本文選題：難治性青光眼 + 睫狀體平坦部濾過術(shù)　； 參考：《中國中醫(yī)科學(xué)院》2010年碩士論文

【摘要】： 目的： 通過臨床觀察,系統(tǒng)評價睫狀體平坦部濾過術(shù)治療難治性青光眼的有效性及安全性,觀察該手術(shù)的降壓效果及對眼部各組織的病理影響,為臨床研究治療難治性青光眼提供新的依據(jù)。 方法： 搜集2005年4月至2009年12月我院確診為難治性青光眼并實施睫狀體平坦部濾過手術(shù)的住院患者68例73只眼,其中男46例50眼,女22例23眼；右眼42只眼,左眼31只眼；年齡10—82歲,平均52.6歲；新生血管性青光眼34眼,抗青光眼術(shù)后眼壓失控8眼,開角型青光眼5眼,閉角型青光眼14眼,繼發(fā)性青光眼9眼,青睫綜合征1眼,先天性青光眼2眼。術(shù)前眼壓：19.6—65mmHg,平均41.1mmHgo術(shù)前視力：無光感44眼,光感至手動6眼,指數(shù)／眼前到0.1患者18眼, 0.1以上5只眼。所有病例均采用睫狀體平坦部濾過術(shù)聯(lián)合絲裂霉素棉片結(jié)膜瓣及鞏膜瓣下留置的方法治療。手術(shù)步驟：①做以穹窿部為基底的結(jié)膜瓣,避開以前手術(shù)位置。⑦做鞏膜瓣,其游離緣距角膜緣6mm,寬4mm,高3mm。③角膜緣后約4mm做深層鞏膜切除及睫狀體平部切除或切開,切除溢出玻璃體。④復(fù)位鞏膜瓣,可調(diào)節(jié)縫線縫合鞏膜瓣。⑤間斷縫合結(jié)膜瓣。術(shù)后隨訪觀察眼壓、視力、疼痛癥狀、術(shù)后并發(fā)癥。隨訪時間為術(shù)后一天到術(shù)后四年。 結(jié)果： 1.術(shù)后眼壓： 術(shù)后一天：9只眼因角膜水腫測不出,6只眼眼壓在26.5mmHg-40.3mmHg之間,58只眼眼壓在0.6mmHg-20.59mmHg。 術(shù)后一周：5只眼壓未測出,3只眼壓在21.1mmHg-42mmHg,65只眼眼壓在2.2mmHg—20.5mmHg。 術(shù)后兩周隨訪72只眼：2只眼眼壓未測出,2只眼眼壓在21mmHg-28.7mmHg,68只眼眼壓在3.7-18.2mmHg。 術(shù)后1個月隨訪67只眼：其中2只眼眼壓不在正常范圍,分別為24.8mmHg、29.6mmHg,65只眼眼壓在0.6mmHg-18.2mmHg。 術(shù)后3個月隨訪67眼：3只眼眼壓不在正常范圍,眼壓在23.3-40mmHg之間,64只眼在4.1-19.7mmHg。 術(shù)后半年隨訪64眼：1眼眼壓為21.5mmHg,63只眼眼壓在2.9mmHg-19.8mmHg。 術(shù)后1年隨訪53眼：1只眼眼壓為22.1mmHg,余52眼眼壓在6.4mmHg-19.3mmHg。完全成功率為92%,條件成功率為98%。 術(shù)后一年半隨訪46眼：眼壓在5.9mmHg-17.6mmHg。完全成功率為88%,條件成功率為98%。 術(shù)后兩年隨訪33眼：眼壓在6.1mmHg-18.9mmHg。完全成功率為88%,條件成功率為100%。 術(shù)后三年隨訪21眼：眼壓在8.9mmHg-19.3mmHg。完全成功率為85%,條件成功率為100%。 術(shù)后四年隨訪9眼：眼壓在11.5mmHg-19.7mmHg。 2.術(shù)后視力： 至本課題隨訪結(jié)束,73只眼中,42只無光感眼仍未變化；其余31眼中4只眼視力輕微下降,17眼視力提高,10只不變。視力提高率為23.5%,視力穩(wěn)定率為71%,視力下降率為5.5%。 3.術(shù)后眼部情況： 術(shù)后前房均不同程度加深。手術(shù)早期,濾泡呈隆起彌散狀態(tài),隨著時間延長,濾過泡趨于平坦。前房浮游物及滲出者15眼,8例于術(shù)后3天消失,7例術(shù)后5天消失。前房積血11只眼,術(shù)后3天吸收6眼,術(shù)后1周吸收4只眼,1眼于術(shù)后11天吸收。新生血管性青光眼34眼,虹膜新生血管術(shù)后一天消退10只眼,術(shù)后3天消退7只眼,術(shù)后5天消退5眼,術(shù)后8天消退3眼,術(shù)后11天、14天各消退1只眼,術(shù)后30天消退2只眼,血管變細(xì)3只眼,不變2只眼。視網(wǎng)膜淺脫離3只眼,術(shù)后1個月恢復(fù)；局部脈絡(luò)膜脫離2只眼,分別術(shù)后1月、3月恢復(fù)；眼球萎縮1只眼。 結(jié)論1.睫狀體平坦部濾過術(shù)可較滿意地控制難治性青光眼眼壓。 2.睫狀體平坦部濾過術(shù)能改善部分患者的視力。 3.睫狀體平坦部濾過術(shù)術(shù)后反應(yīng)輕,術(shù)中、術(shù)后并發(fā)癥少。 總之,睫狀體平坦部濾過術(shù)對于難治性青光眼是一種安全有效的方法,值得推廣使用。
[Abstract]:Objective:
Objective to systematically evaluate the efficacy and safety of ciliary body flat filtration surgery in the treatment of refractory glaucoma through clinical observation, observe the hypotensive effect of the operation and the pathological effects on various tissues of the eye, so as to provide a new basis for clinical research and treatment of refractory glaucoma.
Method:
From April 2005 to December 2009 in our hospital diagnosed with refractory glaucoma and implementation of pars plana filtration surgery patients 68 eyes of 73 cases, including 46 cases of male female 22 cases 50 eyes, 23 eyes; 42 eyes right eye, left eye in 31 eyes; age 10 - 82 years old, average 52.6 years old; 34 neovascular glaucoma eye, glaucoma after intraocular pressure control in 8 eyes, 5 eyes are open angle glaucoma, angle closure glaucoma in 14 eyes, secondary glaucoma in 9 eyes, glaucomatocyclitic crisis in 1 eyes, 2 congenital glaucoma. The preoperative intraocular pressure: 19.6 41.1mmHgo - 65mmHg, the average preoperative visual acuity: no light perception in 44 eyes, light perception to hand in 6 eyes, 0.1 eyes / index more than 0.1 patients in 18 eyes, 5 eyes. All patients were treated by the method of pars plana filtration surgery combined with mitomycin cotton conjunctiva and sclera flap indwelling treatment. Surgical procedures: 1. Do the fornix based conjunctival flap, to avoid the previous operation The position of the scleral flap. The free margin from the limbus, 6mm, wide 4mm, high 3mm. and corneal limbus after 4mm resection or incision deep sclerectomy and pars plana resection. The reset, overflow vitreous body scleral flap, adjustable suture scleral flap suture. The conjunctival flap intraocular pressure. The follow-up, postoperative visual acuity, pain, postoperative complications. The patients were followed up from one day to four years after operation.
Result:
1. postoperative intraocular pressure (IOP):
One day after the operation, 9 eyes were unable to detect corneal edema, 6 eyes had intraocular pressure between 26.5mmHg-40.3mmHg and 58 eyes with intraocular pressure (0.6mmHg-20.59mmHg.).
One week after the operation, 5 eyes were unmeasured, 3 eyes were pressed at 21.1mmHg-42mmHg, and 65 eyes had intraocular pressure in 2.2mmHg - 20.5mmHg.
After two weeks' follow-up, 72 eyes were followed up: 2 eyes were unmeasured, 2 eyes were intraocular pressure in 21mmHg-28.7mmHg, and intraocular pressure in 68 eyes was 3.7-18.2mmHg.
67 eyes were followed up 1 months after the operation: 2 eyes had no intraocular pressure in the normal range, 24.8mmHg, 29.6mmHg, and 65 eye pressure in 0.6mmHg-18.2mmHg.
67 eyes were followed up 3 months after operation: 3 eyes had no intraocular pressure in normal range, intraocular pressure was between 23.3-40mmHg and 64 eyes were in 4.1-19.7mmHg..
After half a year, 64 eyes were followed up: 1 eyes with intraocular pressure of 21.5mmHg and 63 eyes with intraocular pressure in 2.9mmHg-19.8mmHg.
After 1 year follow-up, 53 eyes were followed up: 1 eyes had intraocular pressure of 22.1mmHg, and the total success rate of 6.4mmHg-19.3mmHg. in the remaining 52 eyes was 92% and the rate of conditional success was 98%..
46 eyes were followed up one and a half years after the operation: the total success rate of intraocular pressure (IOP) at 5.9mmHg-17.6mmHg. was 88%, and the successful rate was 98%.
33 eyes were followed up two years after operation: the total success rate of intraocular pressure (IOP) at 6.1mmHg-18.9mmHg. was 88%, and the successful rate was 100%.
21 eyes were followed up three years after operation: the total success rate of intraocular pressure (IOP) at 8.9mmHg-19.3mmHg. was 85%, and the successful rate was 100%.
9 eyes were followed up four years after operation: intraocular pressure (IOP) at 11.5mmHg-19.7mmHg.
2. postoperative visual acuity:
At the end of the study, 42 eyes without photoreceptor remained unchanged in the 73 eyes. In the remaining 31 eyes, 4 eyes had a slight decrease in eyesight, 17 eyes increased vision and 10 remained unchanged. The rate of visual improvement was 23.5%, the stability rate of vision was 71%, and the rate of visual deterioration was 5.5%..
3. eye condition after operation:
The postoperative anterior chamber were deepened. Early surgery, follicular bulge at the state of dispersion, with the prolongation of time, bleb flat. The anterior chamber of zooplankton and exudation in 15 eyes of 8 patients on the 3 postoperative day disappeared in 7 patients after 5 days disappear. Hyphema in 11 eyes, 6 eyes of absorption in 3 days after the absorption of 4 eyes in 1 weeks after surgery, 1 eyes in 11 days after absorption. 34 cases of neovascular glaucoma, 10 eyes disappeared one day postoperative iris neovascularization, 7 eyes disappeared 3 days after surgery, 5 eyes disappeared 5 days after surgery, 3 eyes subsided after 8 days, 11 days after the operation after 14 days, the disappeared in 1 eyes, 2 eyes disappeared 30 days after operation, blood vessels become fine in 3 eyes, unchanged in 2 eyes. Retinal detachment in 3 eyes, 1 months of recovery after operation; local choroidal detachment in 2 eyes, respectively, after January, in March to restore; eyeball atrophy in 1 eyes.
Conclusion 1. ciliary body flattening can control intraocular pressure of refractory glaucoma more satisfactorily.
2. flattening of the ciliary body can improve the visual acuity of some patients.
The postoperative reaction of 3. ciliary body flattening is light, and the postoperative complications are less.
In conclusion, flattening of the ciliary body is a safe and effective method for refractory glaucoma. It is worth popularizing.

【學(xué)位授予單位】：中國中醫(yī)科學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2010
【分類號】：R779.6

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 楊瑾,孫慧敏,袁佳琴;內(nèi)窺鏡睫狀體光凝術(shù)的研究進(jìn)展[J];國外醫(yī)學(xué).眼科學(xué)分冊;2005年01期

2 萬修華,姚克;羊膜移植在重建健康眼球表層中的應(yīng)用[J];國外醫(yī)學(xué).眼科學(xué)分冊;1999年02期

3 紀(jì)澤江,余志洪,魏琳,譚晏華;復(fù)合式小梁切除術(shù)在難治性青光眼的應(yīng)用[J];華西醫(yī)學(xué);2005年01期

4 張仁國;;淺談青光眼的早期防治[J];社區(qū)醫(yī)學(xué)雜志;2006年12期

5 任予斌,張向東,畢毅敏;復(fù)合小梁切除術(shù)治療新生血管性青光眼32例療效觀察[J];新鄉(xiāng)醫(yī)學(xué)院學(xué)報;2005年04期

6 常新琦,孟海林;大節(jié)段小梁切除術(shù)治療新生血管性青光眼[J];眼外傷職業(yè)眼病雜志.附眼科手術(shù);2004年12期

7 李進(jìn)凱;;鞏膜小梁切除前房角分離治療難治性青光眼[J];眼外傷職業(yè)眼病雜志.附眼科手術(shù);2006年06期

8 唐由之;;中醫(yī)抗青光眼手術(shù)的思路與方法——睫狀體平坦部濾過術(shù)[J];中國中醫(yī)眼科雜志;2006年01期

9 馮俊;巢國俊;唐由之;;睫狀體平坦部濾過術(shù)治療難治性青光眼的臨床研究[J];中國中醫(yī)眼科雜志;2006年01期

10 吳烈;唐由之;楊迎新;蘇航;康瑋;;睫狀體平坦部濾過術(shù)對難治性青光眼的臨床研究[J];中國中醫(yī)眼科雜志;2006年01期

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