發(fā)布時(shí)間：2018-02-15 12:57

  本文關(guān)鍵詞： 青光眼 眼內(nèi)壓 二極管激光 睫狀體 光凝　出處：《天津醫(yī)科大學(xué)》2010年碩士論文　論文類型：學(xué)位論文

【摘要】： 目的分析使用二極管激光睫狀體光凝術(shù)(TDLC)治療不同類型中晚期青光眼時(shí)影響術(shù)后眼內(nèi)壓的相關(guān)因素；探討使用二極管激光睫狀體光凝術(shù)更有效控制中晚期青光眼術(shù)后眼內(nèi)壓的方法。 方法第一部分：回顧性臨床病例研究。中晚期青光眼病例共84例84只眼進(jìn)行TDLC治療,分別記錄患者的年齡、性別、青光眼的類別、激光斑點(diǎn)數(shù),術(shù)前、術(shù)后眼壓,術(shù)前、術(shù)后視力,并發(fā)癥的情況,采用偏相關(guān)分析的方法分析影響TDLC術(shù)后眼壓的相關(guān)因素；采用兩變量相關(guān)分析的方法分析術(shù)前術(shù)后眼壓差和激光斑點(diǎn)數(shù)的關(guān)系。 第二部分：前瞻性研究。根據(jù)第一部分的研究結(jié)果,提出根據(jù)患者不同的術(shù)前眼壓分組,在激光功率和持續(xù)時(shí)間不變的情況下,給予不同的激光點(diǎn)數(shù)。第一組,術(shù)前眼壓為22-30 mmHg,術(shù)中給予激光點(diǎn)數(shù)為50點(diǎn)；第二組,術(shù)前眼壓31-50 mmHg,術(shù)中給予激光點(diǎn)數(shù)為70點(diǎn)；第三組,術(shù)前眼壓51-70 mmHg,術(shù)中給予激光點(diǎn)數(shù)為90點(diǎn)。觀察每個(gè)病例的術(shù)后視力、術(shù)后眼壓、并發(fā)癥情況,并與回顧性青光眼病例作對(duì)比,觀察療效。隨訪該方法術(shù)后1天、7天、14天、術(shù)后30天、60天、90天及180天的眼壓,觀察其中期效果。 結(jié)果第一部分：TDLC術(shù)后眼壓與青光眼類型的關(guān)系,將性別、年齡、激光點(diǎn)數(shù)、術(shù)前眼壓作為控制變量,分析青光眼類型與術(shù)后眼壓的關(guān)系。偏相關(guān)系數(shù)r=0.2934,P=0.023。同樣方法,術(shù)后眼壓和術(shù)前眼壓的關(guān)系,偏相關(guān)系數(shù)r=0.6123,P=0.000；術(shù)后眼壓與性別的關(guān)系,偏相關(guān)系數(shù)r=-0.0092,P=0.945；術(shù)后眼壓與年齡的關(guān)系,偏相關(guān)系數(shù)r=-0.1053,P=0.427。術(shù)前術(shù)后眼壓差與激光治療點(diǎn)數(shù)的相關(guān)分析顯示r=0.279；P=0.036。 第二部分：術(shù)后第一天手術(shù)成功率為37.04%,較回顧性青光眼病例的成功率26.19%提高,術(shù)后6個(gè)月的手術(shù)成功率最終上升為92.5%。隨著時(shí)間的推移,術(shù)后眼壓逐漸下降,并越來越接近正常值。觀察期間,沒有嚴(yán)重的并發(fā)癥發(fā)生,沒有出現(xiàn)視力下降。 結(jié)論 1. TDLC治療各種類型中晚期青光眼安全、有效且簡便快捷。 2.對(duì)于中國人,TDLC治療中晚期青光眼的術(shù)后眼內(nèi)壓和青光眼的類型和術(shù)前眼壓相關(guān),而與患者年齡、性別無關(guān)。術(shù)前術(shù)后眼壓差與激光斑點(diǎn)數(shù)呈正相關(guān)。 3.根據(jù)術(shù)前眼壓高低,在激光功率和持續(xù)時(shí)間不變的情況下,給予不同的激光斑點(diǎn)數(shù),該方法治療中晚期青光眼時(shí)是安全的,可行的,能有效的控制術(shù)后眼壓,且不會(huì)增加并發(fā)癥的發(fā)生和降低術(shù)后視力。 4.隨著時(shí)間的推移,TDLC術(shù)后眼壓在半年內(nèi)逐漸且平穩(wěn)地下降至正常范圍。
[Abstract]:Objective to analyze the related factors of intraocular pressure (IOP) in the treatment of different types of advanced glaucoma with diode laser ciliary body photocoagulation (TDLC). To study the method of intraocular pressure control by diode laser ciliary body photocoagulation. Methods the first part: retrospective clinical case study. 84 eyes of 84 patients with advanced glaucoma were treated with TDLC. The age, sex, type of glaucoma, number of laser spots, intraocular pressure before and after operation were recorded, respectively. The postoperative visual acuity and complications were analyzed by partial correlation analysis and two variable correlation analysis were used to analyze the relationship between preoperative and postoperative IOP and the number of laser spots. Part two: prospective study. According to the results of the first part of the study, according to the patients with different preoperative intraocular pressure groups, under the condition of constant laser power and duration, different laser points were given. The intraocular pressure was 22-30 mm Hg before operation, and the laser points were 50 points during the operation. In the second group, the intraoperative intraocular pressure was 31-50 mm Hg, and the laser number was 70 points during the operation. In the third group, the intraoperative intraocular pressure was 51-70 mm Hg, and the intraoperative laser points were 90 points. The postoperative visual acuity of each case was observed. The intraocular pressure and complications were compared with those of the patients with retrospective glaucoma and the curative effect was observed. The intraocular pressure was observed at 1 day, 7 days, 14 days, 30 days, 60 days, 90 days and 180 days after operation, and the medium-term effect was observed. Results in the first part, the relationship between intraocular pressure (IOP) and glaucoma type after TDLC was analyzed. Sex, age, laser points and intraocular pressure before operation were used as control variables to analyze the relationship between IOP and IOP. The relationship between postoperative intraocular pressure and preoperative intraocular pressure, partial correlation coefficient (r = 0.6123), postoperative intraocular pressure (IOP) and sex (r = 0.0092) P ~ (0.945), and postoperative intraocular pressure (IOP) and age (r = -0.1053) P ~ (0.427). The correlation analysis between preoperative and postoperative IOP difference and laser treatment points showed that the IOP was 0.279 and P0.036.The relationship between IOP and postoperative intraocular pressure (IOP) and preoperative intraocular pressure (IOP) was 0. 6123P0. 000, and that between IOP and gender was 0. 0092P0. 945. The second part: the successful rate of operation on the first day of operation was 37.04, which was higher than that of retrospective glaucoma in 26.19%, and the successful rate of operation in 6 months after operation was 92.5. With the passage of time, the intraocular pressure decreased gradually. During the observation period, there were no serious complications and no loss of vision. Conclusion. 1. TDLC is safe, effective and convenient in the treatment of various types of middle and late glaucoma. 2. The intraocular pressure (IOP) and the type of glaucoma were related to the preoperative IOP, but not to the age and sex of the patients, but the IOP difference was positively correlated with the number of laser spots. 3.According to the preoperative intraocular pressure and the constant laser power and duration, different laser spots were given. This method is safe and feasible in the treatment of intermediate and advanced glaucoma, and can effectively control postoperative intraocular pressure. And does not increase the occurrence of complications and reduce postoperative visual acuity. 4. Intraocular pressure gradually and steadily decreased to normal range within half a year after TDLC.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2010
【分類號(hào)】：R779.63

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