本文選題：青光眼 + 原發(fā)性房角關(guān)閉疾病��； 參考：《河北醫(yī)科大學(xué)》2017年碩士論文

【摘要】：青光眼(glaucoma)是世界范圍內(nèi)發(fā)病數(shù)量位居第一的不可逆致盲性眼病。其中,原發(fā)性房角關(guān)閉疾病(primary angle-closure disease,PACD)是我國最常見的青光眼類型,約占47.5%。其發(fā)病與異常的眼球解剖結(jié)構(gòu)有密切的關(guān)系,最新研究認(rèn)為脈絡(luò)膜膨脹增厚是PACD的發(fā)病機(jī)制之一。近年來,眼科診療設(shè)備不斷完善,診療技術(shù)日益提高,尤其是頻域相干光斷層深度增強(qiáng)成像技術(shù)(Enhanced depth imaging spectral—domain optical coherence tomography EDI SD-OCT)的出現(xiàn),可方便、清晰地獲得脈絡(luò)膜斷層影像,并通過測量獲得患者脈絡(luò)膜厚度的具體數(shù)值,且能對其動(dòng)態(tài)變化進(jìn)行觀察。本研究分析脈絡(luò)膜厚度在不同類型PACD中的特點(diǎn)及變化規(guī)律,探討脈絡(luò)膜在原發(fā)性房角關(guān)閉疾病發(fā)生、發(fā)展中的作用。目的:1探究不同分型原發(fā)性房角關(guān)閉疾病患者脈絡(luò)膜厚度的差異,分析前房深度、眼軸長度與脈絡(luò)膜厚度的相關(guān)性;2探討原發(fā)性房角關(guān)閉疾病患者手術(shù)前后脈絡(luò)膜厚度的變化;3探討脈絡(luò)膜厚度在原發(fā)性房角關(guān)閉疾病的發(fā)生、發(fā)展中所起的作用。方法:收集2015年12月至2016年12月在河北醫(yī)科大學(xué)第二醫(yī)院眼科診斷為原發(fā)性房角關(guān)閉疾病的患者82例(155眼)。其中包括可疑原發(fā)性房角關(guān)閉患者24例(24眼),急性原發(fā)性房角關(guān)閉患者28例(35眼),慢性原發(fā)性房角關(guān)閉患者30例(38眼),原發(fā)性閉角型青光眼患者38例(58眼)。另收集于我院行眼部常規(guī)檢查的健康人72例(72眼)作為正常對照組。所有患者均進(jìn)行相關(guān)病史采集:包括患者年齡、性別、現(xiàn)病史等;并進(jìn)行眼部相關(guān)檢查:最佳矯正視力、眼壓、裂隙燈顯微鏡、雙目間接眼底鏡,應(yīng)用IOL-Master測量眼軸長及中央前房深度。應(yīng)用EDI SD-OCT測量患者黃斑中心凹下及距黃斑中心凹1、3mm處上方(S)、下方(I)、顳側(cè)(T)、鼻側(cè)(N)脈絡(luò)膜厚度,并測量距視乳頭1、2mm處上方(S)、下方(I)、顳側(cè)(T)、鼻側(cè)(N)脈絡(luò)膜厚度,對需要手術(shù)治療的急性原發(fā)性房角關(guān)閉及原發(fā)性閉角型青光眼患者55例(76眼)行青白聯(lián)合或小梁切除手術(shù)。并在術(shù)后7天、1個(gè)月對術(shù)眼行EDI SD-OCT檢查,對脈絡(luò)膜厚度進(jìn)行觀察。結(jié)果:1各組在黃斑中心凹下及周圍各個(gè)位點(diǎn)上平均脈絡(luò)膜厚度的差異可疑原發(fā)性房角關(guān)閉(Primary angle-closure suspects,PACS)組、急性原發(fā)性房角關(guān)閉(Acute primary angle-closure,APAC)組、慢性原發(fā)性房角關(guān)閉(Chronic primary angle-closure,CPAC)組、原發(fā)性閉角型青光眼(Primary angle-closure glaucoma,APCG)組、正常對照組的黃斑中心凹下脈絡(luò)膜厚度(Subfoveal choroidal thickness,SFCT)分別為296.25±79.36μm、310.23±68.78μm、280.74±64.34μm、280.69±82.72μm、232.19±72.21μm,經(jīng)統(tǒng)計(jì)分析:PACD各組患者在黃斑中心凹下及周圍不同位點(diǎn)上平均脈絡(luò)膜厚度值均比正常對照組厚,且差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。在PACD各組患者中,APAC組中SFCT及距離黃斑中心凹1、3mm處上方(S)、下方(I)、顳側(cè)(T)、鼻側(cè)(N)最厚,其次PACS組、CPAC組,PACG組最薄,所有PACD患者及正常人中SFCT最厚,且距離黃斑中心凹越遠(yuǎn)脈絡(luò)膜越薄。在PACD各組患者中,APAC組中SFCT均較PACD其余各組厚,且差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。PACS組、CPAC組與PACG組之間SFCT無顯著的統(tǒng)計(jì)學(xué)差異(P0.05)。2各組在視乳頭周圍各個(gè)位點(diǎn)上平均脈絡(luò)膜厚度的差異原發(fā)性房角關(guān)閉疾病患者在視乳頭周圍各個(gè)位點(diǎn)上平均脈絡(luò)膜厚度均比正常人薄,但均無顯著的統(tǒng)計(jì)學(xué)意義(P0.05)。在水平及垂直截面上,原發(fā)性房角關(guān)閉疾病患者各組及正常對照組平均脈絡(luò)膜厚度均距離視乳頭越遠(yuǎn)而越厚,且差異有統(tǒng)計(jì)學(xué)意義(P0.05)。3 AL和ACD與PACD患者黃斑中心凹下脈絡(luò)膜厚度的相關(guān)性分析在原發(fā)性房角關(guān)閉疾病患者中,AL與黃斑中心凹下脈絡(luò)膜厚度呈負(fù)相關(guān)(r=-0.295,P=0.007),然而ACD與SFCT無顯著的相關(guān)關(guān)系(P0.05)。4 PACD患者術(shù)前、術(shù)后黃斑中心凹下及周圍各個(gè)位點(diǎn)上平均脈絡(luò)膜厚度無論術(shù)前還是術(shù)后,PACD患者黃斑區(qū)脈絡(luò)膜厚度均在黃斑中心凹下最厚,且距離黃斑中心凹越遠(yuǎn)其脈絡(luò)膜越薄。PACD患者的術(shù)前SFCT值為:281.76±63.51μm,術(shù)后7天及1個(gè)月分別為:318.41±75.48μm、295.89±66.25μm。術(shù)后7天、1個(gè)月時(shí)其SFCT值較術(shù)前均明顯升高,且差異有統(tǒng)計(jì)學(xué)意義(t1=㧟8.894,P10.001;t2=㧟2.032,P2=0.046)。而術(shù)后1個(gè)月時(shí)SFCT值較7天前降低,差異有統(tǒng)計(jì)學(xué)意義(t=3.384,P=0.001)。5 PACD患者術(shù)前、術(shù)后視乳頭周圍各個(gè)位點(diǎn)上平均脈絡(luò)膜厚度無論術(shù)前還是術(shù)后,視乳頭周圍各個(gè)位點(diǎn)上平均脈絡(luò)膜厚度均隨著與視乳頭距離的增加而增加。PACD患者在術(shù)后7天時(shí)在視乳頭周圍各個(gè)位點(diǎn)上平均脈絡(luò)膜厚度均明顯高于術(shù)前,且差異有統(tǒng)計(jì)學(xué)意義(P0.05)。術(shù)后1個(gè)月時(shí)在距離視乳頭上方2mm、鼻側(cè)1、2mm及顳側(cè)2mm上平均脈絡(luò)膜厚度高于術(shù)前,差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。其中在距離視乳頭鼻側(cè)2mm及顳側(cè)2mm上平均脈絡(luò)膜厚度較術(shù)后7天降低,差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。在距離視乳頭上方2mm及鼻側(cè)1mm上平均脈絡(luò)膜厚度低于術(shù)后7天,但差異均無統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:1 PACS組、APAC組、CPAC組、PACG組患者在黃斑中心凹下及周圍位點(diǎn)脈絡(luò)膜厚度均大于正常對照組,差異有統(tǒng)計(jì)學(xué)意義。在視乳頭周圍位點(diǎn)脈絡(luò)膜厚度小于正常對照組,但差異無統(tǒng)計(jì)學(xué)意義。2 PACD各組中APAC組黃斑中心凹下及周圍各位點(diǎn)上脈絡(luò)膜厚度最厚。3 PACD各組患者及正常對照組中脈絡(luò)膜厚度在各個(gè)位點(diǎn)上分布不均。在黃斑區(qū),SFCT最厚,距離黃斑中心凹越遠(yuǎn)其脈絡(luò)膜越薄;在視盤周圍,視盤最薄,距離視盤越遠(yuǎn)其脈絡(luò)膜越厚。4 PACD患者的眼軸長度與黃斑中心凹下脈絡(luò)膜厚度呈負(fù)相關(guān),而中央前房深度與黃斑中心凹下脈絡(luò)膜厚度無相關(guān)性。5 PACD患者術(shù)后黃斑區(qū)及視乳頭周圍平均脈絡(luò)膜厚度在短期內(nèi)增加,但術(shù)后1個(gè)月時(shí)有下降趨勢。
[Abstract]:Glaucoma (glaucoma) is the world's number one irreversible blinding blindness disease. Primary angle-closure disease (PACD) is the most common type of glaucoma in China, which accounts for a close relationship between the incidence of 47.5%. and the abnormal eyeball anatomy. The latest study suggests that the choroid expansion is expanded. Thickening is one of the pathogenesis of PACD. In recent years, the medical equipment of ophthalmology has been perfected, and the diagnosis and treatment technology is increasing, especially in the frequency domain coherent optical fault depth enhancement imaging (Enhanced depth imaging spectral domain optical coherence tomography EDI SD-OCT), which can easily and clearly obtain the choroidal fault images. The specific values of the choroidal thickness of the patients were measured and the dynamic changes were observed. This study analyzed the characteristics and changes of choroidal thickness in different types of PACD, and discussed the role of choroid in the occurrence and development of the primary angle closure disease. Objective: 1 to explore the patients with different types of primary angle closure disease. The difference of choroidal thickness, the correlation of anterior chamber depth, axial length and choroidal thickness; 2 to explore the changes of choroidal thickness before and after operation in patients with primary angle closure disease; 3 to explore the role of choroidal thickness in the occurrence of primary angle closure disease and the role of the development. Methods: from December 2015 to December 2016 in the river 82 cases (155 eyes) were diagnosed as primary angle closure disease in the second hospital of North Medical University, including 24 cases (24 eyes) with suspected primary angle closure, 28 cases of acute primary angle closure (35 eyes), 30 cases of chronic primary angle closure (38 eyes), 38 cases of primary angle closure glaucoma (58 eyes). 72 healthy people (72 eyes) were used as the normal control group in our hospital. All patients were collected, including age, sex, current history, and eye related examination: best corrected visual acuity, intraocular pressure, slit lamp microscope, binocular indirect ophthalmoscope, and IOL-Master measurement of axial length and central anterior chamber depth. Degree. EDI SD-OCT was used to measure the upper (S), lower (I), temporal (T), and nasal (N) choroidal thickness above the macular central fovea (I), the temporal (T), and the nasal side (N), and to measure the thickness of the lateral (I), temporal (T), and nasal (N) choroid thickness above the 1,2mm of the optic papilla, and the acute angle closure and primary angle closure glaucoma requiring surgical treatment. 55 patients (76 eyes) were treated with white or trabeculectomy. EDI SD-OCT examination was performed at 7 days and 1 months after the operation, and the choroidal thickness was observed. Results: 1 the differences in the average choroidal thickness at the macular fovea and the surrounding loci were suspicious of primary angle closure (Primary angle-closure suspects, PACS). The primary angle closure (Acute primary angle-closure, APAC) group, chronic primary angle closure (Chronic primary angle-closure, CPAC), primary angle closure glaucoma (Primary angle-closure glaucoma, APCG) group, and the normal control group of the macular fovea choroidal thickness were 296.25 79.36 mu m, 310.23 + 68.78 mu m, 280.74 + 64.34 micron m, 280.69 + 82.72 mu m, 232.19 + 72.21 m. The mean choroidal thickness of the patients in the macular center and around the surrounding different sites were all thicker than the normal control group, and the difference was statistically significant (P0.05). In each group of PACD, the APAC group SFCT and the macula range from the macula. The upper (S), the lower (I), the temporal side (T), the nasal side (N) were the thickest, the PACS group, the CPAC group and the PACG group were the thinnest, and the SFCT was the thickest in all the PACD patients and normal people, and the farther from the macular fovea, the thinner the choroid was. In the PACD groups, the APAC groups were all thicker than the other groups, and the difference both had statistical significance. There was no significant difference in SFCT between the group and the PACG group (P0.05) the difference in the average choroidal thickness at the various sites around the optic papillae. The average choroidal thickness at all the sites around the optic papilla was thinner than the normal person, but there was no significant statistical significance (P0.05). The level and vertical section were not significant. On the other hand, the average choroidal thickness of the patients with primary angle closure disease and the normal control group were the farther and thicker from the optic papilla, and the difference was statistically significant (P0.05).3 AL and ACD and the correlation analysis of the macular central choroidal thickness of the patients with PACD in the patients with primary angle closure disease, AL and the choroidal choroid under the macular center. The thickness was negatively correlated (r=-0.295, P=0.007), but there was no significant correlation between ACD and SFCT (P0.05).4 PACD patients before operation. The average choroidal thickness of the macular region in the macular region of PACD patients was the thickest under the macular fovea, and the farther from the macular fovea, before and after the operation. The preoperative SFCT value of.PACD patients was 281.76 + 63.51 mu m, 7 days and 1 months after operation, respectively, 318.41 + 75.48 m, 295.89 + 66.25 M. after 7 days, and 1 months higher than before operation, and the difference was statistically significant (t1=? 8.894, P10.001; t2=? 2.032, P2=0.046). Statistical significance (t=3.384, P=0.001).5 PACD patients, the average choroidal thickness around the peripapillary sites around the optic papilla before and after operation, the average choroidal thickness at the various sites around the papilla increased with the increase in the distance from the optic papilla, which increased the average pulse of the.PACD patients at the 7 day of the optic papilla at the peripapillary sites. The thickness of the collateral membrane was significantly higher than that before the operation, and the difference was statistically significant (P0.05). The average choroidal thickness of 2mm above the optic papilla at 1 months after the operation was higher than that before the operation, and the difference was statistically significant (P0.05). The average choroidal thickness on the nasal side of the optic papilla on the nasal side of the optic papilla and the temporal side of the temporal 2mm was lower than that of the 7 day after the operation. The difference was statistically significant (P0.05). The average choroidal thickness of 2mm and 1mm on the nasal side of the optic papilla was lower than 7 days after the operation, but the difference was not statistically significant (P0.05). Conclusion: the thickness of the choroidal membrane in the 1 PACS group, the APAC group, the CPAC group and the PACG group were all larger than the normal control group, and the difference was statistically significant. The choroidal thickness of the site around the optic papilla was less than that of the normal control group, but the difference was not statistically significant in.2 PACD groups, and the thickness of the choroidal membrane in each group of APAC groups was the thickest of.3 PACD and the choroidal thickness in the normal control group was not evenly distributed. In the macular region, SFCT was the thickest and the macula from the macula area. The thinner the choroid is, the thinner the choroid is, the thinner the optic disc around the disc, the farther from the optic disc, the thicker the choroid of the.4 PACD patient has a negative correlation with the choroidal thickness under the macular fovea, but the central anterior chamber depth is not related to the choroidal thickness of the macular fovea and the average vein in the macular area and the peripapillary veins after the operation of.5 PACD patients. The thickness of the membrane increased in the short term, but decreased at 1 months after operation.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R775

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