本文關(guān)鍵詞： 曲安奈德 玻璃體切除手術(shù) 并發(fā)癥　出處：《鄭州大學(xué)》2010年碩士論文　論文類型：學(xué)位論文

【摘要】： 目的 通過觀察行玻璃體視網(wǎng)膜手術(shù)中注射曲安奈德前后的眼壓及其他眼部改變,探討玻璃體腔內(nèi)注射曲安奈德術(shù)后并發(fā)癥和療效,評價小劑量曲安奈德的安全性。 資料和方法 自2008年9月～2009年9月,選擇不同原因造成的需行玻璃體切除手術(shù),術(shù)中玻璃體腔內(nèi)注射不同劑量曲安奈德的116例患者。男65例,女51例。年齡在17歲～71歲之間,平均年齡35歲。116例患者均行閉合式玻璃體切除手術(shù),其中手術(shù)過程中單純用曲安奈德染色的5眼,常規(guī)行玻璃體切除手術(shù)注入曲安奈德2mg者21眼,注入曲安奈德4mg25眼；常規(guī)行玻璃體染色并注入硅油者6眼,注入曲安奈德2mg者23眼,注入4mg者36眼。在無菌條件下行閉合式玻璃體切除術(shù),手術(shù)過程注射不同劑量的洗滌過的曲安奈德。術(shù)中聯(lián)合晶狀體切除、視網(wǎng)膜前膜剝離或切除、視網(wǎng)膜激光光凝術(shù)、硅油填充。術(shù)前經(jīng)過眼壓計多次準(zhǔn)確測量眼壓并排除高眼壓；房角鏡、UBM檢查排除房角粘連；裂隙燈、檢眼鏡檢查,必要時行B超、眼底彩照及眼底熒光血管造影(fundus fluorescein angiography, FFA)、光學(xué)相干斷層掃描(optical coherence tomography,OCT)等檢查記錄術(shù)前的眼部情況。排除高眼壓病史以及青光眼家族史。排除全身和玻璃體腔內(nèi)應(yīng)用糖皮質(zhì)激素的禁忌癥。術(shù)后觀察患者1天、3天、1周、1個月、2個月、3個月左右的眼壓、炎癥反應(yīng)、晶狀體、視網(wǎng)膜以及視力等眼部情況,以了解曲安奈德玻璃體內(nèi)注射的并發(fā)癥及療效,并針對出現(xiàn)的并發(fā)癥選擇合適的治療方案。 結(jié)果 在本組的116例中,在隨訪過程中觀察到有37例,出現(xiàn)眼壓升高＞5mmHg,占39%；有16例出現(xiàn)眼壓升高10mmHg,占14%,16例眼壓最高時均高于21mmHg。其中有6例在22mmHg～30mmHg之間,有5例在30mmHg～40mmHg之間,有5例眼壓最高在40mmHg以上,1例眼壓最高達到59mmHg.單純行玻璃體染色輔助玻璃體切除術(shù)眼壓未見升高；行玻璃體切除并注入曲安奈德2mg的21眼,2只眼出現(xiàn)眼壓升高5mmHg,1只眼眼壓升高高于10mmHg；行玻璃體切除并注入曲安奈德4mg的25只眼中,9只眼出現(xiàn)眼壓升高5mmHg,4只眼眼壓升高10mmHg；行玻璃體切除硅油填充術(shù)并注入曲安奈德2mg的23眼中,6只眼出現(xiàn)眼壓升高5mmHg,其中2只眼眼壓升高10mmHg；行玻璃體切除硅油填充并注入曲安奈德4mg的36只眼中,有20只眼出現(xiàn)眼壓升高＞5mmHg,9只眼壓升高10mmHg。在本組研究中的37例中,有17例合并高度近視,占眼壓升高總數(shù)的46%。曲安奈德的在玻璃體腔內(nèi)的消失時間為5天～3個月,與曲安奈德的注射劑量、是否合并硅油填充等方面有關(guān)。 結(jié)論 1玻璃體手術(shù)中注射2mg小劑量曲安奈德相對于注射4mg曲安奈德,術(shù)后出現(xiàn)的高眼壓、并發(fā)性白內(nèi)障等并發(fā)癥的發(fā)生率低,相對安全。 2玻璃體手術(shù)中注射2mg曲安奈德能夠有效的抑制PVR,減少術(shù)后炎癥反應(yīng),出現(xiàn)的眼壓升高通過藥物基本上能夠控制。 3合并高度近視應(yīng)用曲安奈德術(shù)后高眼壓的發(fā)生率高。硅油填充會延長曲安奈德的排出時間和高眼壓的持續(xù)時間。在應(yīng)用過程中注意在不影響療效時,適當(dāng)減少曲安奈德的用量,盡量減少不良反應(yīng)的發(fā)生。
[Abstract]:objective
To observe the intraocular pressure and other ocular changes before and after injection of Cu Ann Ned in vitreoretinal surgery, to explore the complications and efficacy of intravitreal injection of Cu Ann Ned, and to evaluate the safety of small dose of Cu Ann Ned.
Information and methods
From September 2008 to September 2009, select the different causes for vitreous body resection, 116 cases with different doses of intravitreal injection of Cu Ann Ned cases. 65 cases were male, 51 were female. The age of 17 to 71 years old, the average age of 35 years old.116 patients underwent closed vitreous surgery. The operation process of pure Cu Ann Ned staining in 5 eyes underwent resection of vitreous body into Cu Ann Ned 2mg in 21 eyes, with Cu Ann Ned 4mg25 eyes; routine staining and injection of silicone oil into the vitreous body in 6 eyes, 23 eyes with Cu Ann Ned 2mg, in 4mg in 36 eyes. In the sterile condition downward closed vitreous body resection. The washing operation process of injection of different doses of Cu Ann Ned. Resection combined with lens implantation, epiretinal membrane peeling or excision, laser photocoagulation and silicone oil tamponade. Preoperative IOP after repeated measurement The intraocular pressure and the exclusion of high intraocular pressure; goniscope and UBM exclude goniosynechia; slit lamp ophthalmoscopy, if necessary, ultrasound, fundus and fundus fluorescein angiography (fundus fluorescein angiography, FFA), optical coherence tomography (optical coherence tomography, OCT) examination were recorded before the eye. Out of high intraocular pressure medical history and family history of glaucoma. Exclusion of contraindications corticosteroids systemic and intravitreal. Postoperative patients were observed for 1 days, 3 days, 1 weeks, 1 months, 2 months, 3 months about intraocular pressure, inflammatory reaction, lens, retina and visual acuity eye conditions, in order to understand the complications and the effect of intravitreal injection of Cu Ann Ned, and choose the appropriate treatment for complications.
Result
In this group of 116 cases, during follow-up were observed in 37 cases, elevation of intraocular pressure occurred in 5mmHg, accounting for 39%; 16 cases of elevated intraocular pressure 10mmHg, accounting for 14%, 16 cases with the highest intraocular pressure was higher than that of 21mmHg. including 6 cases in 22mmHg ~ 30mmHg, there are 5 cases in 30mmHg ~ 40mmHg there are 5 cases, IOP is the highest in more than 40mmHg, 1 cases of intraocular pressure up to 59mmHg. underwent resection of vitreous body dyeing auxiliary vitreous body no increase in intraocular pressure; vitreous body resection and injection of Cu Ann Ned 2mg in 21 eyes, 2 eyes showed elevated intraocular pressure 5mmHg, 1 eyes IOP higher than 10mmHg; for Cu Ann Ned 4mg and injected into the vitreous body resection in 25 eyes appeared in 9 eyes, 4 eyes IOP 5mmHg, 10mmHg elevated intraocular pressure; vitreous body resection for silicone oil tamponade into Cu Ann Ned 2mg in 23 eyes, 6 eyes showed elevated intraocular pressure 5mmHg, including 2 eyes IOP 10mmHg for glass; 36 eyes for silicone oil into Cu Ann Ned 4mg, has appeared in 20 eyes IOP > 5mmHg, pressure 10mmHg. in 9 eyes in the study group of 37 cases, 17 cases with a high degree of myopia, accounting for lost time in the vitreous cavity increased intraocular pressure 46%. of the total number of Cu Ann Ned's 5 days to for 3 months, and the dose of Cu Ann Ned, whether combined with silicone oil filling and so on.
conclusion
1 in vitreous surgery, the incidence of complications such as intraocular hypertension, complicated cataract and postoperative complications such as intraocular pressure (2mg), Cu Ann Ned and Cu Ann Ned 4mg were relatively low and relatively safe.
2 the injection of 2mg triamcinolone in vitreous surgery can effectively inhibit PVR and reduce the postoperative inflammatory response. The increase of intraocular pressure (IOP) is basically controlled by drugs.
3 patients with high myopia using Cu Ann Ned postoperative high intraocular pressure. The high incidence of silicone oil will extend Cu Ann Ned's discharge time and the duration of high intraocular pressure. In the application process in the curative effects, appropriate to reduce the dosage of Cu Ann Ned, as far as possible to reduce the occurrence of adverse reactions.

【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2010
【分類號】：R779.6

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本文編號：1543959