【摘要】：目的：探討經鞏膜睫狀體光凝術（TSCP）激光治療參數與術后眼壓及睫狀體形態(tài)變化的關系，從而指導臨床對經鞏膜睫狀體光凝術光凝射擊點數和爆破點數的選擇。 方法：回顧分析從2010年8月至2011年11月，我院青光眼科收治的診斷為難治性青光眼，并行睫狀體光凝術的患者共65例，選取其中定期復診的患者41例共41眼進行統(tǒng)計分析。分別用眼壓計和超聲生物顯微鏡（UBM）測量手術前及手術后3個月的眼壓、眼前段的參數，總結分析經鞏膜睫狀體光凝術激光治療參數與術后眼壓改變及睫狀體形態(tài)變化的相關性。 結果： 1.本研究共納入41例共41只眼，術前眼壓平均值為58.91±3.62mmHg，術后3個月眼壓平均值為27.27±16.02mmHg，眼壓下降值為31.64±16.33mmHg。術后3個月眼壓明顯低于術前的眼壓，且具有統(tǒng)計學意義（P0.05）。其中，多次抗青光眼術后眼壓失控患者眼壓下降值最小，為17.50±5.44mmHg，明顯低于其他類型難治性青光眼患者，且具有統(tǒng)計學意義（P0.05）。術前與術后3個月UBM檢查參數比較：術前睫狀突數量(CPN)、鞏膜睫狀體夾角（θ）、α角與術后3個月相比，差異具有統(tǒng)計學意義（P0.05）。 2.眼壓下降的程度與睫狀突形態(tài)改變的相關性：鞏膜睫狀體夾角（θ）改變與眼壓下降呈正相關性r=0.925（P0.05）；A角改變與眼壓下降呈正相關性r=0.848（P0.05）；α角改變與眼壓下降呈正相關性r=0.949（P0.05）；睫狀突數量（CPN）改變與眼壓下降呈正相關性r=0.687（P0.05）。睫狀突厚度（CPT）改變與眼壓下降沒有線性相關。 3.眼壓下降的程度與激光治療參數間的相關性：眼壓下降的程度與射擊點數呈正相關性r=0.656（P0.05）；眼壓下降的程度與爆破點數呈正相關性r=0.554（P0.05）。 結論： 1.經鞏膜睫狀體光凝術是治療難治性青光眼的有效方法，且相對方便安全經濟。對不同類型的難治性青光眼療效不同，原發(fā)性閉角型青光眼絕對期效果最好，，多次抗青光眼術后眼壓失控患者治療效果明顯差于其他難治性青光眼患者。 2.經鞏膜睫狀體光凝術后眼壓下降的程度與睫狀體形態(tài)變化的程度呈正相關性，睫狀體形態(tài)變化的程度越大，眼壓下降的程度越大。 3.經鞏膜睫狀體光凝術后眼壓下降的程度與射擊點數、爆破點數呈正相關性，隨著射擊點數、爆破點數的增加，眼壓下降的程度越大。 4.行經鞏膜睫狀體光凝術時，應根據患者術前的眼壓水平來選擇射擊點數和爆破點數，術前眼壓越高，術中越應增加光凝點數和爆破點數。
[Abstract]:Objective: to investigate the relationship between the parameters of (TSCP) laser therapy and postoperative intraocular pressure (IOP) and ciliary body morphology in scleral ciliary body photocoagulation, so as to guide the selection of firing points and blasting points for scleral ciliary body photocoagulation. Methods: from August 2010 to November 2011, 65 patients with refractory glaucoma and ciliary body photocoagulation were analyzed retrospectively. Among them, 41 eyes were selected for regular follow-up. Intraocular pressure (IOP) and anterior segment parameters were measured by intraocular pressure meter (IOP) and ultrasound biomicroscopy (UBM) before and 3 months after operation, and the correlation between the parameters of transscleral ciliary photocoagulation and the changes of intraocular pressure and ciliary body morphology were analyzed. Results: 1. The intraocular pressure was 58.91 鹵3.62mmHg before operation, 27.27 鹵16.02mmHg at 3 months after operation and 31.64 鹵16.33mmHg. IOP 3 months after operation was significantly lower than preoperative IOP (P0.05). Among them, the intraocular pressure of the patients with out-of-control intraocular pressure after multiple anti-glaucoma surgery was the smallest, 17.50 鹵5.44 mmHg, which was significantly lower than that of other types of refractory glaucoma patients, and had statistical significance (P0.05). Comparison of UBM parameters between preoperative and postoperative 3 months: preoperative ciliary process number (CPN), scleral ciliary body angle (胃), 偽 angle compared with postoperative 3 months, the difference was statistically significant (P0.05). The relationship between the degree of intraocular pressure decrease and the change of ciliary process: the change of scleral ciliary body angle (胃) was positively correlated with the decrease of intraocular pressure, the change of angle A was positively correlated with the decrease of intraocular pressure (P0.05), the change of 偽 angle was positively correlated with the decrease of intraocular pressure (P 0.05), the change of 偽 angle was positively correlated with the decrease of intraocular pressure (P 0.05), and the change of angle A was positively correlated with the decrease of intraocular pressure. The number of ciliary process (CPN) was positively correlated with the decrease of intraocular pressure (P 0.05). There was no linear correlation between (CPT) change of ciliary process thickness and intraocular pressure decrease. The degree of IOP drop was positively correlated with firing points (P 0.05), and the degree of IOP drop was positively correlated with blasting points (P 0.05). Conclusion: 1. Transscleral ciliary photocoagulation is an effective method for the treatment of refractory glaucoma, and is relatively convenient, safe and economical. For different types of refractory glaucoma, the effect of primary angle-closure glaucoma in absolute period is the best, and the effect of IOP control after multiple anti-glaucoma surgery is significantly worse than that of other refractory glaucoma patients. 2. After transscleral ciliary body photocoagulation, the degree of intraocular pressure decrease was positively correlated with the degree of ciliary body morphological change. The greater the degree of ciliary body morphology change, the greater the degree of intraocular pressure decrease. After scleral ciliary body photocoagulation, the degree of intraocular pressure decrease was positively correlated with the number of firing points and the number of blasting points. With the increase of firing points, the degree of intraocular pressure decrease was greater. 4. In transscleral ciliary body photocoagulation, shooting points and blasting points should be selected according to the preoperative IOP level. The higher the IOP before operation, the higher the number of photocoagulation points and blasting points should be increased.
【學位授予單位】：吉林大學
【學位級別】：碩士
【學位授予年份】：2012
【分類號】：R779.63

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