本文選題：Ex-PRESS + 青光眼引流釘��； 參考：《浙江大學》2015年博士論文

【摘要】：目的： 探討Ex-PRESS青光眼引流釘植入聯(lián)合白內(nèi)障超聲乳化吸除術(shù),用于合并白內(nèi)障的原發(fā)性閉角型青光眼的手術(shù)治療的安全性和有效性,以及白內(nèi)障吸除后的原發(fā)性閉角型青光眼的前房結(jié)構(gòu)是否符合Ex-PRESS引流釘植入的要求。 方法： 本研究是連續(xù)的非隨機的前瞻性臨床病例對照研究,2013年9月至2014年9月,入組了浙江大學醫(yī)學院附屬第二醫(yī)院眼科中心的收治的青光眼病人,其中試驗組原發(fā)性閉角型青光眼合并白內(nèi)障患者20人25眼,行Ex-PRESS引流釘植入聯(lián)合白內(nèi)障超聲乳化吸除及囊袋內(nèi)人工晶體植入術(shù)；對照原發(fā)性開角型青光眼的患者18人21眼,行單純Ex-PRESS引流釘植入術(shù)的前后房結(jié)構(gòu)。術(shù)前及術(shù)后1天、7天,和1、3、6個月收集術(shù)眼數(shù)據(jù),包括眼壓(IOP)、最佳矯正視力(BCVA)、以及中央前房深度(ACD)、房角開放距離(AOD500)、小梁虹膜角(TIA)、小梁睫狀體距離(TCPD)、引流釘管腔長軸與角膜內(nèi)皮夾角(ACA)等前后房結(jié)構(gòu)數(shù)據(jù)和并發(fā)癥情況等。手術(shù)成功的標準為：6mmHg≤眼壓≤21mmHg,并且視力下降不超過兩行(Snellen表),如使用抗青光眼藥物輔助則為部分成功,未使用藥物控制則為完全成功。 結(jié)果： 試驗組6個月時手術(shù)成功率為92%,其中完全成功率分別為88%,平均眼壓在術(shù)后各個時期都顯著低于術(shù)前(P0.001),在6個月時平均眼壓分別為15.7+3.5mmHg。試驗組由于行白內(nèi)障吸除術(shù),術(shù)后最佳矯正視力(logMAR)較術(shù)前有顯著性提高(P0.001)。在術(shù)后第1天試驗組和對照組分別有3眼(12%)眼壓低于6mmHg,術(shù)后7天均自行恢復正常,并且均未對手術(shù)效果造成長期影響。在接受了聯(lián)合白內(nèi)障超聲乳化吸除術(shù)的Ex-PRESS引流釘植入術(shù)后中央前房深度、房角開放距離、小梁虹膜角、小梁睫狀體距離均大于術(shù)前(P0.001),并且與POAG行單純Ex-PRESS引流釘植入術(shù)后前房結(jié)構(gòu)沒有顯著性差異(P0.05),且引流釘管腔長軸與角膜內(nèi)皮夾角也無組間差異(P0.05)。 結(jié)論： 白內(nèi)障超聲乳化吸除術(shù)后,前房加深,房角開放,達到了Ex-PRESS引流釘植入手術(shù)的前房深度要求。在聯(lián)合白內(nèi)障超聲乳化吸除術(shù)的前提下,Ex-PRESS青光眼引流釘用于合并白內(nèi)障閉角型青光眼的手術(shù)是安全而有效的。這是Ex-PRESS引流釘植入術(shù)擴大適應癥的有力證據(jù)。
[Abstract]:Objective: To investigate the safety and efficacy of Ex-PRESS glaucoma drainage nail implantation combined with phacoemulsification for primary angle-closure glaucoma complicated with cataract. And whether the anterior chamber structure of primary angle-closure glaucoma after cataract aspiration meets the requirement of Ex-PRESS drainage nail implantation. Methods: This study was a series of nonrandomized prospective clinical case-control studies. From September 2013 to September 2014, glaucoma patients were admitted to the Center of Ophthalmology of the second affiliated Hospital of Zhejiang University School of Medicine. In the experimental group, 25 eyes of 20 patients with primary angle-closure glaucoma complicated with cataract were treated with Ex-PRESS drainage nail implantation, phacoemulsification and intraocular lens implantation in the capsule, and 18 patients with 21 eyes with primary open-angle glaucoma. The anterior and posterior chamber structure of simple Ex-PRESS drainage nail implantation was performed. Preoperative and postoperative data were collected 1 day, 7 days, and 1 month, 6 months after operation. The results included IOP, BCV AV, ACD, AOD500, TIAA, TCPD, ACD, and complications, such as anterior chamber depth, anterior chamber angle, trabecular iris angle, trabecular ciliary body distance (TCPD), long axis of drainage nail and cornea endothelium angle (ACAA), and so on. The standard of successful operation was: 1: 6mmHg 鈮，

本文編號：1868387