ALPI聯(lián)合LPI與小梁切除術(shù)在急性PACG中的療效觀察研究
發(fā)布時間：2018-08-21 11:56
【摘要】：目的:探討激光周邊虹膜成形術(shù)(Laser Peripheral Iridoplasty,ALPI)聯(lián)合激光周邊虹膜切除術(shù)(Laser Peripheral Iridotomy,LPI)與傳統(tǒng)小梁切除術(shù)(trabeculectomy)分別對原發(fā)性急性閉角型青光眼(primary acute angle closure glaucoma)首次大發(fā)作患眼的術(shù)后治療效果。意義在于通過對比ALPI聯(lián)合LPI術(shù)與小梁切除術(shù),為臨床治療急性PACG尋求一種有效、安全、微創(chuàng)的治療方法。方法:隨機(jī)選擇2014年9月到2016年9月在延安大學(xué)附屬醫(yī)院眼科接受治療的急性PACG首次大發(fā)作60例患者60只眼進(jìn)行觀察;隨機(jī)分為兩組,每組30只眼,A組施行ALPI聯(lián)合LPI術(shù),B組施行傳統(tǒng)小梁切除術(shù),手術(shù)均由同一術(shù)者操作。分別檢測并記錄術(shù)前及術(shù)后1周(w)、術(shù)后3個月(m)的視力值、眼壓(intraocular pressure,IOP)測量值;檢測并記錄術(shù)前、術(shù)后3個月前房深度(anterior chamber depth,ACD)、房角開放距離500(anterior chamber angle,AOD_(500));檢測并記錄術(shù)前及術(shù)后3個月視野、杯/盤比(C/D)、盤沿面積、視神經(jīng)纖維層厚度(retinal never fiber layer,RNFL)。通過SPSS20.0統(tǒng)計學(xué)軟件對A組、B組行術(shù)前、術(shù)后1w、術(shù)后3個月的視力、IOP進(jìn)行重復(fù)測量資料方差分析的研究;對A組、B組術(shù)前、術(shù)后3個月ACD、AOD_(500)進(jìn)行配對t檢驗;對A、B兩組之間ACD、AOD_(500)進(jìn)行獨(dú)立樣本t檢驗;對A組、B組的視野、C/D值、盤沿面積、RNFL的值術(shù)前、術(shù)后3m進(jìn)展情況進(jìn)行χ2檢驗的研究。結(jié)果:1.眼壓(1)A組術(shù)前、術(shù)后1周、術(shù)后3個月眼壓的檢測結(jié)果如下:術(shù)前眼壓(15.44±2.28)mm Hg、術(shù)后1周眼壓(14.13±2.96)mm Hg、術(shù)后3個月眼壓(15.50±3.50)mm Hg,P=0.00,差異有統(tǒng)計學(xué)意義。(2)B組術(shù)前、術(shù)后1周、術(shù)后3個月眼壓的檢測結(jié)果如下:術(shù)前眼壓(15.00±2.78)mm Hg、術(shù)后1周眼壓(14.50±7.01)mm Hg、術(shù)后3個月眼壓(14.81±4.07)mm Hg,P=0.00,差異有統(tǒng)計學(xué)意義。(3)A組與B組術(shù)后眼壓相比較結(jié)果為P=0.33,差異無統(tǒng)計學(xué)意義。2.視力(1)A組術(shù)前、術(shù)后1周、術(shù)后3個月視力的檢測結(jié)果如下:術(shù)前視力(0.37±0.30)、術(shù)后1周視力(0.57±0.26)、術(shù)后3個月視力(0.57±0.25),P=0.00,差異有統(tǒng)計學(xué)意義。(2)B組術(shù)前、術(shù)后1周、術(shù)后3個月視力的檢測結(jié)果如下:術(shù)前視力(0.36±0.24)、術(shù)后1周視力(0.46±0.24)、術(shù)后3個月視力(0.45±0.23),P=0.00,差異有統(tǒng)計學(xué)意義。(3)A組與B組手術(shù)后視力相比較結(jié)果為P=0.33,差異無統(tǒng)計學(xué)意義。3.超聲生物顯微鏡(Ultrasound biomicroscopy,UBM)測得前房相關(guān)參數(shù)3.1 ACD(1)A組術(shù)前、術(shù)后3個月ACD檢測結(jié)果如下:術(shù)前(1733.67±306.56)μm,術(shù)后3個月(1835.33±249.59)μm,P=0.01,差異有統(tǒng)計學(xué)意義。(2)B組術(shù)前、術(shù)后3個月ACD檢測結(jié)果如下:術(shù)前(1758.33±134.42)μm,術(shù)后3個月(1841.00±144.35)μm,P=0.00,差異有統(tǒng)計學(xué)意義。(3)A、B兩組之間術(shù)后ACD相比較P=0.54,差異無統(tǒng)計學(xué)意義。3.2.AOD_(500)(1)A組術(shù)前、術(shù)后3個月AOD_(500)檢測結(jié)果如下:術(shù)前AOD_(500)(鼻)(98.57±75.89),術(shù)后AOD_(500)(鼻)(227.70±114.20),P=0.00,差異有統(tǒng)計學(xué)意義;術(shù)前AOD_(500)(下)(60.00±53.38),術(shù)后AOD_(500)(下)(203.27±118.45),P=0.00,差異有統(tǒng)計學(xué)意義;術(shù)前AOD_(500)(顳)(85.27±80.13),術(shù)后AOD_(500)(顳)(226.27±117.40),P=0.00,差異有統(tǒng)計學(xué)意義;術(shù)前AOD_(500)(上)(44.27±60.32),術(shù)后AOD_(500)(上)(117.67±89.85),P=0.00,差異有統(tǒng)計學(xué)意義。(2)B組術(shù)前、術(shù)后3個月AOD_(500)檢測結(jié)果如下:術(shù)前AOD_(500)(鼻)(101.07±73.88),術(shù)后AOD_(500)(鼻)(208.97±104.94),P=0.00,差異有統(tǒng)計學(xué)意義;術(shù)前AOD_(500)(下)(57.60±53.49),術(shù)后AOD_(500)(下)(187.27±111.27),P=0.00,差異有統(tǒng)計學(xué)意義;術(shù)前AOD_(500)(顳)(81.43±75.75),術(shù)后AOD_(500)(顳)(219.23±110.83),P=0.00,差異有統(tǒng)計學(xué)意義;術(shù)前AOD_(500)(上)(41.60±56.42),術(shù)后AOD_(500)(上)(109.10±82.77),P=0.00,差異有統(tǒng)計學(xué)意義。(3)A、B兩組之間術(shù)后AOD_(500)相比較PAOD_(500)(鼻)=0.37;PAOD_(500)(下)=0.58;PAOD_(500)(顳)=0.89;PAOD_(500)(上)=0.80,差異均無統(tǒng)計學(xué)意義。4.視野A組視野進(jìn)展率為0.0%,B組視野進(jìn)展率為3.3%,兩者視野進(jìn)展率相比較結(jié)果P=0.50,差異無統(tǒng)計學(xué)意義。5.C/D A組C/D值進(jìn)展率為0.0%,B組C/D值進(jìn)展率為3.3%,兩者C/D進(jìn)展率相比較結(jié)果P=0.50,差異無統(tǒng)計學(xué)意義。6.盤沿面積A組盤沿面積減少進(jìn)展率為3.3%,B組盤沿面積減少進(jìn)展率為3.3%,兩者進(jìn)展率相比較結(jié)果P=0.75,差異無統(tǒng)計學(xué)意義。7.視網(wǎng)膜神經(jīng)纖維層厚度A組RNFL厚度變薄進(jìn)展率為3.3%,B組RNFL厚度變薄進(jìn)展率為3.3%,兩者進(jìn)展率相比較結(jié)果P=0.75,差異無統(tǒng)計學(xué)意義。結(jié)論:兩種治療方法對急性PACG首次大發(fā)作患者3個月短、中期療效如下:1.ALPI聯(lián)合LPI術(shù)以及傳統(tǒng)小梁切除術(shù)術(shù)后眼壓均較術(shù)前有所下降,術(shù)后視力均較術(shù)前提高,但兩者之間眼壓、視力無明顯差別;2.ALPI聯(lián)合LPI術(shù)以及傳統(tǒng)小梁切除術(shù)術(shù)后前房ACD、AOD_(500)均較術(shù)前增大,但兩者之間無明顯差異;3.ALPI聯(lián)合LPI術(shù)與傳統(tǒng)小梁切除術(shù)相比對于術(shù)后3個月視野、C/D值、盤沿面積的減小、RNFL變薄進(jìn)展的控制兩者之間無明顯差異
[Abstract]:Objective: To evaluate the effect of laser peripheral iridoplasty (ALPI) combined with laser peripheral iridotomy (LPI) and trabeculectomy in the treatment of primary acute angle closure glaucoma (PACG) with the first major attack. Results. The significance of ALPI combined with LPI and trabeculectomy was to find an effective, safe and minimally invasive treatment for acute PACG. Methods: 60 eyes of 60 patients with the first major attack of acute PACG were randomly selected from September 2014 to September 2016. The visual acuity, intraocular pressure (IOP) and anterior chamber depth (A) were measured and recorded before and after 1 week (w) and 3 months (m) respectively. CD, anterior chamber angle 500 (AOD_ (500)); visual field, cup/disc ratio (C/D), disc edge area, retinal never fiber layer (RNFL) were measured and recorded before and after operation for 3 months. Material analysis of variance; paired t test for ACD and AOD_ (500) before and 3 months after operation in group A and group B; independent sample t test for ACD and AOD_ (500) between group A and group B; _2 test for visual field, C/D value, disc edge area, RNFL value before and 3 m after operation in group A and group B. Results: 1. The results of intraocular pressure were as follows: intraocular pressure (IOP) was 15.44 (+ 2.28) mm Hg before operation, 14.13 (+ 2.96) mm Hg one week after operation, and 15.50 (+ 3.50) mm Hg three months after operation, P = 0.00. The difference was statistically significant. (2) IOP of group B was as follows: IOP was 15.00 (+ 2.78) mm Hg before operation, 14.50 (+ 7.01) mm Hg one week after operation. Hg, intraocular pressure 3 months after surgery (14.81 + 4.07) mm Hg, P = 0.00, the difference was statistically significant. (3) Compared with group B, the intraocular pressure of group A was P = 0.33, there was no significant difference. 2. Visual acuity (1) Visual acuity of group A before surgery, 1 week after surgery, 3 months after surgery were as follows: preoperative visual acuity (0.37 + 0.30), 1 week visual acuity (0.57 + 0.26), 3 months after surgery visual acuity (0.57 + 0.26). There were significant differences in visual acuity before operation, one week after operation and three months after operation in group B. The results were as follows: preoperative visual acuity (0.36.24), one week visual acuity (0.46.24), three months visual acuity (0.45.23), P = 0.00. There was no significant difference in visual acuity between group A and group B (P = 0.33). Significance. 3. Ultrasound biomicroscopy (UBM) measurement of anterior chamber related parameters 3.1 ACD (1) A group before surgery, 3 months after surgery ACD detection results were as follows: preoperative (1733.67 65507 34.42 micron, 3 months after surgery (1841.00 + 144.35) micron, P = 0.00, the difference was statistically significant. (3) A, B, ACD postoperative comparison between the two groups P = 0.54, there was no significant difference. 3.2 AOD (500) (1) A group before surgery, 3 months after surgery AOD (500) detection results were as follows: preoperative AOD (500) (nose) (98.57 75.89), postoperative AOD (500) (nose) (227.70 114.20), P = 0.00, the difference was statistically significant. AOD_ (500) (below) (60.00 53.38) before operation, AOD_ (500) (below) (203.27 118.45), P = 0.00 after operation, the difference was statistically significant; AOD_ (500) (temporal) (85.27 80.13) before operation, AOD_ (500) (temporal) (226.27 117.40), P = 0.00 after operation, the difference was statistically significant; AOD_ (500) before operation (above) (44.27 60.32), AOD_ (500) (above) (117.67 89.85), P = 0.00, P = 0.00). The results of AOD_ (500) in group B were as follows: AOD_ (500) (nose) (101.07 73.88) before operation, AOD_ (500) (nose) (208.97 104.94), P = 0.00 after operation; AOD_ (500) (below) (57.60 53.49) before operation, AOD_ (500) (below) (187.27 111.27), P = 0.00 after operation. Preoperative AOD_ (500) (temporal) (81.43 75.75), postoperative AOD_ (500) (temporal) (219.23 110.83), P = 0.00, the difference was statistically significant; preoperative AOD_ (500) (above) (41.60 56.42), postoperative AOD_ (500) (above) (109.10 82.77), P = 0.00, the difference was statistically significant. (3) A, postoperative AOD_ (500) between the two groups compared with PAOD_ (500) (nose) = 0.37; OD (500) (below) = 0.58; The progress rate of visual field in group A was 0.0%, and that in group B was 3.3%. There was no significant difference between the progress rate of visual field in group A and group B (P = 0.50). The progress rate of C/D was 0.0% in group C/D A and 3.3% in group B (P = 0.50). 6. The progressive rate of rim area reduction was 3.3% in group A and 3.3% in group B. The progressive rate of rim area reduction was P = 0.75, with no significant difference. 7. The progressive rate of RNFL thickness thinning was 3.3% in group A and 3.3% in group B, respectively. There was no significant difference between the two treatments (P = 0.75). CONCLUSION: The two treatments were effective for the first major attack of acute PACG within 3 months. The middle-term results were as follows: 1. Intraocular pressure (IOP) decreased after ALPI combined with LPI and trabeculectomy, but the visual acuity improved after trabeculectomy, but there was no significant difference between the two treatments. The ACD and AOD_ (500) of anterior chamber increased after LPI and traditional trabeculectomy, but there was no significant difference between them. 3. Compared with traditional trabeculectomy, ALPI combined with LPI had no significant difference in visual field, C/D value, disc area, and RNFL thinning progression control.
【學(xué)位授予單位】：延安大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R779.6
本文編號：2195639
[Abstract]:Objective: To evaluate the effect of laser peripheral iridoplasty (ALPI) combined with laser peripheral iridotomy (LPI) and trabeculectomy in the treatment of primary acute angle closure glaucoma (PACG) with the first major attack. Results. The significance of ALPI combined with LPI and trabeculectomy was to find an effective, safe and minimally invasive treatment for acute PACG. Methods: 60 eyes of 60 patients with the first major attack of acute PACG were randomly selected from September 2014 to September 2016. The visual acuity, intraocular pressure (IOP) and anterior chamber depth (A) were measured and recorded before and after 1 week (w) and 3 months (m) respectively. CD, anterior chamber angle 500 (AOD_ (500)); visual field, cup/disc ratio (C/D), disc edge area, retinal never fiber layer (RNFL) were measured and recorded before and after operation for 3 months. Material analysis of variance; paired t test for ACD and AOD_ (500) before and 3 months after operation in group A and group B; independent sample t test for ACD and AOD_ (500) between group A and group B; _2 test for visual field, C/D value, disc edge area, RNFL value before and 3 m after operation in group A and group B. Results: 1. The results of intraocular pressure were as follows: intraocular pressure (IOP) was 15.44 (+ 2.28) mm Hg before operation, 14.13 (+ 2.96) mm Hg one week after operation, and 15.50 (+ 3.50) mm Hg three months after operation, P = 0.00. The difference was statistically significant. (2) IOP of group B was as follows: IOP was 15.00 (+ 2.78) mm Hg before operation, 14.50 (+ 7.01) mm Hg one week after operation. Hg, intraocular pressure 3 months after surgery (14.81 + 4.07) mm Hg, P = 0.00, the difference was statistically significant. (3) Compared with group B, the intraocular pressure of group A was P = 0.33, there was no significant difference. 2. Visual acuity (1) Visual acuity of group A before surgery, 1 week after surgery, 3 months after surgery were as follows: preoperative visual acuity (0.37 + 0.30), 1 week visual acuity (0.57 + 0.26), 3 months after surgery visual acuity (0.57 + 0.26). There were significant differences in visual acuity before operation, one week after operation and three months after operation in group B. The results were as follows: preoperative visual acuity (0.36.24), one week visual acuity (0.46.24), three months visual acuity (0.45.23), P = 0.00. There was no significant difference in visual acuity between group A and group B (P = 0.33). Significance. 3. Ultrasound biomicroscopy (UBM) measurement of anterior chamber related parameters 3.1 ACD (1) A group before surgery, 3 months after surgery ACD detection results were as follows: preoperative (1733.67 65507 34.42 micron, 3 months after surgery (1841.00 + 144.35) micron, P = 0.00, the difference was statistically significant. (3) A, B, ACD postoperative comparison between the two groups P = 0.54, there was no significant difference. 3.2 AOD (500) (1) A group before surgery, 3 months after surgery AOD (500) detection results were as follows: preoperative AOD (500) (nose) (98.57 75.89), postoperative AOD (500) (nose) (227.70 114.20), P = 0.00, the difference was statistically significant. AOD_ (500) (below) (60.00 53.38) before operation, AOD_ (500) (below) (203.27 118.45), P = 0.00 after operation, the difference was statistically significant; AOD_ (500) (temporal) (85.27 80.13) before operation, AOD_ (500) (temporal) (226.27 117.40), P = 0.00 after operation, the difference was statistically significant; AOD_ (500) before operation (above) (44.27 60.32), AOD_ (500) (above) (117.67 89.85), P = 0.00, P = 0.00). The results of AOD_ (500) in group B were as follows: AOD_ (500) (nose) (101.07 73.88) before operation, AOD_ (500) (nose) (208.97 104.94), P = 0.00 after operation; AOD_ (500) (below) (57.60 53.49) before operation, AOD_ (500) (below) (187.27 111.27), P = 0.00 after operation. Preoperative AOD_ (500) (temporal) (81.43 75.75), postoperative AOD_ (500) (temporal) (219.23 110.83), P = 0.00, the difference was statistically significant; preoperative AOD_ (500) (above) (41.60 56.42), postoperative AOD_ (500) (above) (109.10 82.77), P = 0.00, the difference was statistically significant. (3) A, postoperative AOD_ (500) between the two groups compared with PAOD_ (500) (nose) = 0.37; OD (500) (below) = 0.58; The progress rate of visual field in group A was 0.0%, and that in group B was 3.3%. There was no significant difference between the progress rate of visual field in group A and group B (P = 0.50). The progress rate of C/D was 0.0% in group C/D A and 3.3% in group B (P = 0.50). 6. The progressive rate of rim area reduction was 3.3% in group A and 3.3% in group B. The progressive rate of rim area reduction was P = 0.75, with no significant difference. 7. The progressive rate of RNFL thickness thinning was 3.3% in group A and 3.3% in group B, respectively. There was no significant difference between the two treatments (P = 0.75). CONCLUSION: The two treatments were effective for the first major attack of acute PACG within 3 months. The middle-term results were as follows: 1. Intraocular pressure (IOP) decreased after ALPI combined with LPI and trabeculectomy, but the visual acuity improved after trabeculectomy, but there was no significant difference between the two treatments. The ACD and AOD_ (500) of anterior chamber increased after LPI and traditional trabeculectomy, but there was no significant difference between them. 3. Compared with traditional trabeculectomy, ALPI combined with LPI had no significant difference in visual field, C/D value, disc area, and RNFL thinning progression control.
【學(xué)位授予單位】：延安大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R779.6
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10 郭春雨;李思珍;蔡嘯谷;郭黎霞;范肅潔;崔宏宇;張志宏;張青;孫蘭萍;孫霞;梁遠(yuǎn)波;王寧利;;激光周邊虹膜切開術(shù)及其聯(lián)合周邊虹膜成形術(shù)對粘連性房角關(guān)閉的療效對比:5年隨訪研究[J];眼科;2013年01期
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