發(fā)布時間：2018-03-21 07:52

  本文選題：激光　切入點：青光眼　出處：《延安大學》2017年碩士論文　論文類型：學位論文

【摘要】：目的:本研究主要通過577nm與532nm兩種波長的激光周邊虹膜成形術(Laser peripheral iridoplasty,ALPI)聯(lián)合YAG激光周邊虹膜切除術(Laser peripheral iridotomy,LPI)治療原發(fā)性急性閉角型青光眼,評價其差異性、臨床療效及安全性,為今后激光治療原發(fā)性急性閉角型青光眼提供數(shù)據支持。方法:隨機選取2015年9月至2017年2月在延安大學附屬醫(yī)院治療的原發(fā)性急性閉角型青光眼患者28例30只眼,其中15只眼行577nm波長激光周邊虹膜成形術聯(lián)合YAG激光周邊虹膜切除術(A組),15只眼行532nm波長激光周邊虹膜成形術聯(lián)合YAG激光周邊虹膜切除術(B組)。所有治療均征得患者及家屬同意,并在治療前簽署知情同意書。使用天津索維活體超聲生物顯微鏡(UBM)測得術前、術后3d、術后3mo相關參數(shù):ACD(前房深度)、AOD500(500μm處房角開放距離)、ACA500(500μm處房角開放距離對應的前房角)、IT3(周邊虹膜厚度)。使用德國海德堡角膜共焦顯微鏡測得術前及術后3d角膜內皮計數(shù)。用日本TOPCON非接觸眼壓計監(jiān)測術前、術后1h、術后1d、術后1wk、術后1mo、術后3mo眼壓。觀察術后并發(fā)癥,滴眼液使用情況。使用全自動電腦視野檢查分析系統(tǒng)(TEC-3F)分析患眼術后3d與術后3mo視野。以上所有操作及檢查均由專人完成,所有數(shù)據均采用SPSS 20.0軟件進行分析。其中眼壓與UBM相關參數(shù)等時間依賴性變量間比較用重復測量資料的方差分析,進一步分析組內兩個時間點間變化采用配對t檢驗,組內治療前后角膜內皮計數(shù)的變化、組內術后視野變化采用配對t檢驗,而組間內皮損失對比、組間視野變化對比用獨立樣本t檢驗。結果:1.眼壓:2組患者在術前、術后1h,術后1d,術后1mo,術后3mo的眼壓運用重復測量資料的方差分析得出:各組內不同時間段眼壓變化有統(tǒng)計學意義(P0.05),總體呈下降趨勢;而2組間眼壓變化差異無統(tǒng)計學意義(p0.05)。2.角膜內皮計數(shù):測得2組患者在術前、術后3d的角膜內皮計數(shù)。組內治療前后角膜內皮計數(shù)變化采用配對t檢驗得出:各組內術前術后角膜內皮計數(shù)差異無統(tǒng)計學意義(p0.05);兩組間角膜內皮損失比較采用獨立樣本t檢驗得出:2組間角膜內皮損失量差異無統(tǒng)計學意義(p0.05)。3.ubm相關參數(shù):3.1測得2組患者在術前、術后3d、術后3mo的acd、aod500、aca500、it3,運用重復測量資料的方差分析得出:(1)各組內不同時間段acd值變化均有統(tǒng)計學意義(p0.05),而2組間acd值變化差異均無統(tǒng)計學意義(p0.05)。(2)各組內不同時間段aod500值變化均有統(tǒng)計學意義(p0.05),而2組間aod500值變化差異均無統(tǒng)計學意義(p0.05)。(3)各組內不同時間段aca500值變化均有統(tǒng)計學意義(p0.05),而2組間aca500值變化差異均無統(tǒng)計學意義(p0.05)。(4)各組內不同時間段it3值變化均有統(tǒng)計學意義(p0.05),而2組間it值變化差異均無統(tǒng)計學意義(p0.05)。3.2a組:(1)acd術后3d較術前明顯增大,有統(tǒng)計學意義(p0.05);術后3mo較術后3d變化無統(tǒng)計學意義(p0.05)。(2)aod500術后3d較術前明顯增大,有統(tǒng)計學意義(p0.05);術后3mo較術后3d變化沒有統(tǒng)計學意義(p0.05)。(3)aca500術后3d較術前明顯增大,有統(tǒng)計學意義(p0.05);術后3mo較術后3d變化沒有統(tǒng)計學意義(p0.05)。(4)it3術后3d較術前減小,有統(tǒng)計學意義(p0.05);術后3mo較術后3d增大,有統(tǒng)計學意義(p0.05);術后3mo較術前減小,其中三個象限(鼻側、上方、下方)無統(tǒng)計學意義(p0.05),一個象限(顳側)有統(tǒng)計學意義(p0.05)。3.3b組:(1)acd術后3d較術前明顯增大,有統(tǒng)計學意義(p0.05)),術后3mo較術后3d變化無統(tǒng)計學意義(p0.05)。(2)aod500術后3d較術前明顯增大,有統(tǒng)計學意義(p0.05),術后3mo較術后3d變化沒有統(tǒng)計學意義(p0.05)。(3)aca500術后3d較術前明顯增大,有統(tǒng)計學意義(p0.05),術后3mo較術后3d變化沒有統(tǒng)計學意義(p0.05)。(4)it3術后3d較術前減小,有統(tǒng)計學意義(p0.05),術后3mo較術后3d增大,有統(tǒng)計學意義(p0.05),術后3mo較術前減小,有統(tǒng)計學意義(P0.05)。4.觀察兩組術后3mo較術后3d視野無差異。5.本次研究30只眼均無嚴重并發(fā)癥,術后1h前房炎癥細胞分級為0.5+。6.術后根據情況逐次停用降眼壓滴眼液,入選30只眼,除1只眼(A組)術后因停用降眼壓滴眼液后眼壓升高,后又加用降眼壓滴眼液得以控制,余均能于術后1wk停藥。結論:1.577nm波長與532nm波長激光周邊虹膜成形術聯(lián)合YAG激光周邊虹膜切除術治療原發(fā)性急性閉角型青光眼在療效、安全性方面無差異。2.577nm波長與532nm波長激光周邊虹膜成形術聯(lián)合YAG激光周邊虹膜切除術治療原發(fā)性急性閉角型青光眼,能有效加深患者的前房深度、房角開放度,前房開放距離,從而減少臨床用藥,控制眼壓,保護視功能。3.577nm波長與532nm波長激光周邊虹膜成形術聯(lián)合YAG激光周邊虹膜切除術治療原發(fā)性急性閉角型青光眼前后角膜內皮計數(shù)無顯著減少,術后無嚴重并發(fā)癥,安全性較高。
[Abstract]:Objective: This study mainly through 577nm and 532nm laser peripheral iridectomy two wavelength plasty (Laser peripheral iridoplasty, ALPI) combined with YAG laser peripheral iridectomy (Laser peripheral, iridotomy, LPI) for the treatment of primary acute angle closure glaucoma, evaluation of the differences, the clinical efficacy and safety, for the future of laser treatment provide data support of primary acute angle closure glaucoma. Methods: randomly selected from September 2015 to February 2017 in Affiliated Hospital of Yan'an University for treatment of primary acute angle closure glaucoma and 28 eyes of 30 cases, of which 15 eyes underwent 577nm laser peripheral iridoplasty combined with YAG laser peripheral iridectomy (A group), 15 eyes 532nm the wavelength of laser peripheral iridoplasty combined with YAG laser iridectomy (group B) were treated. All patients and their family members consent, and signed informed consent before treatment. Sovi in vivo ultrasound biomicroscopy (UBM) in Tianjin was measured before surgery, postoperative 3D, postoperative 3Mo related parameters: ACD (anterior chamber depth), AOD500 (500 m angle opening distance (500 m), ACA500 at the anterior chamber angle opening distance corresponding angle), IT3 (peripheral iris the thickness of 3D). Corneal endothelial cell counting using Germany Heidelberg corneal confocal microscope measured before and after the surgery. With Japanese TOPCON non-contact tonometer monitoring before surgery, postoperative 1H, postoperative 1D, postoperative 1wk, postoperative 1Mo, postoperative intraocular pressure 3Mo. Postoperative complications, the use of eye drops. The use of automatic analysis system of computer vision inspection (TEC-3F) of eyes with postoperative 3D with 3Mo vision. All of the above operations and check by hand to complete, all the data were analyzed with SPSS 20 software. The IOP and UBM parameters related to time dependent variables were compared using repeated measurement data analysis of variance further, Analysis of two time points within the group were compared by paired t test before and after treatment, changes of corneal endothelial counts within the group, group of postoperative vision were compared by paired t test, and between groups of endothelial loss comparison, comparison between the two groups in perspective with the independent sample t test. Results: 1. hypertension patients in the 2 groups before operation after the operation, 1H, 1D after surgery, postoperative 1Mo, postoperative intraocular pressure using the 3Mo variance of repeated measurement data analysis: there were significant changes of intraocular pressure within each group at different time (P0.05), the overall downward trend; while the difference of intraocular pressure between the 2 groups was statistically significant (P0.05).2. corneal endothelial cell counting measured: 2 groups of patients before surgery, corneal endothelial cell counting 3D after surgery. The treatment group before and after the change of corneal endothelial cell counting using a paired t test showed that within each group of differences in corneal endothelium before and after surgery was not statistically significant between the two groups (P0.05); corneal endothelial loss compared with independent 鏍鋒湰t媯，

本文編號：1642932