【摘要】：背景青光眼是由于病理性眼壓增高而引起視神經(jīng)萎縮、視野缺損,最終可以導(dǎo)致失明的全球第二位致盲性眼病,全球患病率高達(dá)3.54%[1],其病因尚不明確。傳統(tǒng)青光眼小梁切除術(shù)是常用的外引流手術(shù)方式,但易出現(xiàn)術(shù)后早期低眼壓、淺前房、惡性青光眼等手術(shù)并發(fā)癥。聯(lián)合鞏膜瓣可調(diào)整縫線的小梁切除術(shù)有利于早期形成前房,良好地控制眼壓,大大降低淺前房等術(shù)后并發(fā)癥。但鞏膜可調(diào)整縫線是否會(huì)引起角膜散光,術(shù)后何時(shí)屈光度到達(dá)穩(wěn)定狀態(tài),是眼科學(xué)者所關(guān)注的問(wèn)題。目的探討鞏膜瓣可調(diào)整縫線的小梁切除術(shù)對(duì)角膜散光的影響及術(shù)后屈光度穩(wěn)定的時(shí)間。方法收集2014年6月至2016年7月于新鄉(xiāng)醫(yī)學(xué)院第一附屬醫(yī)院眼科收治的57例原發(fā)性青光眼患者,將其分為兩組,實(shí)驗(yàn)組為聯(lián)合可調(diào)整縫線的小梁切除術(shù)患者33例40眼,對(duì)照組為常規(guī)小梁切除術(shù)患者24例30眼,檢查記錄術(shù)前、術(shù)后第1天、術(shù)后1周(可調(diào)整縫線拆除前)、可調(diào)整縫線拆除后第1天、1月、3月的角膜地形圖、角膜曲率及眼壓情況。結(jié)果1.實(shí)驗(yàn)組角膜散光術(shù)后第1天(4.35±1.29D)、術(shù)后1周(3.80±1.31D)、拆線后第1天(3.23±1.19D)與術(shù)前(1.48±0.79D)相比,差異有顯著統(tǒng)計(jì)學(xué)意義(P0.01),術(shù)后1月(1.50±0.71D)、3月(1.36±0.61D)與術(shù)前相比,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);對(duì)照組角膜散光術(shù)后第1天(1.78±0.33D)、術(shù)后1周(1.42±0.32D)與術(shù)前(1.12±0.36D)相比,差異有顯著統(tǒng)計(jì)學(xué)意義(P0.01),術(shù)后1月(1.25±0.31D)、3月(1.09±0.34D)與術(shù)前相比,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。2.實(shí)驗(yàn)組角膜散光術(shù)后第1天(4.35±1.29D)、術(shù)后1周(3.80±1.31D)與對(duì)照組(1.78±0.33D、1.42±0.32D)相比,差異具有顯著統(tǒng)計(jì)學(xué)意義(P0.01);術(shù)后1月(1.50±0.71D)、3月(1.36±0.61D)與對(duì)照組(1.25±0.31D、1.09±0.34D)相比,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。3.實(shí)驗(yàn)組角膜散光術(shù)后1月(1.50±0.71D)與3月(1.36±0.61D)相比,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);對(duì)照組角膜散光術(shù)后1月(1.25±0.31D)與3月(1.09±0.34D)相比,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論1.鞏膜瓣可調(diào)整縫線拆除前明顯增加角膜散光度數(shù)。2.可調(diào)整縫線拆除后角膜散光度數(shù)減少,術(shù)后3月趨于穩(wěn)定,術(shù)后3月時(shí)角膜散光以循規(guī)性散光為主。
[Abstract]:Background Glaucomatous glaucoma is the second leading cause of blindness caused by optic atrophy and visual field defect due to increased pathological IOP. The global prevalence rate of glaucoma is as high as 3.54% [1]. The etiology of glaucoma is still unclear. Trabeculectomy is a common external drainage operation, but it is easy to occur early postoperative complications such as low intraocular pressure, shallow anterior chamber, malignant glaucoma and so on. Trabeculectomy combined with adjustable suture of scleral flap is beneficial to early formation of anterior chamber, good control of intraocular pressure and reduction of postoperative complications such as shallow anterior chamber. However, whether the scleral adjustable suture will cause corneal astigmatism and when the diopter will reach a stable state after surgery is an issue of concern to ophthalmologists. Objective to investigate the effect of trabeculectomy with adjustable suture of scleral flap on corneal astigmatism and the time of postoperative diopter stability. Methods from June 2014 to July 2016, 57 patients with primary glaucoma were divided into two groups: 33 cases (40 eyes) of trabeculectomy combined with adjustable suture, and 57 cases of primary glaucoma treated in the first affiliated Hospital of Xinxiang Medical College from June 2014 to July 2016. The control group consisted of 24 patients (30 eyes) with conventional trabeculectomy. The corneal topography, corneal curvature and intraocular pressure were recorded before operation, 1 day after operation, 1 week after operation (before the removal of adjustable suture), 1 day, 1 month and 3 months after the removal of suture. Result 1. In the experimental group, there were significant differences between the first day (4.35 鹵1.29D), the postoperative week (3.80 鹵1.31D), the first day after the removal of the wire (3.23 鹵1.19D) and the preoperative period (1.48 鹵0.79D) (P 0.01), the postoperative 1 month (1.50 鹵0.71D), the third month (1.36 鹵0.61D) compared with the preoperative. There was no significant difference between the control group and the control group on the 1st day (1.78 鹵0.33D), 1 week (1.42 鹵0.32D) and 1.12 鹵0.36D, respectively (P 0.01), 1 month after operation (1.25 鹵0.31D), 3 months (1.09 鹵0.34D) and 1 month after the operation (1.09 鹵0.34D), there was no significant difference (P 0.05). There was no significant difference between the experimental group and the control group on the 1st day (4.35 鹵1.29D) and the 1st week (3.80 鹵1.31D) compared with the control group (1.78 鹵0.33Dl 1.42 鹵0.32D) (P0.01), but at 1 month (1.50 鹵0.71D) and 3 months (1.36 鹵0.61D) compared with the control group (1.25 鹵0.31D, 1.09 鹵0.34D), there was no significant difference (P0.05). There was no significant difference between the experimental group (1.50 鹵0.71 D) and the third month (1.36 鹵0.61D) (P0.05), but there was no significant difference between the control group (1.25 鹵0.31D) and the control group (1.09 鹵0.34D) (P0.05). Conclusion 1. The scleral flap can be adjusted to increase the corneal astigmatism by 2. 2 before removing the suture. The degree of corneal astigmatism decreased after removable suture, and tended to be stable at 3 months after operation, and the main astigmatism was regular astigmatism at 3 months after operation.
【學(xué)位授予單位】：新鄉(xiāng)醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R779.6

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