本文關(guān)鍵詞： 原位濾過道再通術(shù) 濾過泡瘢痕化 眼壓失控　出處：《吉林大學(xué)》2011年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：觀察原位濾過道再通術(shù)與再次小梁切除術(shù)治療抗青光眼術(shù)后眼壓失控的臨床療效。 資料和方法：以12例(13只眼)小梁切除術(shù)后濾過道瘢痕化的青光眼患者為實驗組(A組),同期入院的19例(22只眼)小梁切除術(shù)后濾過道瘢痕化的青光眼患者為對照組(B組)。用裂隙燈、前房角鏡觀察周邊虹膜切除孔及球結(jié)膜濾過泡的情況,兩組患者首次手術(shù)失敗的原因均為濾過道外阻塞。局部或全身應(yīng)用降眼壓藥物,兩組患者術(shù)前眼壓均在40mmHg以下。對A組患者行原位濾過道再通術(shù),B組患者再次行小梁切除術(shù)。首次小梁切除術(shù)與原位濾過道再通術(shù)以及再次小梁切除術(shù)均由同一術(shù)者完成。術(shù)后定期監(jiān)測患者的眼壓情況,采用Kronfeld分型標(biāo)準(zhǔn)記錄濾過泡的形態(tài)及功能。Kaplan-Meier法對比分析A、B兩組濾過泡的生存時間。 結(jié)果：(1)術(shù)后眼壓：術(shù)后第7天,A組眼壓由術(shù)前的28.15±7.54(15～40) mmHg降至13.77±4.71(10～24)mmHg; B組眼壓由術(shù)前的25.36±8.89(16-40) mmHg降至15.05±4.36(9～28)mmHg。末次隨訪時,A組眼壓為17.38±10.50(12～50)mmHg;B組眼壓為16.00±11.08(11～50)mmHg。原位再通組與再次小梁切除組術(shù)后眼壓的差別無統(tǒng)計學(xué)意義(P0.05)。(2)術(shù)后濾過泡形態(tài)及功能：術(shù)后第7天,兩組濾泡形態(tài)彌漫扁平或微隆起,泡壁適中并有少量血管分布,濾過功能均良好。末次隨訪時,A組：功能型濾過泡10例11只眼,無功能型濾過泡2例2只眼；B組：功能型濾過泡17例20只眼,無功能型濾過泡2例2只眼。Kaplan-Meier生存分析結(jié)果表明,兩組濾過泡生存時間的差別無統(tǒng)計學(xué)意義(P0.05)。(3)兩組患者均無脈絡(luò)膜上腔出血、角膜內(nèi)皮失代償、白內(nèi)障以及黃斑囊樣水腫等術(shù)中和術(shù)后并發(fā)癥的發(fā)生。 結(jié)論：(1)與再次小梁切除術(shù)相比,原位濾過道再通術(shù)同樣可以有效控制眼壓,且濾過泡形態(tài)、功能均良好。(2)原位濾過道再通術(shù)具有眼部正常組織破壞少、術(shù)后瘢痕面積小,并發(fā)癥少,遠期療效穩(wěn)定等優(yōu)點,不失為治療抗青光眼術(shù)后眼壓失控的有效術(shù)式之一。(3)首次小梁切除術(shù)與原位濾過道再通術(shù)應(yīng)由同一術(shù)者完成,這樣二次手術(shù)才更安全、更具有實際意義。
[Abstract]:Objective: to observe the clinical effect of orthotopic filtration and trabeculectomy in the treatment of intraocular pressure loss after glaucoma surgery. Materials and methods: 12 cases (13 eyes) of trabeculectomy and 19 cases (22 eyes) of glaucoma treated by trabeculectomy were treated as experimental group A and 19 cases with scarring glaucoma after trabeculectomy. Group B: slit lamp, Anterior chamber angle endoscopy was used to observe the peripheral iris excision foramen and bulbar conjunctiva filtration bleb. The reason of the first operation failure in both groups was the obstruction of the extraductal tract, local or systemic application of intraocular pressure lowering drugs. The preoperative IOP of both groups was below 40mmHg. The patients in group A were treated with in situ filtering and recanalization. The patients in group B underwent trabeculectomy again. The first trabeculectomy, in situ filtration recanalization and re-trabeculectomy were performed by the same method. The patient's intraocular pressure was monitored regularly after operation. The morphology and function of bleb were recorded by Kronfeld typing standard. Kaplan-Meier method was used to compare and analyze the survival time of two groups. Results intraocular pressure (IOP) in group A decreased from 28.15 鹵7.541540 mmHg to 13.77 鹵4.71U 1024mm Hgon on the 7th day after operation, and IOP in group B decreased from 25.36 鹵8.89516-40 mmHg to 15.05 鹵4.36928mm Hg.Intraocular pressure in group A was 17.38 鹵10.50,1250mm Hgg at the last follow-up. Intraocular pressure in group B was 16.00 鹵11.081150mm Hg.Intraocular pressure in group B was 16.00 鹵11.081150mm Hg.Ocular pressure in group A was 15.05 鹵4.36928mm Hg.After the last follow-up, IOP was 17.38 鹵10.50mm Hgg in group B and 16.00 鹵11.081150mm Hgg in group B. There was no significant difference in posterior intraocular pressure (P 0.05).) the morphology and function of filtering bleb: on the 7th day after operation, there was no significant difference in posterior intraocular pressure (P < 0.05). The follicles in both groups were diffusely flat or slightly bulged, with moderate wall and a small amount of vasculature, with good filtering function. In group A, 10 cases (11 eyes) with functional bleb were followed up at the last follow-up, 11 eyes of 10 cases were functional bleb, 11 eyes of 10 cases were treated with functional bleb. The results of Kaplan-Meier survival analysis showed that 17 cases (20 eyes) were functional blebs, 2 cases (2 eyes) without functional blebs, and 2 eyes (2 eyes) without functional blebs. There were no intraoperative and postoperative complications such as suprachoroidal hemorrhage, corneal endothelial decompensation, cataract and macular cystic edema. Conclusion compared with the second trabeculectomy, in situ filtering and recanalization can also effectively control intraocular pressure, and the function of filtering bleb is good. 2) in situ filtering, the normal tissue damage is less and the scar area is small after operation. The advantages of less complications and stable long-term curative effect are one of the effective methods for the treatment of intraocular pressure loss after glaucoma surgery.) the first trabeculectomy and the in-situ filtration and passage recanalization should be performed by the same person. Only in this way can the second operation be more safe. More practical significance.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2011
【分類號】：R779.6

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