本文選題：閉角型青光眼 + 睫狀肌麻痹��； 參考：《天津醫(yī)科大學(xué)》2011年碩士論文

【摘要】：目的 1.應(yīng)用超聲生物顯微鏡(ultrasound biomicroscopy, UBM)及Pentacam眼前節(jié)分析系統(tǒng)觀察原發(fā)性閉角型青光眼(primary angle-closure glaucoma,PACG)散瞳前后眼前節(jié)形態(tài)變化,對各個(gè)測量值之間進(jìn)行整體的綜合分析,為臨床工作提供參考依據(jù)。 2.非接觸眼壓計(jì)監(jiān)測原發(fā)性閉角型青光眼應(yīng)用睫狀肌麻痹計(jì)劑散瞳前后眼壓變化,分析急性與慢性閉角型青光眼散瞳后眼壓變化的差異。 方法 1.選擇2010年4月至2010年11月在天津醫(yī)科大學(xué)眼科中心住院的原發(fā)性閉角型青光眼患者68眼(68例),其中急性閉角型青光眼患者32例(32眼),慢性閉角型青光眼患者36例(36眼),所有患者均即將施行白內(nèi)障摘除聯(lián)合人工晶狀體植入+復(fù)合小梁切除術(shù)。應(yīng)用Pentacam眼前節(jié)分析系統(tǒng)及UBM對68例患者應(yīng)用睫狀肌麻痹計(jì)劑散瞳前后的眼前節(jié)形態(tài)學(xué)進(jìn)行檢查。 2.采用非接觸眼壓計(jì)測量原發(fā)性閉角型青光眼應(yīng)用復(fù)方托吡卡胺后15min、30mim、1h、2h、3h、4h眼壓,整體分析眼壓動態(tài)變化。采用SPSS16.0統(tǒng)計(jì)軟件包對數(shù)據(jù)進(jìn)行統(tǒng)計(jì)學(xué)分析。 結(jié)果 1. PACG用睫狀肌麻痹劑后在反映角膜改變的參數(shù)中,中央角膜厚度加厚,差異有統(tǒng)計(jì)學(xué)意義(P0.05)；角膜頂點(diǎn)厚度、角膜最薄處厚度、水平角膜曲率、垂直角膜曲率、角膜散光、Ecc值、散光軸向散瞳前后差異無統(tǒng)計(jì)學(xué)意義(P0.05)。 2.在反映房角改變的參數(shù)中,9、3、12、6點(diǎn)位房角開放度減小,9、3、12、6點(diǎn)位距離鞏膜突500微米處房角開放距離房角開放距離減小,中央前房深度加深,距鞏膜突500μm,小梁網(wǎng)內(nèi)表面垂直于虹膜表面的虹膜厚度1(IT1),近瞳孔緣虹膜最厚處的虹膜厚度2(IT2),差異有統(tǒng)計(jì)學(xué)意義(P0.05)。 3.在反映睫狀體改變的參數(shù)中,睫狀體厚度減小,鞏膜睫狀體夾角增大,差異有顯著性(P0.05)；小梁網(wǎng)睫狀突距離減小,鞏膜虹膜夾角增大,但差異無統(tǒng)計(jì)學(xué)意義(P0.05)。 4. PACG應(yīng)用睫狀肌麻痹計(jì)劑散瞳后監(jiān)測眼壓4小時(shí),兩組患者眼壓較散瞳前均有升高,A-PACG組眼壓升高明顯,眼壓升高幅度≥8mmHg, A-PACG組有7例,C-PACG組有1例,兩組相比較差異有統(tǒng)計(jì)學(xué)意義(P0.05)。 結(jié)論 1.原發(fā)性閉角型青光眼局部應(yīng)用睫狀肌麻痹劑后,中央角膜厚度增加,中央前房深度加深,前房容積加大,房角變窄,虹膜增厚,睫狀體變薄且向后移位,鞏膜虹膜夾角增大,這些眼前節(jié)變化是青光眼發(fā)作的解剖基礎(chǔ)。 2.原發(fā)性閉角型青光眼患者局部應(yīng)用睫狀肌麻痹劑散瞳后的4小時(shí)內(nèi),急性閉角型青光眼與慢性閉角型青光眼患者眼壓均有增高,但是急性患者眼壓升高更明顯,眼壓升高幅度更大,更易引起青光眼急性發(fā)作。慢性患者眼壓雖有升高,眼壓升高不明顯,眼壓升高幅度比較小,不易引起青光眼急性發(fā)作。
[Abstract]:objective
1. the morphological changes of anterior segment of primary angle closure glaucoma (primary angle-closure glaucoma, PACG) were observed by ultrasound biomicroscopy (UBM) and Pentacam anterior segment analysis system. The overall analysis of the measured values was integrated to provide reference for clinical work.
2. non contact tonometer monitored the changes of intraocular pressure before and after the mydriasis of ciliary muscle paralysis in primary angle closure glaucoma, and analyzed the difference of intraocular pressure (IOP) of acute and chronic angle closure glaucoma after mydriasis.
Method
1. the 68 eyes (68 cases) of primary angle closure glaucoma hospitalized in Ophthalmological Center of Tianjin Medical University from April 2010 to November 2010 were selected, including 32 cases of acute angle closure glaucoma (32 eyes) and 36 cases of chronic angle closure glaucoma (36 eyes). All patients were imminent cataract extraction combined with intraocular lens implantation + compound small Liang Qie. The anterior segment morphology of 68 patients before and after mydriasis was examined by Pentacam anterior segment analysis system and UBM.
2. the dynamic changes in intraocular pressure (15min, 30mim, 1H, 2h, 3h, 4h) were measured by noncontact intraocular pressure (tonometer) measurement of primary angle closure glaucoma and the intraocular pressure of 30mim, 1H, 2h, 3H and 4H were analyzed. The statistical analysis of the data was carried out by the SPSS16.0 statistical package.
Result
1. PACG with ciliary muscle paralysis agent in the parameters reflecting the corneal change, the thickness of the central cornea was thicker, the difference was statistically significant (P0.05); the thickness of the corneal vertex, the thickness of the cornea, the horizontal corneal curvature, the vertical corneal curvature, the corneal astigmatism, the Ecc value, and the axial dispersion of astigmatism before and after the pupil (P0.05).
2. in the parameters reflecting the change of the angle of the room, the opening angle of the 9,3,12,6 point angle decreased, the opening distance of the angle open distance of the 9,3,12,6 point distance from the scleral process decreased, the depth of the central anterior chamber was deepened, the distance from the scleral process 500 u m, the iris thickness perpendicular to the iris surface was 1 (IT1), and the iris near the near pupil edge of the iris was the thickest iris. The thickness was 2 (IT2), and the difference was statistically significant (P0.05).
3. in the parameters reflecting the ciliary body change, the thickness of ciliary body decreased and the angle of scleral ciliary body increased significantly (P0.05), the ciliary process distance of trabecular meshwork decreased and the iris angle increased, but the difference was not statistically significant (P0.05).
4. PACG was used to monitor intraocular pressure for 4 hours after the mydriasis of the ciliary muscle paralysis agent. The intraocular pressure in the two groups was higher than that before the pupil. In group A-PACG, the intraocular pressure increased obviously, the increase of intraocular pressure was more than 8mmHg, there were 7 cases in group A-PACG, 1 in group C-PACG, and the difference between the two groups was statistically significant (P0.05).
conclusion
1. after the local application of ciliary muscle paralysis agent in primary angle closure glaucoma, the central corneal thickness increased, the depth of the central anterior chamber deepened, the volume of the anterior chamber increased, the angle of the chamber narrowed, the iris was thickened, the ciliary body was thinner and backward, the iris angle increased, and these anterior segments were the anatomical basis of the glaucoma attack.
2. patients with primary angle closure glaucoma have increased intraocular pressure in acute angle closure glaucoma and chronic angle closure glaucoma within 4 hours after local application of the ciliary muscle paralysis agent. However, the increase of intraocular pressure is more obvious in acute patients, the increase of intraocular pressure is greater and the acute attack of the eye is more likely to be caused. The increase of intraocular pressure is not obvious, and the increase of intraocular pressure is relatively small, which is not easy to cause acute attack of glaucoma.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2011
【分類號】：R775.2

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