闭角型青光眼滤过术后继发脉络膜脱离的相关因素研究

发布时间：2018-06-06 00:28

本文选题：闭角型青光眼 + 脉络膜脱离　；参考：《吉林大学》2011年硕士论文

【摘要】：目的：(1)探讨闭角型青光眼滤过术后继发脉络膜脱离与术前存在睫状体脱离的相关性,为闭角型青光眼滤过手术后继发脉络膜脱离的预防、发现及治疗提供理论依据,有效的减少该并发症的发生；(2)进一步证明超声生物显微镜(UBM, Ultrasound biomicroscopy)在青光眼临床应用中的价值。方法：回顾性的分析2007年11月-2010年1月于吉林大学第二医院青光眼科收治并行小梁切除术治疗的502例(632眼)闭角型青光眼患者的临床资料,男236例,女266例,年龄为50-80岁,平均为(65.85±6.11)岁。其中311例(407眼)为急性闭角型青光眼(AACG),占64.4%；191例(225眼)为慢性闭角型青光眼(CACG),占35.6%。(1)根据AACG组和CACG组滤过术后继发脉络膜脱离的例数进行统计学分析。(2)根据AACG组和CACG组滤过术前存在睫状体脱离的例数进行统计学分析。(3)根据(1)(2)的数据中进行x2检验,从分析中得出闭角型青光眼滤过术后继发脉络膜脱离与术前存在睫状体脱离是否具有相关性。(4)502例(632眼)闭角型青光眼患者中术后继发脉络膜脱离的29例(30眼)患者为A组,同时随机选取同一时期入院行小梁切除术治疗但术后未继发脉络膜脱离的30例(35眼)闭角型青光眼患者为对照组B组。将AB两组的性别构成、年龄分布、术前中央前房深度、术前眼压、术后眼压及手术前后眼压下降幅度进行统计学分析。结果：(1) CACG滤过术后继发脉络膜脱离的发生率高于AACG,差异具有统计学意义(P0.05)。(2) AACG滤过术前存在睫状体脱离的发生率高于CACG,差异具有统计学意义(P0.05)。(3)将AACG组患者术前存在睫状体脱离与滤过术后继发脉络膜脱离的眼数进行χ2检验,,得出统计学结果为P0.05认为差异无统计学意义,AACG滤过术后继发脉络膜脱离与术前存在睫状体脱离无相关性。(4)将CACG组患者术前存在睫状体脱离与滤过术后继发脉络膜脱离的眼数进行χ2检验,,得出统计学结果为P0.05认为差异具有统计学意义,CACG滤过术后继发脉络膜脱离与术前存在睫状体脱离具有相关性。(5) A组的年龄分布比B组高,差异具有统计学意义(p0.05),即年龄越大,滤过术后继发脉络膜脱离的发生率越高。(6) A组的术前平均中央前房深度(ACD)比B组低,差异具有统计学意义(p0.05),说明术前前房越浅,术后越易继发脉络膜脱离。(7) A组的术前眼压高于B组,差异具有统计学意义(p0.05);A组的滤过手术前后眼压下降幅度高于B组,差异具有统计学意义(p0.05),说明术前眼压越高,经滤过手术后,眼压下降幅度越大,术后越易继发脉络膜脱离。(8)术后继发脉络膜脱离的患者经保守治疗全部恢复。结论：(1)滤过性手术后继发脉络膜脱离是一个由多种因素共同导致的复杂的病理过程。(2)术前眼压越高,经手术后眼压下降幅度越大,继发脉络膜脱离的可能性越大。(3)慢性闭角型青光眼滤过术后继发脉络膜脱离与术前存在睫状体脱离具有相关性。(4)急性闭角型青光眼滤过术前存在睫状体脱离的发生率高于慢性闭角型青光眼；术后继发脉络膜脱离的发生率低于慢性闭角型青光眼。(5)滤过术后继发脉络膜脱离合并I～II级浅前房的治疗方式应首选保守治疗。
[Abstract]:Objective: (1) to explore the correlation between secondary choroidal detachment and the presence of ciliary body detachment before surgery for glaucoma filtering surgery, and to provide a theoretical basis for the prevention, discovery and treatment of secondary choroidal detachment after angle closure glaucoma filtering surgery, and to effectively reduce the incidence of this complication; (2) further proof of the ultrasonic biomicroscope (UBM, Ul) The clinical value of trasound biomicroscopy in glaucoma.
Methods: a retrospective analysis of the clinical data of 502 cases (632 eyes) with angle closure glaucoma treated with trabeculectomy in the second hospital of Jilin University, November 2007. 236 men, 266 women, 50-80 years old, with an average age of 65.85 + 6.11 years, 311 cases (407 eyes) as acute angle closure glaucoma (AACG), including 632 eyes (65.85 + 6.11) years old. Accounting for 64.4%; 191 cases (225 eyes) were chronic angle closure glaucoma (CACG), accounting for 35.6%. (1) according to the number of cases of secondary choroidal detachment in group AACG and group CACG. (2) the number of cases of ciliary body detachment before the AACG and CACG groups were analyzed. (3) according to the data of (1) (2), the x2 test was carried out, from the analysis of the analysis. There is a correlation between secondary choroidal detachment after closure of angle closure glaucoma and preoperative ciliary body detachment. (4) 29 cases (30 eyes) of secondary choroidal detachment in 502 (632 eyes) patients with angle closure glaucoma were in group A, at the same time randomly selected trabeculectomy at the same time admission but not secondary choroid membrane after operation. 30 cases (35 eyes) of angle closure glaucoma were divided into the control group B. The sex composition of the two groups of AB, the age distribution, the pre operation central anterior chamber depth, the intraocular pressure before operation, the intraocular pressure after operation and the decrease of intraocular pressure before and after the operation were statistically analyzed.
Results: (1) the incidence of secondary choroidal detachment after CACG filtration was higher than that of AACG (P0.05). (2) the incidence of ciliary body detachment before AACG filtration was higher than that of CACG, and the difference was statistically significant (P0.05). (3) the number of ciliary body detachment and secondary choroidal detachment in the AACG group before operation was found. By the chi 2 test, the statistical results were found to have no statistical significance for P0.05, and there was no correlation between the secondary choroidal detachment after AACG filtration and the presence of ciliary body detachment before the operation. (4) the number of eyes of the group CACG patients before the ciliary detachment and secondary choroidal detachment after the filtration was tested by chi chi 2, and the statistical results were found to be P0.05 recognition. The statistical significance of the difference was statistically significant. (5) the age distribution in the A group was higher than that of the B group (5), the difference was statistically significant (P0.05), that is, the older the age, the higher the incidence of secondary choroidal detachment after filtration. (6) the average preoperative anterior chamber depth (ACD) in the A group. Compared with the B group, the difference was statistically significant (P0.05), indicating that the anterior chamber of the anterior chamber was more shallow and the more easily secondary choroidal detachment. (7) the preoperative intraocular pressure of group A was higher than that of group B, the difference was statistically significant (P0.05); the decrease of intraocular pressure in group A was higher than that of the B group, and the difference was statistically significant (P0.05), indicating that the higher the intraocular pressure was before operation, the filtration was filtered. After surgery, the greater the decrease of intraocular pressure, the more likely postoperative choroidal detachment. (8) the patients with secondary choroidal detachment after operation were all recovered by conservative treatment.
Conclusions: (1) secondary choroidal detachment after filtration surgery is a complicated pathological process caused by a variety of factors. (2) the higher the intraocular pressure before operation, the greater the decrease of intraocular pressure after operation, the greater the possibility of secondary choroidal detachment. (3) the secondary choroidal detachment after the filtration of chronic angle closure glaucoma and the presence of ciliary body before the operation. (4) the incidence of ciliary body detachment in acute angle closure glaucoma before filtering surgery is higher than that of chronic angle closure glaucoma; the incidence of secondary choroidal detachment after operation is lower than that of chronic angle closure glaucoma. (5) the treatment of secondary choroidal detachment with I to II in the shallow anterior chamber should be the first choice.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R779.6

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