本文選題：青光眼 + 閉角型　； 參考：《青島大學(xué)》2011年碩士論文

【摘要】：目的觀察急性閉角型青光眼急性發(fā)作期患眼行晶狀體超聲乳化聯(lián)合后房型人工晶狀體植入術(shù)后角膜內(nèi)皮的變化,并探討引起其變化的相關(guān)因素,以期了解此手術(shù)方式對(duì)急性閉角型青光眼急性發(fā)作眼角膜內(nèi)皮細(xì)胞的損傷及影響因素。 方法收集于2009年3月至2010年6月因急性閉角型青光眼(acute angle-closure glaucoma, AACG)急性發(fā)作期收入院并行超聲乳化手術(shù)治療的患眼的臨床資料。完成常規(guī)隨診后囑患者于術(shù)后3m、6m、12m時(shí)隨診,檢查患者視力、眼壓及角膜內(nèi)皮細(xì)胞情況。比較AACG患者患眼角膜內(nèi)皮細(xì)胞與對(duì)側(cè)眼角膜內(nèi)皮細(xì)胞之間的差異并分析相關(guān)影響因素。比較AACG患者患眼術(shù)前術(shù)后角膜內(nèi)皮細(xì)胞的變化,并計(jì)算各隨訪期角膜內(nèi)皮細(xì)胞丟失率,分析術(shù)后角膜內(nèi)皮細(xì)胞丟失率的相關(guān)影響因素。 結(jié)果58例(63眼)AACG患者完成隨訪。術(shù)后隨訪12m。AACG急性發(fā)作期眼角膜內(nèi)皮細(xì)胞顯著下降(F=18.51,P=0.000),角膜內(nèi)皮細(xì)胞丟失率為14.1%。高眼壓持續(xù)時(shí)間長(zhǎng)組角膜內(nèi)皮細(xì)胞丟失率高于高眼壓持續(xù)時(shí)間短組(F=6.593,P=0.016)；前房穿刺組角膜內(nèi)皮細(xì)胞較藥物組角膜內(nèi)皮細(xì)胞下降,差異無(wú)統(tǒng)計(jì)學(xué)意義(F=0.145,P=0.705)。術(shù)后角膜內(nèi)皮細(xì)胞密度較術(shù)前顯著下降(P值均為0.000),術(shù)后3m、6m、12m角膜內(nèi)皮細(xì)胞下降率分別為23.5%、31.51%、31.92%。與術(shù)前相比,術(shù)后3m時(shí)六角形細(xì)胞百分?jǐn)?shù)顯著減少(P=0.042),平均細(xì)胞面積顯著增大(P=0.047).角膜內(nèi)皮細(xì)胞下降率與眼軸長(zhǎng)度、前房深度均呈負(fù)相關(guān)(r=-0.293,P=0.014；r=-0.312,P=0.01)。角膜內(nèi)皮細(xì)胞下降率與晶狀體厚度、超聲乳化時(shí)間、超聲乳化能量均呈正相關(guān)(r=0.329,P=0.007；r=0.427,P=0.001；r=0.396,P=0.003)。前房深度與眼軸長(zhǎng)度呈正相關(guān)(r=0.336,P=0.006),與晶狀體厚度呈負(fù)相關(guān)(r=-0.387,P=0.002)。 結(jié)論本研究觀察了AACG超聲乳化術(shù)后角膜內(nèi)皮細(xì)胞的損傷及相關(guān)影響因素的研究。發(fā)現(xiàn)AACG急性大發(fā)作后角膜內(nèi)皮細(xì)胞明顯下降,丟失率為14.1%,其與高眼壓持續(xù)時(shí)間有關(guān),與前房穿刺放液無(wú)關(guān)。行超聲乳化術(shù)后3m、6m、12m角膜內(nèi)皮細(xì)胞丟失率分別為23.5%、31.51%、31.92%,差異無(wú)顯著性。術(shù)后角膜內(nèi)皮細(xì)胞丟失率與眼軸長(zhǎng)度、前房深度呈負(fù)相關(guān),與晶狀體厚度、超聲乳化時(shí)間及超聲乳化能量呈正相關(guān)。
[Abstract]:Objective to observe the changes of corneal endothelium after phacoemulsification combined with posterior chamber intraocular lens implantation in patients with acute angle-closure glaucoma (ACG) and to explore the related factors. Objective to investigate the injury of corneal endothelial cells in acute angle-closure glaucoma (ACG) and its influencing factors. Methods from March 2009 to June 2010, the clinical data of patients with acute angle-closure glaucoma were collected and treated by phacoemulsification. After the routine follow-up was completed, the patients were asked to follow up at 3mto 6mand 12m after operation to examine the visual acuity, intraocular pressure and corneal endothelial cells. To compare the difference between corneal endothelial cells and contralateral corneal endothelial cells in AACG patients and analyze the related factors. To compare the changes of corneal endothelial cells before and after operation in patients with AACG, to calculate the rate of corneal endothelial cell loss in each follow-up period, and to analyze the related factors of corneal endothelial cell loss rate after operation. Results 58 patients (63 eyes) with AACG were followed up. The corneal endothelial cells decreased significantly during the acute attack of 12m.AACG and the loss rate of corneal endothelial cells was 14.1%. The loss rate of corneal endothelial cells in the group of long duration of high intraocular pressure was higher than that in the group of short duration of high intraocular pressure, and the corneal endothelial cells in the anterior chamber puncture group were lower than those in the drug group, and there was no significant difference between the two groups. The corneal endothelial cell density decreased significantly after operation (P = 0.000), and the decrease rate of corneal endothelial cells was 33.5% and 31.92%, respectively. Compared with those before operation, the percentage of hexagonal cells decreased significantly at 3 m after operation, and the average cell area increased significantly. The decrease rate of corneal endothelial cells was negatively correlated with the length of eye axis and the depth of anterior chamber. The decrease rate of corneal endothelial cells was positively correlated with lens thickness, phacoemulsification time and phacoemulsification energy. There was a positive correlation between anterior chamber depth and axial length of the eye, and a negative correlation between anterior chamber depth and lens thickness. Conclusion the injury of corneal endothelial cells after AACG phacoemulsification and the related factors were observed. It was found that the corneal endothelial cells decreased significantly after acute attack of AACG, and the loss rate was 14.1%, which was related to the duration of high intraocular pressure, but not to anterior chamber puncture. After phacoemulsification, the loss rate of corneal endothelial cells was 23.5and 31.51and 31.92, respectively. There was no significant difference between the two groups. The rate of corneal endothelial cell loss was negatively correlated with eye axis length and anterior chamber depth, and positively correlated with lens thickness, phacoemulsification time and phacoemulsification energy.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2011
【分類(lèi)號(hào)】：R779.66

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