本文關鍵詞：不同手術方式治療新生血管性青光眼的療效觀察　出處：《昆明醫(yī)科大學》2015年碩士論文　論文類型：學位論文

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【摘要】：目的：本文比較Ex-press青光眼引流器植入術和小梁切除術+睫狀體冷凝術治療新生血管性青光眼的療效,從而探索NVG的最佳治療方案。方法：選擇2012.1-2014.12于昆明醫(yī)科大學第一附屬醫(yī)院眼科住院治療的新生血管性青光眼患者,共48例(51只眼),所有患者均給予經(jīng)睫狀體平坦部玻璃體腔注射Lucentis0.1ml(1.0mg)。注藥3-5天后,根據(jù)不同的手術方式將其分為兩組：A組(Ex-press青光眼引流器植入術組)：23例26眼,行Ex-press青光眼引流器植入術；B組(小梁切除術+睫狀體冷凝術組)：25例25眼,行小梁切除術+睫狀體冷凝術。觀察比較兩組手術前至術后1周、1月、3月、6月,分別記錄兩組的平均眼壓、視力、使用抗青光眼藥物數(shù)量、手術成功率(完全成功和部分成功的人數(shù)占各組總?cè)藬?shù)的比例)、并發(fā)癥情況,并進行兩組間比較。結(jié)果：1.兩組術后1周、1月、3月、6月的平均眼壓較術前明顯降低,其中A組分別降低29.93mmhg,31mmhg,31.66mmhg,31.62mmhg;B組分別降低22.64mmhg,23.6 mmhg,24.2mmhg,26.16mmhg。差異有統(tǒng)計學意義(P0.001)。2.A組較B組術后1周、1月、3月的平均眼壓高,分別高5.46mmhg,5.57mmhg, 5.63mmhg。差異有統(tǒng)計學意義(P0.05)。A組與B組術后6月平均眼壓分別為14.73±5.02,18mmhg.36±10.23mmhg,B組較A組高3.63mmhg。差異無統(tǒng)計學意義(P=0.1)。3.兩組術后使用降眼壓藥物的數(shù)量分別為0.42±0.95,1.24±1.64,較術前使用的降眼壓藥物數(shù)量明顯減少,差異有統(tǒng)計學意義(P0.001)。兩組間相比,A組較B組術后使用降眼壓藥物的數(shù)量少0.82種,差異有統(tǒng)計學意義(t=2.1681,P=0.03647)。4.兩組成功率分別為88.5%,60.0%。A組較B組手術成功率高,差異有統(tǒng)計學意義(x 2=6.7436,P=0.009)。5.兩組術后并發(fā)癥分別進行對比,總的并發(fā)癥發(fā)生率分別為19.2%,60.0%。B組總的并發(fā)癥發(fā)生率明顯高于A組,差異有統(tǒng)計學意義(P=0.006)。其中前房出血的發(fā)生率分別為7.7%,32.0%,B組明顯高于A組,差異有統(tǒng)計學意義(P=0.02)。兩組間淺前房、低眼壓、前房滲出、脈絡膜脫離、眼球萎縮的發(fā)生率比較無統(tǒng)計學差異(P0.05)結(jié)論：1.Ex-press青光眼引流器植入術和小梁切除術+睫狀體冷凝術對于治療NVG均有顯著效果。2.Ex-press青光眼引流器植入術降眼壓效果更好,手術成功率高,且操作簡單,術后用藥少,術后并發(fā)癥少,視力維持好,對于有一定視功能的患者是一種較為安全有效的治療方法。3.小梁切除術+睫狀體冷凝術是一種破壞性手術,術后并發(fā)癥多,但操作簡單,可多次進行,只要嚴格掌握適應癥,冷凍量適度,不失為新生血管性青光眼的治療選擇之一。
[Abstract]:Objective: To compare the efficacy of Ex-press glaucoma drainage device implantation and trabeculectomy combined with cyclocryotherapy for neovascular glaucoma, so as to explore the best treatment of NVG. Methods: 2012.1-2014.12 in the First Affiliated Hospital of Kunming Medical University hospital treatment of patients with neovascular glaucoma, 48 cases (51 eyes) and all the patients were treated with pars plana intravitreal injection of Lucentis0.1ml (1.0mg). 3-5 days after injection, according to the different operation mode will be divided into two groups: group A (Ex-press glaucoma drainage device implantation group):23 cases 26 eyes underwent Ex-press glaucoma drainage device implantation; group B (small trabeculectomy + CYCLOCRYOSURGERY group):25 cases 25 eyes underwent trabeculectomy + CYCLOCRYOSURGERY. The two groups were observed and compared before surgery to 1 weeks after surgery, January, March, June, the average intraocular pressure were recorded, two groups of the vision, the With the number of anti glaucoma drugs, surgical success rate (complete success and success ratio of the number of the total number of groups), complications, and compared between the two groups. Results: 1. of the two groups after 1 weeks, January, March, June the average IOP decreased significantly in the A group, respectively. 29.93mmhg, 31mmhg, 31.66mmhg, 31.62mmhg; group B were reduced by 22.64mmhg, 23.6 mmHg, 24.2mmhg, 26.16mmhg. difference was statistically significant (P0.001) in.2.A group than in B group after 1 weeks of operation, in January March, the average intraocular pressure were high, high 5.46mmhg, 5.57mmhg, there were significant differences in 5.63mmhg. (P0.05).A group and B group after June the average IOP was 14.73 + 5.02,18mmhg.36 + 10.23mmhg, B group was higher than A group 3.63mmhg. showed no significant difference (P=0.1).3. two group after use number of hypotensive drugs were 0.42 + 0.95,1.24 + 1.64, compared with the preoperative IOP drug use quantity obviously Reduce, the difference was statistically significant (P0.001). Compared between the two groups, A group than in B group after the IOP drug of the number of 0.82, the difference was statistically significant (t=2.1681, P=0.03647).4. two group success rate was 88.5%, 60.0%.A group compared with B group, the success rate is high, the difference was statistically significant (x 2=6.7436, P=0.009.5.) postoperative complications of two groups were compared. The total complication rate was 19.2%, 60.0%.B group the overall complication rate was significantly higher than A group, the difference was statistically significant (P=0.006). The anterior chamber hemorrhage rate respectively is 7.7%, 32%, B group was significantly higher than that of A group, the difference was statistically significant (P=0.02). Among the two groups of shallow anterior chamber, low intraocular pressure, anterior chamber exudation, choroidal detachment, eyeball atrophy rate had no significant difference (P0.05) conclusion: 1.Ex-press glaucoma drainage device implantation and trabeculectomy + CYCLOCRYOSURGERY for treatment NVG treatment had a significant effect of.2.Ex-press glaucoma drainage device implantation intraocular pressure lowering effect is better, the success rate is high, and has the advantages of simple operation, less postoperative medication, less postoperative complications, maintain good eyesight, for a visual function in some patients is a safe and effective treatment method for.3. trabeculectomy + ciliary body cryotherapy is a destructive operation, postoperative complications, but the operation is simple, can be repeated, as long as the indications, frozen in moderation, one choice is the treatment of neovascular glaucoma.

【學位授予單位】：昆明醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R779.6

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