本文關(guān)鍵詞： 閉角型青光眼 白內(nèi)障 超聲乳化 房角分離　出處：《河北醫(yī)科大學(xué)》2010年碩士論文　論文類型：學(xué)位論文

【摘要】： 目的:對比超聲乳化白內(nèi)障吸除人工晶狀體植入聯(lián)合小梁切除術(shù)(以下簡稱三聯(lián))、超聲乳化白內(nèi)障吸除人工晶狀體植入術(shù)(以下簡稱單純超乳)及超聲乳化白內(nèi)障吸除人工晶狀體植入聯(lián)合房角分離術(shù)(以下簡稱超乳聯(lián)合房角分離)對閉角型青光眼合并白內(nèi)障的治療效果,以期為手術(shù)治療原發(fā)性閉角型青光眼(primary angle-closure glaucoma,PACG)合并白內(nèi)障提供臨床指導(dǎo)。 方法: 1試驗(yàn)分組:根據(jù)房角粘連情況將患眼分為A(房角粘連關(guān)閉≤l80°),B(180°房角粘連關(guān)閉≤270°),C(房角粘連關(guān)閉270°)三組,每組隨機(jī)分為兩個(gè)手術(shù)組。 2手術(shù)選擇:A組共72眼,隨機(jī)分為兩組,分別采用單純超乳、超乳聯(lián)合房角分離。B組共106眼,C組60眼,均分別隨機(jī)分為兩組,分別采用三聯(lián)、超乳聯(lián)合房角分離。 3術(shù)前及術(shù)后隨訪視力、眼壓、裂隙燈、眼底、房角、視野。 結(jié)果: 1視力:238眼中14眼視力無變化或下降,超乳+房角分離中僅2眼視力無提高,無一例視力下降。 2眼壓:三組中兩個(gè)亞組之間的術(shù)前眼壓差異無統(tǒng)計(jì)學(xué)意義術(shù)后:A組:房角分離組眼壓明顯低于單純超乳組(P0.01),不同時(shí)相之間眼壓無差別(P0.05)。B組:房角分離組與三聯(lián)組眼壓存在差別(P0.05),不同時(shí)相之間眼壓存在差別(P0.01)。一周時(shí),三聯(lián)組眼壓最低,后有升高趨勢;而房角分離組一周時(shí)眼壓高于三聯(lián)組,其后稍有降低,1個(gè)月后眼壓趨于穩(wěn)定并低于三聯(lián)組,差異具有統(tǒng)計(jì)學(xué)意義(P0.01)。C組:房角分離組平均眼壓稍低于三聯(lián)組眼壓,差異無統(tǒng)計(jì)意義(P0.05)。 3房角變化 房角分離的119眼術(shù)后1月房角鏡檢查房角均不同程度開放,周邊虹膜前粘連基本消失。角鏡檢查未發(fā)現(xiàn)再次粘連及關(guān)閉。 對照組術(shù)后前房角較術(shù)前部分增寬,虹膜根部較術(shù)前平坦,部分患者房角重新開放,周邊虹膜前粘連的范圍變小。但變化不及房角分離組明顯。隨訪期內(nèi),三聯(lián)組中有4眼虹膜周切口前粘連。 4視野 房角分離患者中視野復(fù)查資料完整的47眼:A組、B組術(shù)后視野平均光敏度(MS)較術(shù)前顯著性增高( P 0.01),視野指數(shù)MD絕對值較術(shù)前下降,有統(tǒng)計(jì)學(xué)意義( P 0.05)。C組術(shù)后MS較術(shù)前有下降趨勢,但無差異( P 0.05 ) ;術(shù)后視野指數(shù)MD絕對值較術(shù)前提高,但無統(tǒng)計(jì)學(xué)差異( P 0.05 )。 結(jié)論: 1對于PACG合并白內(nèi)障患者,房角粘連關(guān)閉≤l80°的,僅行單純超乳、人工晶體植入就可控制眼壓;180°房角粘連關(guān)閉≤270°,超乳合并房角分離優(yōu)于三聯(lián),并發(fā)癥少、眼壓控制更佳;房角粘連關(guān)閉270°的患者,超乳合并房角分離與三聯(lián)眼壓控制無差異。 2對于房角粘連關(guān)閉≥270°的慢性閉角型青光眼,眼壓控制較急閉型青光眼差。雖然術(shù)前房角粘連關(guān)閉所在象限術(shù)后房角重新開放,但20%慢閉眼的眼壓仍未得到有效控制。 3 PACG合并白內(nèi)障患者早期行手術(shù)治療,術(shù)后視野光敏度提高,暗點(diǎn)變淺,視野好轉(zhuǎn)。晚期再行手術(shù)治療,眼壓可趨于穩(wěn)定,但視野可能仍有惡化趨勢.
[Abstract]:Objective: To compare the phacoemulsification and intraocular lens implantation combined with trabeculectomy (hereinafter referred to as triple), phacoemulsification and intraocular lens implantation (hereinafter referred to as ultra pure milk) and phacoemulsification and intraocular lens implantation combined with goniosynechialysis (hereinafter referred to as the phacoemulsification combined with goniosynechialysis) to close angle closure glaucoma with cataract treatment, in order for the surgical treatment of primary angle closure glaucoma (primary angle-closure glaucoma, PACG) with cataract and to provide clinical guidance.
Method:
1 test group: according to goniosynechia eyes will be divided into A (goniosynechia off less than L80 degrees), B (adhesion 180 degrees angle closure is smaller than 270 DEG), C (goniosynechia closed 270 degrees) three groups, each group were randomly divided into two groups.
2 operation selection: group A, 72 eyes, were randomly divided into two groups. They were divided into two groups by single emulsion, super emulsification combined with corner separation,.B group, 106 eyes, group C 60 eyes. They were randomly divided into two groups.
3 preoperative and postoperative follow-up of visual acuity, intraocular pressure, slit lamp, fundus, room angle, and visual field.
Result:
1 visual acuity: there was no change or decline in 14 eyes in 238 eyes. Only 2 eyes had no improvement in visual acuity in hyper emulsion + atrial angle separation, and no case of visual acuity was decreased.
2 intraocular pressure: there was no significant difference of three groups in two groups between preoperative IOP differences: group A: goniosynechiolysis IOP was obviously lower than that of phaco group (P0.01), no difference between different phases of intraocular pressure (P0.05) group.B: goniosynechiolysis group and triple group differences (intraocular pressure P0.05), different phase differences between the intraocular pressure (P0.01). One week after the lowest IOP, triple, has a rising trend; and goniosynechiolysis group a week when intraocular pressure was higher than the triple group, then decreased slightly, 1 months after the IOP was stable and lower than the triple group, the difference has statistical significance (P0.01).C group: goniosynechiolysis group mean IOP was slightly lower than the triple group, intraocular pressure, the difference was not statistically significant (P0.05).
3 atrial angle change
The corner separation in 119 eyes after 1 months gonioscopy examination angle were open, peripheral anterior synechia of iris disappeared. Angle was not found again adhesion and closed.
In the control group, the anterior chamber angle was widened partially after operation, the iris root was more flat than before operation, the angle of the anterior chamber was re opened in some patients, and the extent of the anterior synechia area around the periphery was smaller. However, the change of the anterior chamber angle was smaller than that in the angle separation group. During the follow-up period, there were 4 eyes with anterior synechia in the triple group.
4 field of vision
Goniosynechiolysis 47 eye view review with complete data: A group, B group, postoperative vision meansensitivity (MS) was significantly higher than that before operation (P 0.01), the absolute value of vision index MD decreased, with statistical significance (P 0.05).C group MS after operation than before operation a downward trend, but no significant difference (P 0.05); postoperative vision index of the absolute value of MD were improved, but the difference was not statistically significant (P 0.05).
Conclusion:
1 PACG for patients with cataract, goniosynechia off less than L80 degrees, only underwent phacoemulsification, intraocular lens implantation can control intraocular pressure; 180 degrees goniosynechia close less than or equal to 270 degrees, with super milk goniosynechiolysis is better than triple, less complications, better control of intraocular pressure; goniosynechia closed 270 degree patients super milk with goniosynechiolysis, and triple IOP control no difference.
2 for goniosynechia closed more than 270 degrees of chronic angle closure glaucoma, intraocular pressure control is more acute closed glaucoma. Although the adhesion in the anterior chamber angles of the quadrant angle after re open, not closed but 20% slow intraocular pressure was controlled effectively.
3 PACG patients with early cataract patients underwent surgical treatment, postoperative vision sensitivity enhancement, vision improved. Scotoma becomes shallow, late and underwent surgery, intraocular pressure can be stabilized, but the view may still have a deteriorating trend.

【學(xué)位授予單位】：河北醫(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)】：R779.66

【引證文獻(xiàn)】

相關(guān)期刊論文 前1條

1 吳娜;梁越;孟韜;;超生乳化術(shù)治療糖尿病患者白內(nèi)障的療效觀察[J];臨床合理用藥雜志;2012年30期

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本文編號(hào)：1533929