光学相干断层扫描对青光眼联合白内障术后黄斑厚度变化的初步观察

发布时间：2018-08-08 20:32

【摘要】： 目的： 应用光学相干断层扫描(optical coherence tomography,OCT)观察青光眼联合白内障术后黄斑中心凹视网膜厚度的变化。 方法： 本研究选自2009年2月至2010年2月因原发性青光眼和白内障在湘雅医院眼科住院的病人及医院体检的正常人。分为4组：A组：原发性青光眼合并白内障的患者34例34眼,行白内障超声乳化联合小梁切除术。B组：单纯年龄相关性白内障患者45例45眼,行白内障超声乳化术。C组：原发性青光眼患者40例48眼,行小梁切除术。D组：正常组,22例44眼。采用OCT测量A、B、C各组术前、术后1周、4周黄斑中心凹视网膜厚度及D组正常眼的黄斑中心凹视网膜厚度,并比较各组及各组间术前术后黄斑中心凹视网膜厚度的变化。 结果： 1.D组黄斑中心凹视网膜厚度为189.82±25.24 um。A、B、C各组术前黄斑中心凹视网膜厚度分别为196.82±41.88um、190.53±26.65um、182.75±36.86um。A、B、C、D组比较差异无统计学意义(P0.05)。 2.A组术前、术后1周、4周黄斑中心凹视网膜厚度分别为196.82±41.88um、228.79±45.73um、225.94.±41.38um。术后1周、4周同术前比较黄斑中心凹视网膜厚度增加,差异有统计学意义(p0.05)。 3.B组术前、术后1周、4周的黄斑中心凹视网膜厚度分别为190.53±26.65um、191.53.±26.96 um、202.40±26.11 um。术后1周、4周同术前比较黄斑中心凹视网膜厚度增加,仅于术后4周差异有统计学意义(p0.05)。 4.C组术前、术后1周、4周的黄斑中心凹视网膜厚度分别为182.75±36.86um、187.96±34.03um、184.17.±39.28um。术后1周、4周同术前比较黄斑中心凹视网膜厚度增加,差异无统计学意义(p0.05)。各组之间两两比较,A组与B组,A组与C组黄斑中心凹视网膜厚度有差异,差异有统计学意义(p0.05),B组与C组差异无统计学意义(P0.05)。 5.A组和C组术前眼压与黄斑中心凹视网膜厚度呈正相关,相关系数为(r=0.401,P=0.019和r=0.382,P=0.007)；B组术前眼压与黄斑中心凹视网膜厚度无相关性,相关系数为(r=0.205,P=0.176)。 6.A组术后视力与术后1、4周黄斑中心凹视网膜厚度呈负相关,相关系数为(r=-0.423,P=0.013；r=-0.404,P=0.018)；B组与C组术后视力与术后1、4周黄斑中心凹视网膜厚度无相关性,相关系数为(r=0.008,P=0.957；r=0.220,P=0.147)和(r=-0.226,P=0.123：r=-0.160,P-0.277)。 结论： 1.白内障超声乳化术后可导致黄斑中心凹视网膜厚度增厚,在联合青光眼小梁切除手术时增厚更为明显。 2.OCT是临床上观察青光眼联合白内障术后早期黄斑变化的一种简便,快捷,无创伤的方法。
[Abstract]:Objective: to observe the retinal thickness of macular fovea after glaucoma and cataract surgery by optical coherence tomography (Oct). Methods: from February 2009 to February 2010, the patients admitted to Xiangya Eye Hospital for primary glaucoma and cataract and the normal subjects were studied. Group A: 34 cases (34 eyes) with primary glaucoma and cataract, group B (45 eyes) were treated with phacoemulsification combined with trabeculectomy (group B), and 45 cases (45 eyes) with age-related cataract were treated with phacoemulsification combined with trabeculectomy. Phacoemulsification was performed on 40 patients with primary glaucoma (48 eyes) and trabeculectomy group (44 eyes). The retinal thickness of macular central fovea was measured by OCT before operation, 1 week after operation and 4 weeks after operation, and the retinal thickness of macular central fovea in group D was compared before and after operation. Results: 1. The retinal thickness of macular fovea in group D was 189.82 卤25.24 um.An, the retinal thickness of macular fovea in group D was 196.82 卤41.88 uma, 190.53 卤26.65um.There was no significant difference between group A and group A before operation (P0.05). The retinal thickness of macular fovea was 228.79 卤45.73umn, 225.94 卤41.38um. The retinal thickness of macular fovea in group B was 190.53 卤26.65 uma, 191.53 卤26.96 uma, 202.40 卤26.11 uma, respectively. The retinal thickness of macular fovea increased 1 week after operation and 4 weeks after operation, only 4 weeks after operation (p0.05). The retinal thickness of macular central fovea in group C was 182.75 卤36.86 uma 187.96 卤34.03umn / 184.17 卤39.28 uma before operation and 4 weeks after operation respectively. The retinal thickness of macular fovea increased 1 week and 4 weeks after operation (p 0.05). The retinal thickness of macular fovea in group A and group B was different from that in group A and group C. There was no significant difference between group B and group C (P0.05). 5. Intraocular pressure was positively correlated with retinal thickness of central fovea of macula in group A and C (r = 0.401, P = 0.019, r = 0.382, P = 0.007). There was no correlation between intraocular pressure (IOP) and retinal thickness of macular central fovea in group B (r = 0.205). In group A, postoperative visual acuity was negatively correlated with retinal thickness of macular central fovea at 1 week and the correlation coefficient was (r = 0.423). There was no correlation between the visual acuity of group B and group C and the retinal thickness of macular central fovea at 1 and 4 weeks postoperatively. The correlation coefficients were (r = 0.008) (r = 0.220) and (r = 0.226) (r = 0.123: r = 0.160 ~ (-1) P ~ (-0.277). Conclusion: 1. After phacoemulsification of cataract, the thickness of macular fovea can be thickened. 2.OCT is a simple, rapid and noninvasive method for observing the early macular changes after glaucoma and cataract surgery.
【学位授予单位】：中南大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R779.6

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