本文選題：青光眼　切入點：Ex-PRESS　出處：《南昌大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:觀察Ex-PRESS引流釘植入術(shù)在青光眼的治療中的短期療效及并探討其安全性。方法:1研究對象為我院原發(fā)性開角型青光眼患者,其中行Ex-PRESS引流釘植入術(shù)為15例23眼(引流釘組),行小梁切除術(shù)為16例26眼(小梁切除組),分別收集兩組術(shù)后1天、3天、1周、2周、1月、2月、3月、6月的視力、眼壓、并發(fā)癥、使用降眼壓藥物的情況以及手術(shù)成功率,對其結(jié)果進行比較分析。手術(shù)成功標(biāo)準(zhǔn)為眼壓較術(shù)前下降20%或眼壓位于5mm Hg與20mm Hg之間。2研究對象為我院行Ex-PRESS引流釘植入術(shù)的特殊類型青光眼患者(18例20眼),收集術(shù)后1天、3天、1周、2周、1月、2月、3月、6月的視力、眼壓、并發(fā)癥以及使用降眼壓藥物的情況,將結(jié)果與術(shù)前比較,分析其手術(shù)效果。納為本研究的特殊類型青光眼包括先天性青光眼,色素性青光眼,新生血管性青光眼,假性剝脫綜合征,葡萄膜炎繼發(fā)性青光眼,激素性青光眼,抗青光眼手術(shù)失敗的青光眼,外傷性青光眼以及人工晶體植入術(shù)后青光眼;手術(shù)成功標(biāo)準(zhǔn)為眼壓較術(shù)前下降20%或眼壓處于5mm Hg與20mm Hg之間。結(jié)果:1引流釘組術(shù)后視力與術(shù)前相比,術(shù)后1天、3天、1周、2周具有顯著性差異(p0.05),比術(shù)前降低,1月視力恢復(fù),與術(shù)前比較無統(tǒng)計學(xué)差異(p0.05);小梁切除組術(shù)后視力與術(shù)前相比,術(shù)后1天、3天、1周、2周、1月具有顯著性差異(p0.05),明顯比術(shù)前視力降低,2月視力恢復(fù),與術(shù)前相比無統(tǒng)計學(xué)意義(p0.05);引流釘組與小梁切除組兩組視力術(shù)后各個時間點相比無統(tǒng)計學(xué)差異(p0.05)。引流釘組與小梁切除組術(shù)后眼壓與術(shù)前相比,1天、3天、1周、2周、1月、2月、3月、6月眼壓具有顯著性差異(p0.05),明顯比術(shù)前眼壓降低。引流釘組與小梁切除組術(shù)后眼壓兩組相比,各個時間點皆無顯著性差異(p0.05)。術(shù)后6月兩組成功率相比無顯著性差異(p0.05)。引流釘組出現(xiàn)并發(fā)癥的為3眼(淺前房1眼,引流釘入口虹膜堵塞1眼,暫時性高眼壓1眼),小梁切除組并發(fā)癥為12眼(淺前房6眼,前房積血4眼,暫時性高眼壓1眼,濾過泡滲漏1眼)。兩組并發(fā)癥比較,具有統(tǒng)計學(xué)意義(p0.05),引流釘組并發(fā)癥較小梁切除組少。2引流釘治療特殊類型青光眼術(shù)后視力與術(shù)前相比,術(shù)后1天、3天、1周、2周、1月與術(shù)前相比具有統(tǒng)計學(xué)差異(p0.05),視力下降,2月視力恢復(fù),與術(shù)前相比無統(tǒng)計學(xué)差異(p0.05);術(shù)后眼壓與比術(shù)前相比明顯降低,具有統(tǒng)計學(xué)差異(p0.05);術(shù)后并發(fā)癥發(fā)生共6眼(33%),包括淺前房合并脈絡(luò)膜脫離1眼,淺前房3眼,后彈力層脫離1眼,前房積血1眼。手術(shù)完全成功17眼(85%),條件成功1眼(5%),術(shù)后眼壓失控2眼(10%)。結(jié)論:對于原發(fā)性開角型青光眼及其他特殊類型青光眼的治療,Ex-PRESS引流釘植入術(shù)短期降眼壓的效果顯著;并且在治療原發(fā)性開角型青光眼方面,Ex-PRESS引流釘植入術(shù)與小梁切除術(shù)術(shù)后降眼壓效果、視力、手術(shù)成功率無顯著性差異,但Ex-PRESS引流釘植入術(shù)后視力恢復(fù)較快,且并發(fā)癥發(fā)生較小梁切除術(shù)少。
[Abstract]:Objective: to observe the short-term efficacy and safety of Ex-PRESS drainage nail implantation in the treatment of glaucoma. Ex-PRESS drainage nail implantation was performed in 15 cases (23 eyes) (drainage nail group) and trabeculectomy group (16 cases 26 eyes) (trabeculectomy group). The visual acuity, intraocular pressure and complications were collected from two groups respectively. The use of IOP drugs and the success rate of the operation, The results were compared and analyzed. The successful standard of operation was that IOP decreased by 20% or IOP was located between 5mm Hg and 20mm Hg. 18 cases (20 eyes) of glaucoma with special type glaucoma underwent Ex-PRESS drainage nail implantation were treated with intraocular pressure reduction or intraocular pressure (IOP) between 5 mm Hg and 20 mm Hg. Visual acuity was observed 1 day, 3 days, 1 week, 2 weeks, January, February, March, March, Intraocular pressure (IOP), complications and the use of intraocular pressure lowering drugs (IOP) were compared with those before surgery. The special types of glaucoma in this study included congenital glaucoma, pigmented glaucoma, neovascularization glaucoma. Pseudoexfoliation syndrome, secondary uveitis glaucoma, hormone glaucoma, glaucoma with failed glaucoma surgery, traumatic glaucoma and glaucoma after intraocular lens implantation; The successful standard of operation was that the intraocular pressure was 20% lower than that before operation or the intraocular pressure was between 5 mm Hg and 20 mm Hg. Results compared with preoperative visual acuity, the postoperative visual acuity of the group treated with 1: 1 drainage nail was significantly different from that of preoperative 1 day and 1 week and 2 weeks after operation, which was lower than that before operation, and the visual acuity recovered in January. The visual acuity of trabeculectomy group was significantly lower than that of preoperative visual acuity, and the visual acuity of trabeculectomy group was significantly lower than that of preoperative visual acuity in February, and the visual acuity of trabeculectomy group was significantly lower than that of pre-operation group, and the visual acuity of trabeculectomy group was significantly lower than that of preoperative visual acuity. There was no significant difference in postoperative visual acuity between the drainage nail group and trabeculectomy group (p 0.05). The intraocular pressure of drainage nail group and trabeculectomy group was significantly higher than that of preoperative group (P 0.05). The intraocular pressure of drainage nail group and trabeculectomy group was 1 day after operation. On February, March, June, IOP was significantly lower than that of preoperative IOP. The intraocular pressure in the drainage nail group and trabeculectomy group was significantly lower than that in the trabeculectomy group, and the intraocular pressure was significantly lower in the drainage nail group than in the trabeculectomy group. There was no significant difference at all time points (p0.05). There was no significant difference in the success rate between the two groups on June. Complications occurred in 3 eyes in the drainage nail group (1 eye in the shallow anterior chamber, 1 eye in the inlet of the drainage nail, 1 eye in the iris obstruction at the entrance of the drainage nail), and there was no significant difference in the success rate between the two groups on June. The complications of trabeculectomy group were 12 eyes (6 eyes with shallow anterior chamber, 4 eyes with hyphema, 1 eye with temporary high intraocular pressure and 1 eye with bleb leakage). The complications in the drainage nail group were less than that in the trabeculectomy group, and the postoperative visual acuity of the drainage nail group in the treatment of special type glaucoma was lower than that in the preoperative group. On January, the visual acuity decreased, the visual acuity recovered in February, and there was no significant difference between preoperative and postoperative intraocular pressure (IOP). The complications occurred in 6 eyes, including 1 eye of shallow anterior chamber with choroidal detachment, 3 eyes of shallow anterior chamber and 1 eye of posterior elastic layer detachment. Hyphema in 1 eye, complete success in 17 eyes (85 eyes), successful operation in 1 eye (5 eyes), postoperative intraocular pressure loss in 2 eyes (10 eyes). Conclusion: for primary open angle glaucoma and other special types of glaucoma, the effect of short-term reduction of IOP by Ex-PRESS drainage nail implantation is remarkable. In the treatment of primary open-angle glaucoma, there was no significant difference in the effect of intraocular pressure reduction, visual acuity and success rate between Ex-PRESS drainage nail implantation and trabeculectomy, but the visual acuity recovered quickly after Ex-PRESS drainage nail implantation. The complications were less than trabeculectomy.
【學(xué)位授予單位】：南昌大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R779.6

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