原发性闭角型青光眼局部应用睫状肌麻痹剂后眼前节形态及眼压变化的研究

发布时间：2018-06-19 19:03

本文选题：闭角型青光眼 + 睫状肌麻痹　；参考：《天津医科大学》2011年硕士论文

【摘要】：目的 1.应用超声生物显微镜(ultrasound biomicroscopy, UBM)及Pentacam眼前节分析系统观察原发性闭角型青光眼(primary angle-closure glaucoma,PACG)散瞳前后眼前节形态变化,对各个测量值之间进行整体的综合分析,为临床工作提供参考依据。 2.非接触眼压计监测原发性闭角型青光眼应用睫状肌麻痹计剂散瞳前后眼压变化,分析急性与慢性闭角型青光眼散瞳后眼压变化的差异。方法 1.选择2010年4月至2010年11月在天津医科大学眼科中心住院的原发性闭角型青光眼患者68眼(68例),其中急性闭角型青光眼患者32例(32眼),慢性闭角型青光眼患者36例(36眼),所有患者均即将施行白内障摘除联合人工晶状体植入+复合小梁切除术。应用Pentacam眼前节分析系统及UBM对68例患者应用睫状肌麻痹计剂散瞳前后的眼前节形态学进行检查。 2.采用非接触眼压计测量原发性闭角型青光眼应用复方托吡卡胺后15min、30mim、1h、2h、3h、4h眼压,整体分析眼压动态变化。采用SPSS16.0统计软件包对数据进行统计学分析。结果 1. PACG用睫状肌麻痹剂后在反映角膜改变的参数中,中央角膜厚度加厚,差异有统计学意义(P0.05)；角膜顶点厚度、角膜最薄处厚度、水平角膜曲率、垂直角膜曲率、角膜散光、Ecc值、散光轴向散瞳前后差异无统计学意义(P0.05)。 2.在反映房角改变的参数中,9、3、12、6点位房角开放度减小,9、3、12、6点位距离巩膜突500微米处房角开放距离房角开放距离减小,中央前房深度加深,距巩膜突500μm,小梁网内表面垂直于虹膜表面的虹膜厚度1(IT1),近瞳孔缘虹膜最厚处的虹膜厚度2(IT2),差异有统计学意义(P0.05)。 3.在反映睫状体改变的参数中,睫状体厚度减小,巩膜睫状体夹角增大,差异有显著性(P0.05)；小梁网睫状突距离减小,巩膜虹膜夹角增大,但差异无统计学意义(P0.05)。 4. PACG应用睫状肌麻痹计剂散瞳后监测眼压4小时,两组患者眼压较散瞳前均有升高,A-PACG组眼压升高明显,眼压升高幅度≥8mmHg, A-PACG组有7例,C-PACG组有1例,两组相比较差异有统计学意义(P0.05)。结论 1.原发性闭角型青光眼局部应用睫状肌麻痹剂后,中央角膜厚度增加,中央前房深度加深,前房容积加大,房角变窄,虹膜增厚,睫状体变薄且向后移位,巩膜虹膜夹角增大,这些眼前节变化是青光眼发作的解剖基础。 2.原发性闭角型青光眼患者局部应用睫状肌麻痹剂散瞳后的4小时内,急性闭角型青光眼与慢性闭角型青光眼患者眼压均有增高,但是急性患者眼压升高更明显,眼压升高幅度更大,更易引起青光眼急性发作。慢性患者眼压虽有升高,眼压升高不明显,眼压升高幅度比较小,不易引起青光眼急性发作。
[Abstract]:objective
1. the morphological changes of anterior segment of primary angle closure glaucoma (primary angle-closure glaucoma, PACG) were observed by ultrasound biomicroscopy (UBM) and Pentacam anterior segment analysis system. The overall analysis of the measured values was integrated to provide reference for clinical work.
2. non contact tonometer monitored the changes of intraocular pressure before and after the mydriasis of ciliary muscle paralysis in primary angle closure glaucoma, and analyzed the difference of intraocular pressure (IOP) of acute and chronic angle closure glaucoma after mydriasis.
Method
1. the 68 eyes (68 cases) of primary angle closure glaucoma hospitalized in Ophthalmological Center of Tianjin Medical University from April 2010 to November 2010 were selected, including 32 cases of acute angle closure glaucoma (32 eyes) and 36 cases of chronic angle closure glaucoma (36 eyes). All patients were imminent cataract extraction combined with intraocular lens implantation + compound small Liang Qie. The anterior segment morphology of 68 patients before and after mydriasis was examined by Pentacam anterior segment analysis system and UBM.
2. the dynamic changes in intraocular pressure (15min, 30mim, 1H, 2h, 3h, 4h) were measured by noncontact intraocular pressure (tonometer) measurement of primary angle closure glaucoma and the intraocular pressure of 30mim, 1H, 2h, 3H and 4H were analyzed. The statistical analysis of the data was carried out by the SPSS16.0 statistical package.
Result
1. PACG with ciliary muscle paralysis agent in the parameters reflecting the corneal change, the thickness of the central cornea was thicker, the difference was statistically significant (P0.05); the thickness of the corneal vertex, the thickness of the cornea, the horizontal corneal curvature, the vertical corneal curvature, the corneal astigmatism, the Ecc value, and the axial dispersion of astigmatism before and after the pupil (P0.05).
2. in the parameters reflecting the change of the angle of the room, the opening angle of the 9,3,12,6 point angle decreased, the opening distance of the angle open distance of the 9,3,12,6 point distance from the scleral process decreased, the depth of the central anterior chamber was deepened, the distance from the scleral process 500 u m, the iris thickness perpendicular to the iris surface was 1 (IT1), and the iris near the near pupil edge of the iris was the thickest iris. The thickness was 2 (IT2), and the difference was statistically significant (P0.05).
3. in the parameters reflecting the ciliary body change, the thickness of ciliary body decreased and the angle of scleral ciliary body increased significantly (P0.05), the ciliary process distance of trabecular meshwork decreased and the iris angle increased, but the difference was not statistically significant (P0.05).
4. PACG was used to monitor intraocular pressure for 4 hours after the mydriasis of the ciliary muscle paralysis agent. The intraocular pressure in the two groups was higher than that before the pupil. In group A-PACG, the intraocular pressure increased obviously, the increase of intraocular pressure was more than 8mmHg, there were 7 cases in group A-PACG, 1 in group C-PACG, and the difference between the two groups was statistically significant (P0.05).
conclusion
1. after the local application of ciliary muscle paralysis agent in primary angle closure glaucoma, the central corneal thickness increased, the depth of the central anterior chamber deepened, the volume of the anterior chamber increased, the angle of the chamber narrowed, the iris was thickened, the ciliary body was thinner and backward, the iris angle increased, and these anterior segments were the anatomical basis of the glaucoma attack.
2. patients with primary angle closure glaucoma have increased intraocular pressure in acute angle closure glaucoma and chronic angle closure glaucoma within 4 hours after local application of the ciliary muscle paralysis agent. However, the increase of intraocular pressure is more obvious in acute patients, the increase of intraocular pressure is greater and the acute attack of the eye is more likely to be caused. The increase of intraocular pressure is not obvious, and the increase of intraocular pressure is relatively small, which is not easy to cause acute attack of glaucoma.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R775.2

【参考文献】