超声乳化联合小梁切除与联合房角分离术治疗急性闭角型青光眼合并白内障的疗效
发布时间：2018-08-19 05:47
【摘要】：目的:观察与对比超声乳化白内障吸除联合小梁切除术与超声乳化白内障吸除联合房角分离术治疗原发性急性闭角型青光眼合并白内障的临床效果和安全性。 对象和方法:回顾性分析研究2006年8月到2009年8月在重庆市第九人民医院眼科住院的原发性急性闭角型青光眼合并白内障患者67例(70眼);其中男性25例(26眼,其中一人是双眼),女性42例(44眼,其中两人是双眼)。33眼行超声乳化白内障吸除植入人工晶体联合小梁切除术(以下简称小梁组),37眼行超声乳化白内障吸除植入人工晶体联合房角分离术(以下简称房角组);随访时间3-12个月,通过观察两种不同手术方式组患者术前与术后眼压、视力、中央前房深度、周边前房深度、房角、晶状体厚度、眼轴长度、晶状体厚度/眼轴长度系数、术后用药情况及并发症,分析两种不同手术方式对治疗原发性急性闭角型青光眼合并白内障的临床疗效。 结果: 1眼压:小梁组术前眼压为45.83±15.97mmHg,术后眼压为15.18±5.62mmHg(P0.01);房角组术前眼压为41.36±13.06mmHg,术后眼压为17.09±7.66mmHg(P0.01)。小梁组术后眼压降低幅度为30.66±14.15mmHg,房角组术后眼压降低幅度为22.35±8.72mmHg,差异有统计学意义(P0.05)。 2视力:术后12个月时复查视力:小梁组27眼(81.8%)术后末次视力提高1行以上,4眼(12.1%)术后末次视力基本无变化(以术前所测视力为标准,国际标准视力表上下1行范围),1眼(3.1%)术后视力下降1行以上,术前、术后视力构成比差异有统计学意义(χ2=31.061,P0.01);房角组34眼(91.9%)术后末次视力提高1行以上,2眼(5.4%)术后末次视力基本无变化,1眼(2.7%)术后视力下降1行以上,术前、术后视力构成比差异有统计学意义(χ2=32.996,P0.01);小梁组和房角组术后视力比较构成比差异无统计学意义(χ2=4.863,P=0.677)。 3中央前房深度:小梁组术前、术后中央前房深度分别为1.4706±0.2034mm、3.2794±0.3772mm(P0.01);房角组术前、术后分别为1.5168±0.1879mm、3.5832±0.3186mm(P0.01);小梁组和房角组术后中央前房深度加深幅度分别为1.8088±0.3879mm和2.0665±0.2784mm,差异有统计学意义(P0.01)。 4周边前房深度及房角: 4.1周边前房深度:将周边前房深度分级视为等级变量,小梁组术前、术后周边前房深度分别为1.1515±0.3641、2.9091±0.2919(P0.01);房角组术前、术后分别为1.1081±0.3148、3.9730±0.1644(P0.01)。 4.2房角:采用spaeth房角分类法,将spaeth房角分类法中房角形态的A、B、C、D分别视为等级变量1、2、3、4做统计学分析,小梁组术前、术后房角分别为1.0606±0.2423、3.6061±0.4962(P0.01);房角组术前、术后分别为1.1078±0.3145、3.9149±0.2767(P0.01);术后小梁组和房角组房角分别为3.6061±0.4962和3.9189±0.2767,差异有统计学意义(P=0.002)。 5晶状体厚度、眼轴长度、晶状体厚度/眼轴长度系数: 5.1晶状体厚度:术前小梁组、房角组晶状体厚度分别为5.0482±0.2311mm、5.0584±0.2274mm(P=0.853);术后小梁组和房角组人工晶体厚度均不足1mm,两种手术方式术前术后晶状体厚度变化差值均有统计学意义(P0.01)。 5.2眼轴长度:小梁组术前、术后眼轴长度分别为21.7858±0.5374mm、21.8176±0.5209mm(P=0.102);房角组术前、术后分别为21.8138±0.5526mm、21.8543±0.4808mm(P=0.086)。 5.3晶状体厚度/眼轴长度系数:术前小梁组、房角组晶状体厚度/眼轴长度系数分别为0.2319±0.0121、0.2321±0.0125(P=0.944);术后小梁组和房角组晶状体厚度/眼轴长度系数分别为0.0446±0.0113、0.0447±0.0115(P=0.967)。 6术后并发症:术后角膜水肿小梁组5眼(15.2%),房角组5眼(13.5%);虹膜纤维素样渗出及前房炎症小梁组9眼(27.3%),房角组2眼(5.4%);睫状环阻滞性青光眼小梁组2眼(6.1%),房角组1眼(2.7%);术后浅前房小梁组6眼(18.2%),房角组1眼(2.7%);结膜滤泡渗漏小梁组2眼(6.1%);脉络膜脱离小梁组3眼(9.1%),房角组无;瞳孔人工晶体粘连者小梁组3眼(9.1%),房角组2眼(5.4%);后发性白内障小梁组2眼(6.1%),房角组1眼(2.7%)。 7.手术成功率:70例患眼完全成功60眼(85.71%),条件成功7眼(10.00%),失败3眼(4.29%);其中小梁组(共33眼)完全成功30眼(90.91%),条件成功2眼(6.06%),失败1眼(3.03%);房角组(共37眼)完全成功30眼(81.08%),条件成功5眼(13.51%),失败2眼(5.41%)。 结论:超声乳化白内障吸除人工晶体植入联合小梁切除术与联合房角分离术均是治疗原发性急性闭角型青光眼合并白内障的安全有效的方法;小梁组在眼压控制方面的术后疗效优于房角组;房角组在中央前房深度加深幅度和房角形态变化方面的术后疗效优于小梁组;小梁组的术后并发症多于房角组。
[Abstract]:Objective: To observe and compare the clinical efficacy and safety of phacoemulsification combined with trabeculectomy and phacoemulsification combined with angle separation in the treatment of primary acute angle closure glaucoma with cataract.
PARTICIPANTS AND METHODS: From August 2006 to August 2009, 67 patients (70 eyes) with primary acute angle-closure glaucoma and cataract admitted to the Ophthalmology Department of Chongqing Ninth People's Hospital were retrospectively analyzed, including 25 males (26 eyes), one female (44 eyes) and 42 females (two eyes). Intraocular lens implantation combined with trabeculectomy (trabeculectomy group), 37 eyes underwent phacoemulsification and intraocular lens implantation combined with angle separation (angle group); the follow-up time was 3-12 months. The intraocular pressure, visual acuity, central anterior chamber depth, peripheral anterior chamber depth, and chamber depth were observed before and after operation in the two groups. Angle, lens thickness, axial length, lens thickness/axial length coefficient, postoperative medication and complications were analyzed for the clinical efficacy of two different surgical methods in the treatment of primary acute angle-closure glaucoma with cataract.
Result:
IOP: The intraocular pressure of trabecular group was 45.83 (+ 15.97 mmHg) before operation and 15.18 (+ 5.62 mmHg) after operation (P 0.01); the intraocular pressure of angle group was 41.36 (+ 13.06mmHg) before operation and 17.09 (+ 7.66 mmHg) (P 0.01). The intraocular pressure of trabecular group decreased by 30.66 (+ 14.15 mmHg) and angle group by 22.35 (+ 8.72 mmHg) after operation (P 0.01). 05).
Visual acuity: 12 months after surgery: 27 eyes (81.8%) in trabecular meshwork group had improved their last visual acuity by more than one line, 4 eyes (12.1%) had no change in the last visual acuity after surgery (according to preoperative visual acuity, 1 line above and below the international standard visual acuity scale), 1 eye (3.1%) had decreased visual acuity by more than one line after surgery. The final visual acuity of 34 eyes (91.9%) in the angle group was improved by more than one line, 2 eyes (5.4%) had no change, and 1 eye (2.7%) had more than one line of decreased visual acuity. There was a significant difference in the ratio of postoperative visual acuity between the trabecular group and the angle group (_2=32.996, P 0.01). Significance (chi 2=4.863, P=0.677).
Central anterior chamber depth: trabecular group before surgery, the central anterior chamber depth was 1.4706 (+ 0.2034 mm), 3.2794 (+ 0.3772 mm) (P 0.01); angle group before surgery, the postoperative central anterior chamber depth were 1.5168 (+ 0.1879 mm), 3.5832 (+ 0.3186 mm) (P 0.01); trabecular group and angle group after surgery central anterior chamber depth were 1.8088 (+ 0.3879 mm) and 2.0665 (+ 0.2784 mm), the difference was statistically significant. Academic meaning (P0.01).
4 peripheral anterior chamber depth and angle:
4.1 Peripheral anterior chamber depth: Peripheral anterior chamber depth grading was regarded as a grading variable. Before trabecular surgery, the peripheral anterior chamber depth was 1.1515 (+ 0.3641), 2.9091 (+ 0.2919) (P 0.01) in trabecular group, and 1.1081 (+ 0.3148), 3.9730 (+ 0.1644) (P 0.01) in angle group.
4.2 Angle: A, B, C, D were classified as grade variables 1, 2, 3, 4 by Spaeth Angle Classification. The angle of trabecular group was 1.060606.2423, 3.6061.4962 (P 0.01), 1.1078.3145, 3.9149.2767 (P 0.01) before operation and 3.9149.2767 (P 0.01) after operation. The angle of the atrial horn group was 3.6061 + 0.4962 and 3.9189 + 0.2767 respectively, the difference was statistically significant (P=0.002).
5 lens thickness, axial length, lens thickness / axial length coefficient:
5.1 Lens thickness: Preoperative trabecular lens thickness, anterior chamber angle group lens thickness were 5.0482 (+ 0.2311 mm), 5.0584 (+ 0.2274 mm) (P = 0.853); postoperative trabecular lens thickness and anterior chamber angle group intraocular lens thickness were less than 1 mm, the difference between the two surgical methods of preoperative and postoperative lens thickness was statistically significant (P 0.01).
5.2 Axial Length: Before and after trabecular surgery, the axial length of trabecular surgery was 21.7858 (+ 0.5374 mm) and 21.8176 (+ 0.5209mm) (P = 0.102), respectively; before and after surgery, the axial length of angle group was 21.8138 (+ 0.5526 mm) and 21.8543 (+ 0.4808mm) (P = 0.086).
5.3 Lens thickness/axial length coefficients: The preoperative trabecular lens thickness/axial length coefficients were 0.2319 (+0.0121) and 0.2321 (+0.0125) (P = 0.944) in the angle group, and 0.0446 (+0.0113) and 0.0447 (+0.0115) (P = 0.967) in the trabecular lens thickness/axial length coefficients in the angle group and the angle group respectively.
6 Postoperative complications: corneal edema in 5 eyes (15.2%) in trabecular group, anterior chamber angle in 5 eyes (13.5%); iris cellulose exudation and anterior chamber inflammation in 9 eyes (27.3%) in trabecular group, anterior chamber angle in 2 eyes (5.4%); ciliary ring block glaucoma in 2 eyes (6.1%) in trabecular group, anterior chamber angle in 1 eye (2.7%); superficial anterior chamber trabecular group in 6 eyes (18.2%) and anterior chamber angle in 1 eye (2.7%); Trabecular group 2 eyes (6.1%), choroidal detachment trabecular group 3 eyes (9.1%), angle group no; pupil intraocular lens adhesion trabecular group 3 eyes (9.1%), angle group 2 eyes (5.4%); posterior cataract trabecular group 2 eyes (6.1%) and angle group 1 eye (2.7%).
7. Successful rate of surgery: 70 cases of complete success in 60 eyes (85.71%), conditional success in 7 eyes (10.00%) and failure in 3 eyes (4.29%); Trabecular group (33 eyes) complete success in 30 eyes (90.91%), conditional success in 2 eyes (6.06%), failure in 1 eye (3.03%); angle group (37 eyes) complete success in 30 eyes (81.08%), conditional success in 5 eyes (13.51%) and failure in 2 eyes (5.41%).
Conclusion: Phacoemulsification and intraocular lens implantation combined with trabeculectomy and angle separation are safe and effective methods for primary acute angle closure glaucoma with cataract. The postoperative effect of the state change is better than that of the trabecular group, and the postoperative complications of the trabecular group are more than those of the atrial angle group.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R779.6
本文编号：2190775
[Abstract]:Objective: To observe and compare the clinical efficacy and safety of phacoemulsification combined with trabeculectomy and phacoemulsification combined with angle separation in the treatment of primary acute angle closure glaucoma with cataract.
PARTICIPANTS AND METHODS: From August 2006 to August 2009, 67 patients (70 eyes) with primary acute angle-closure glaucoma and cataract admitted to the Ophthalmology Department of Chongqing Ninth People's Hospital were retrospectively analyzed, including 25 males (26 eyes), one female (44 eyes) and 42 females (two eyes). Intraocular lens implantation combined with trabeculectomy (trabeculectomy group), 37 eyes underwent phacoemulsification and intraocular lens implantation combined with angle separation (angle group); the follow-up time was 3-12 months. The intraocular pressure, visual acuity, central anterior chamber depth, peripheral anterior chamber depth, and chamber depth were observed before and after operation in the two groups. Angle, lens thickness, axial length, lens thickness/axial length coefficient, postoperative medication and complications were analyzed for the clinical efficacy of two different surgical methods in the treatment of primary acute angle-closure glaucoma with cataract.
Result:
IOP: The intraocular pressure of trabecular group was 45.83 (+ 15.97 mmHg) before operation and 15.18 (+ 5.62 mmHg) after operation (P 0.01); the intraocular pressure of angle group was 41.36 (+ 13.06mmHg) before operation and 17.09 (+ 7.66 mmHg) (P 0.01). The intraocular pressure of trabecular group decreased by 30.66 (+ 14.15 mmHg) and angle group by 22.35 (+ 8.72 mmHg) after operation (P 0.01). 05).
Visual acuity: 12 months after surgery: 27 eyes (81.8%) in trabecular meshwork group had improved their last visual acuity by more than one line, 4 eyes (12.1%) had no change in the last visual acuity after surgery (according to preoperative visual acuity, 1 line above and below the international standard visual acuity scale), 1 eye (3.1%) had decreased visual acuity by more than one line after surgery. The final visual acuity of 34 eyes (91.9%) in the angle group was improved by more than one line, 2 eyes (5.4%) had no change, and 1 eye (2.7%) had more than one line of decreased visual acuity. There was a significant difference in the ratio of postoperative visual acuity between the trabecular group and the angle group (_2=32.996, P 0.01). Significance (chi 2=4.863, P=0.677).
Central anterior chamber depth: trabecular group before surgery, the central anterior chamber depth was 1.4706 (+ 0.2034 mm), 3.2794 (+ 0.3772 mm) (P 0.01); angle group before surgery, the postoperative central anterior chamber depth were 1.5168 (+ 0.1879 mm), 3.5832 (+ 0.3186 mm) (P 0.01); trabecular group and angle group after surgery central anterior chamber depth were 1.8088 (+ 0.3879 mm) and 2.0665 (+ 0.2784 mm), the difference was statistically significant. Academic meaning (P0.01).
4 peripheral anterior chamber depth and angle:
4.1 Peripheral anterior chamber depth: Peripheral anterior chamber depth grading was regarded as a grading variable. Before trabecular surgery, the peripheral anterior chamber depth was 1.1515 (+ 0.3641), 2.9091 (+ 0.2919) (P 0.01) in trabecular group, and 1.1081 (+ 0.3148), 3.9730 (+ 0.1644) (P 0.01) in angle group.
4.2 Angle: A, B, C, D were classified as grade variables 1, 2, 3, 4 by Spaeth Angle Classification. The angle of trabecular group was 1.060606.2423, 3.6061.4962 (P 0.01), 1.1078.3145, 3.9149.2767 (P 0.01) before operation and 3.9149.2767 (P 0.01) after operation. The angle of the atrial horn group was 3.6061 + 0.4962 and 3.9189 + 0.2767 respectively, the difference was statistically significant (P=0.002).
5 lens thickness, axial length, lens thickness / axial length coefficient:
5.1 Lens thickness: Preoperative trabecular lens thickness, anterior chamber angle group lens thickness were 5.0482 (+ 0.2311 mm), 5.0584 (+ 0.2274 mm) (P = 0.853); postoperative trabecular lens thickness and anterior chamber angle group intraocular lens thickness were less than 1 mm, the difference between the two surgical methods of preoperative and postoperative lens thickness was statistically significant (P 0.01).
5.2 Axial Length: Before and after trabecular surgery, the axial length of trabecular surgery was 21.7858 (+ 0.5374 mm) and 21.8176 (+ 0.5209mm) (P = 0.102), respectively; before and after surgery, the axial length of angle group was 21.8138 (+ 0.5526 mm) and 21.8543 (+ 0.4808mm) (P = 0.086).
5.3 Lens thickness/axial length coefficients: The preoperative trabecular lens thickness/axial length coefficients were 0.2319 (+0.0121) and 0.2321 (+0.0125) (P = 0.944) in the angle group, and 0.0446 (+0.0113) and 0.0447 (+0.0115) (P = 0.967) in the trabecular lens thickness/axial length coefficients in the angle group and the angle group respectively.
6 Postoperative complications: corneal edema in 5 eyes (15.2%) in trabecular group, anterior chamber angle in 5 eyes (13.5%); iris cellulose exudation and anterior chamber inflammation in 9 eyes (27.3%) in trabecular group, anterior chamber angle in 2 eyes (5.4%); ciliary ring block glaucoma in 2 eyes (6.1%) in trabecular group, anterior chamber angle in 1 eye (2.7%); superficial anterior chamber trabecular group in 6 eyes (18.2%) and anterior chamber angle in 1 eye (2.7%); Trabecular group 2 eyes (6.1%), choroidal detachment trabecular group 3 eyes (9.1%), angle group no; pupil intraocular lens adhesion trabecular group 3 eyes (9.1%), angle group 2 eyes (5.4%); posterior cataract trabecular group 2 eyes (6.1%) and angle group 1 eye (2.7%).
7. Successful rate of surgery: 70 cases of complete success in 60 eyes (85.71%), conditional success in 7 eyes (10.00%) and failure in 3 eyes (4.29%); Trabecular group (33 eyes) complete success in 30 eyes (90.91%), conditional success in 2 eyes (6.06%), failure in 1 eye (3.03%); angle group (37 eyes) complete success in 30 eyes (81.08%), conditional success in 5 eyes (13.51%) and failure in 2 eyes (5.41%).
Conclusion: Phacoemulsification and intraocular lens implantation combined with trabeculectomy and angle separation are safe and effective methods for primary acute angle closure glaucoma with cataract. The postoperative effect of the state change is better than that of the trabecular group, and the postoperative complications of the trabecular group are more than those of the atrial angle group.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R779.6
【参考文献】
相关期刊论文 前3条
1 梁远波,王宁利,乔利亚,宋旭东;对单纯白内障手术治疗合并白内障的闭角型青光眼的疗效评价[J];中华眼科杂志;2004年11期
2 王宁利!510060,欧阳洁,周文炳!510060,赖铭莹,叶天才!510060,曾明兵!510060,陈静嫦!510060;中国人闭角型青光眼房角关闭机制的研究[J];中华眼科杂志;2000年01期
3 张秀兰;葛坚;蔡小于;杜绍林;凌运兰;林明楷;;三种手术方式治疗原发性闭角型青光眼初步疗效比较研究[J];中国实用眼科杂志;2006年07期
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