3月恢复；眼球萎缩1只眼。结论1.睫状体平坦部滤过术可较满意地控制难治性青光眼眼压。 2.睫状体平坦部滤过术能改善部分患者的视力。 3.睫状体平坦部滤过术术后反应轻,术中、术后并发症少。总之,睫状体平坦部滤过术对于难治性青光眼是一种安全有效的方法,值得推广使用。
[Abstract]:Objective:
Objective to systematically evaluate the efficacy and safety of ciliary body flat filtration surgery in the treatment of refractory glaucoma through clinical observation, observe the hypotensive effect of the operation and the pathological effects on various tissues of the eye, so as to provide a new basis for clinical research and treatment of refractory glaucoma.
Method:
From April 2005 to December 2009 in our hospital diagnosed with refractory glaucoma and implementation of pars plana filtration surgery patients 68 eyes of 73 cases, including 46 cases of male female 22 cases 50 eyes, 23 eyes; 42 eyes right eye, left eye in 31 eyes; age 10 - 82 years old, average 52.6 years old; 34 neovascular glaucoma eye, glaucoma after intraocular pressure control in 8 eyes, 5 eyes are open angle glaucoma, angle closure glaucoma in 14 eyes, secondary glaucoma in 9 eyes, glaucomatocyclitic crisis in 1 eyes, 2 congenital glaucoma. The preoperative intraocular pressure: 19.6 41.1mmHgo - 65mmHg, the average preoperative visual acuity: no light perception in 44 eyes, light perception to hand in 6 eyes, 0.1 eyes / index more than 0.1 patients in 18 eyes, 5 eyes. All patients were treated by the method of pars plana filtration surgery combined with mitomycin cotton conjunctiva and sclera flap indwelling treatment. Surgical procedures: 1. Do the fornix based conjunctival flap, to avoid the previous operation The position of the scleral flap. The free margin from the limbus, 6mm, wide 4mm, high 3mm. and corneal limbus after 4mm resection or incision deep sclerectomy and pars plana resection. The reset, overflow vitreous body scleral flap, adjustable suture scleral flap suture. The conjunctival flap intraocular pressure. The follow-up, postoperative visual acuity, pain, postoperative complications. The patients were followed up from one day to four years after operation.
Result:
1. postoperative intraocular pressure (IOP):
One day after the operation, 9 eyes were unable to detect corneal edema, 6 eyes had intraocular pressure between 26.5mmHg-40.3mmHg and 58 eyes with intraocular pressure (0.6mmHg-20.59mmHg.).
One week after the operation, 5 eyes were unmeasured, 3 eyes were pressed at 21.1mmHg-42mmHg, and 65 eyes had intraocular pressure in 2.2mmHg - 20.5mmHg.
After two weeks' follow-up, 72 eyes were followed up: 2 eyes were unmeasured, 2 eyes were intraocular pressure in 21mmHg-28.7mmHg, and intraocular pressure in 68 eyes was 3.7-18.2mmHg.
67 eyes were followed up 1 months after the operation: 2 eyes had no intraocular pressure in the normal range, 24.8mmHg, 29.6mmHg, and 65 eye pressure in 0.6mmHg-18.2mmHg.
67 eyes were followed up 3 months after operation: 3 eyes had no intraocular pressure in normal range, intraocular pressure was between 23.3-40mmHg and 64 eyes were in 4.1-19.7mmHg..
After half a year, 64 eyes were followed up: 1 eyes with intraocular pressure of 21.5mmHg and 63 eyes with intraocular pressure in 2.9mmHg-19.8mmHg.
After 1 year follow-up, 53 eyes were followed up: 1 eyes had intraocular pressure of 22.1mmHg, and the total success rate of 6.4mmHg-19.3mmHg. in the remaining 52 eyes was 92% and the rate of conditional success was 98%..
46 eyes were followed up one and a half years after the operation: the total success rate of intraocular pressure (IOP) at 5.9mmHg-17.6mmHg. was 88%, and the successful rate was 98%.
33 eyes were followed up two years after operation: the total success rate of intraocular pressure (IOP) at 6.1mmHg-18.9mmHg. was 88%, and the successful rate was 100%.
21 eyes were followed up three years after operation: the total success rate of intraocular pressure (IOP) at 8.9mmHg-19.3mmHg. was 85%, and the successful rate was 100%.
9 eyes were followed up four years after operation: intraocular pressure (IOP) at 11.5mmHg-19.7mmHg.
2. postoperative visual acuity:
At the end of the study, 42 eyes without photoreceptor remained unchanged in the 73 eyes. In the remaining 31 eyes, 4 eyes had a slight decrease in eyesight, 17 eyes increased vision and 10 remained unchanged. The rate of visual improvement was 23.5%, the stability rate of vision was 71%, and the rate of visual deterioration was 5.5%..
3. eye condition after operation:
The postoperative anterior chamber were deepened. Early surgery, follicular bulge at the state of dispersion, with the prolongation of time, bleb flat. The anterior chamber of zooplankton and exudation in 15 eyes of 8 patients on the 3 postoperative day disappeared in 7 patients after 5 days disappear. Hyphema in 11 eyes, 6 eyes of absorption in 3 days after the absorption of 4 eyes in 1 weeks after surgery, 1 eyes in 11 days after absorption. 34 cases of neovascular glaucoma, 10 eyes disappeared one day postoperative iris neovascularization, 7 eyes disappeared 3 days after surgery, 5 eyes disappeared 5 days after surgery, 3 eyes subsided after 8 days, 11 days after the operation after 14 days, the disappeared in 1 eyes, 2 eyes disappeared 30 days after operation, blood vessels become fine in 3 eyes, unchanged in 2 eyes. Retinal detachment in 3 eyes, 1 months of recovery after operation; local choroidal detachment in 2 eyes, respectively, after January, in March to restore; eyeball atrophy in 1 eyes.
Conclusion 1. ciliary body flattening can control intraocular pressure of refractory glaucoma more satisfactorily.
2. flattening of the ciliary body can improve the visual acuity of some patients.
The postoperative reaction of 3. ciliary body flattening is light, and the postoperative complications are less.
In conclusion, flattening of the ciliary body is a safe and effective method for refractory glaucoma. It is worth popularizing.

【学位授予单位】：中国中医科学院
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R779.6

【参考文献】