超聲乳化聯(lián)合小梁切除與聯(lián)合房角分離術(shù)治療急性閉角型青光眼合并白內(nèi)障的療效
發(fā)布時間：2018-08-19 05:47
【摘要】：目的:觀察與對比超聲乳化白內(nèi)障吸除聯(lián)合小梁切除術(shù)與超聲乳化白內(nèi)障吸除聯(lián)合房角分離術(shù)治療原發(fā)性急性閉角型青光眼合并白內(nèi)障的臨床效果和安全性。 對象和方法:回顧性分析研究2006年8月到2009年8月在重慶市第九人民醫(yī)院眼科住院的原發(fā)性急性閉角型青光眼合并白內(nèi)障患者67例(70眼);其中男性25例(26眼,其中一人是雙眼),女性42例(44眼,其中兩人是雙眼)。33眼行超聲乳化白內(nèi)障吸除植入人工晶體聯(lián)合小梁切除術(shù)(以下簡稱小梁組),37眼行超聲乳化白內(nèi)障吸除植入人工晶體聯(lián)合房角分離術(shù)(以下簡稱房角組);隨訪時間3-12個月,通過觀察兩種不同手術(shù)方式組患者術(shù)前與術(shù)后眼壓、視力、中央前房深度、周邊前房深度、房角、晶狀體厚度、眼軸長度、晶狀體厚度/眼軸長度系數(shù)、術(shù)后用藥情況及并發(fā)癥,分析兩種不同手術(shù)方式對治療原發(fā)性急性閉角型青光眼合并白內(nèi)障的臨床療效。 結(jié)果: 1眼壓:小梁組術(shù)前眼壓為45.83±15.97mmHg,術(shù)后眼壓為15.18±5.62mmHg(P0.01);房角組術(shù)前眼壓為41.36±13.06mmHg,術(shù)后眼壓為17.09±7.66mmHg(P0.01)。小梁組術(shù)后眼壓降低幅度為30.66±14.15mmHg,房角組術(shù)后眼壓降低幅度為22.35±8.72mmHg,差異有統(tǒng)計學意義(P0.05)。 2視力:術(shù)后12個月時復查視力:小梁組27眼(81.8%)術(shù)后末次視力提高1行以上,4眼(12.1%)術(shù)后末次視力基本無變化(以術(shù)前所測視力為標準,國際標準視力表上下1行范圍),1眼(3.1%)術(shù)后視力下降1行以上,術(shù)前、術(shù)后視力構(gòu)成比差異有統(tǒng)計學意義(χ2=31.061,P0.01);房角組34眼(91.9%)術(shù)后末次視力提高1行以上,2眼(5.4%)術(shù)后末次視力基本無變化,1眼(2.7%)術(shù)后視力下降1行以上,術(shù)前、術(shù)后視力構(gòu)成比差異有統(tǒng)計學意義(χ2=32.996,P0.01);小梁組和房角組術(shù)后視力比較構(gòu)成比差異無統(tǒng)計學意義(χ2=4.863,P=0.677)。 3中央前房深度:小梁組術(shù)前、術(shù)后中央前房深度分別為1.4706±0.2034mm、3.2794±0.3772mm(P0.01);房角組術(shù)前、術(shù)后分別為1.5168±0.1879mm、3.5832±0.3186mm(P0.01);小梁組和房角組術(shù)后中央前房深度加深幅度分別為1.8088±0.3879mm和2.0665±0.2784mm,差異有統(tǒng)計學意義(P0.01)。 4周邊前房深度及房角: 4.1周邊前房深度:將周邊前房深度分級視為等級變量,小梁組術(shù)前、術(shù)后周邊前房深度分別為1.1515±0.3641、2.9091±0.2919(P0.01);房角組術(shù)前、術(shù)后分別為1.1081±0.3148、3.9730±0.1644(P0.01)。 4.2房角:采用spaeth房角分類法,將spaeth房角分類法中房角形態(tài)的A、B、C、D分別視為等級變量1、2、3、4做統(tǒng)計學分析,小梁組術(shù)前、術(shù)后房角分別為1.0606±0.2423、3.6061±0.4962(P0.01);房角組術(shù)前、術(shù)后分別為1.1078±0.3145、3.9149±0.2767(P0.01);術(shù)后小梁組和房角組房角分別為3.6061±0.4962和3.9189±0.2767,差異有統(tǒng)計學意義(P=0.002)。 5晶狀體厚度、眼軸長度、晶狀體厚度/眼軸長度系數(shù): 5.1晶狀體厚度:術(shù)前小梁組、房角組晶狀體厚度分別為5.0482±0.2311mm、5.0584±0.2274mm(P=0.853);術(shù)后小梁組和房角組人工晶體厚度均不足1mm,兩種手術(shù)方式術(shù)前術(shù)后晶狀體厚度變化差值均有統(tǒng)計學意義(P0.01)。 5.2眼軸長度:小梁組術(shù)前、術(shù)后眼軸長度分別為21.7858±0.5374mm、21.8176±0.5209mm(P=0.102);房角組術(shù)前、術(shù)后分別為21.8138±0.5526mm、21.8543±0.4808mm(P=0.086)。 5.3晶狀體厚度/眼軸長度系數(shù):術(shù)前小梁組、房角組晶狀體厚度/眼軸長度系數(shù)分別為0.2319±0.0121、0.2321±0.0125(P=0.944);術(shù)后小梁組和房角組晶狀體厚度/眼軸長度系數(shù)分別為0.0446±0.0113、0.0447±0.0115(P=0.967)。 6術(shù)后并發(fā)癥:術(shù)后角膜水腫小梁組5眼(15.2%),房角組5眼(13.5%);虹膜纖維素樣滲出及前房炎癥小梁組9眼(27.3%),房角組2眼(5.4%);睫狀環(huán)阻滯性青光眼小梁組2眼(6.1%),房角組1眼(2.7%);術(shù)后淺前房小梁組6眼(18.2%),房角組1眼(2.7%);結(jié)膜濾泡滲漏小梁組2眼(6.1%);脈絡膜脫離小梁組3眼(9.1%),房角組無;瞳孔人工晶體粘連者小梁組3眼(9.1%),房角組2眼(5.4%);后發(fā)性白內(nèi)障小梁組2眼(6.1%),房角組1眼(2.7%)。 7.手術(shù)成功率:70例患眼完全成功60眼(85.71%),條件成功7眼(10.00%),失敗3眼(4.29%);其中小梁組(共33眼)完全成功30眼(90.91%),條件成功2眼(6.06%),失敗1眼(3.03%);房角組(共37眼)完全成功30眼(81.08%),條件成功5眼(13.51%),失敗2眼(5.41%)。 結(jié)論:超聲乳化白內(nèi)障吸除人工晶體植入聯(lián)合小梁切除術(shù)與聯(lián)合房角分離術(shù)均是治療原發(fā)性急性閉角型青光眼合并白內(nèi)障的安全有效的方法;小梁組在眼壓控制方面的術(shù)后療效優(yōu)于房角組;房角組在中央前房深度加深幅度和房角形態(tài)變化方面的術(shù)后療效優(yōu)于小梁組;小梁組的術(shù)后并發(fā)癥多于房角組。
[Abstract]:Objective: To observe and compare the clinical efficacy and safety of phacoemulsification combined with trabeculectomy and phacoemulsification combined with angle separation in the treatment of primary acute angle closure glaucoma with cataract.
PARTICIPANTS AND METHODS: From August 2006 to August 2009, 67 patients (70 eyes) with primary acute angle-closure glaucoma and cataract admitted to the Ophthalmology Department of Chongqing Ninth People's Hospital were retrospectively analyzed, including 25 males (26 eyes), one female (44 eyes) and 42 females (two eyes). Intraocular lens implantation combined with trabeculectomy (trabeculectomy group), 37 eyes underwent phacoemulsification and intraocular lens implantation combined with angle separation (angle group); the follow-up time was 3-12 months. The intraocular pressure, visual acuity, central anterior chamber depth, peripheral anterior chamber depth, and chamber depth were observed before and after operation in the two groups. Angle, lens thickness, axial length, lens thickness/axial length coefficient, postoperative medication and complications were analyzed for the clinical efficacy of two different surgical methods in the treatment of primary acute angle-closure glaucoma with cataract.
Result:
IOP: The intraocular pressure of trabecular group was 45.83 (+ 15.97 mmHg) before operation and 15.18 (+ 5.62 mmHg) after operation (P 0.01); the intraocular pressure of angle group was 41.36 (+ 13.06mmHg) before operation and 17.09 (+ 7.66 mmHg) (P 0.01). The intraocular pressure of trabecular group decreased by 30.66 (+ 14.15 mmHg) and angle group by 22.35 (+ 8.72 mmHg) after operation (P 0.01). 05).
Visual acuity: 12 months after surgery: 27 eyes (81.8%) in trabecular meshwork group had improved their last visual acuity by more than one line, 4 eyes (12.1%) had no change in the last visual acuity after surgery (according to preoperative visual acuity, 1 line above and below the international standard visual acuity scale), 1 eye (3.1%) had decreased visual acuity by more than one line after surgery. The final visual acuity of 34 eyes (91.9%) in the angle group was improved by more than one line, 2 eyes (5.4%) had no change, and 1 eye (2.7%) had more than one line of decreased visual acuity. There was a significant difference in the ratio of postoperative visual acuity between the trabecular group and the angle group (_2=32.996, P 0.01). Significance (chi 2=4.863, P=0.677).
Central anterior chamber depth: trabecular group before surgery, the central anterior chamber depth was 1.4706 (+ 0.2034 mm), 3.2794 (+ 0.3772 mm) (P 0.01); angle group before surgery, the postoperative central anterior chamber depth were 1.5168 (+ 0.1879 mm), 3.5832 (+ 0.3186 mm) (P 0.01); trabecular group and angle group after surgery central anterior chamber depth were 1.8088 (+ 0.3879 mm) and 2.0665 (+ 0.2784 mm), the difference was statistically significant. Academic meaning (P0.01).
4 peripheral anterior chamber depth and angle:
4.1 Peripheral anterior chamber depth: Peripheral anterior chamber depth grading was regarded as a grading variable. Before trabecular surgery, the peripheral anterior chamber depth was 1.1515 (+ 0.3641), 2.9091 (+ 0.2919) (P 0.01) in trabecular group, and 1.1081 (+ 0.3148), 3.9730 (+ 0.1644) (P 0.01) in angle group.
4.2 Angle: A, B, C, D were classified as grade variables 1, 2, 3, 4 by Spaeth Angle Classification. The angle of trabecular group was 1.060606.2423, 3.6061.4962 (P 0.01), 1.1078.3145, 3.9149.2767 (P 0.01) before operation and 3.9149.2767 (P 0.01) after operation. The angle of the atrial horn group was 3.6061 + 0.4962 and 3.9189 + 0.2767 respectively, the difference was statistically significant (P=0.002).
5 lens thickness, axial length, lens thickness / axial length coefficient:
5.1 Lens thickness: Preoperative trabecular lens thickness, anterior chamber angle group lens thickness were 5.0482 (+ 0.2311 mm), 5.0584 (+ 0.2274 mm) (P = 0.853); postoperative trabecular lens thickness and anterior chamber angle group intraocular lens thickness were less than 1 mm, the difference between the two surgical methods of preoperative and postoperative lens thickness was statistically significant (P 0.01).
5.2 Axial Length: Before and after trabecular surgery, the axial length of trabecular surgery was 21.7858 (+ 0.5374 mm) and 21.8176 (+ 0.5209mm) (P = 0.102), respectively; before and after surgery, the axial length of angle group was 21.8138 (+ 0.5526 mm) and 21.8543 (+ 0.4808mm) (P = 0.086).
5.3 Lens thickness/axial length coefficients: The preoperative trabecular lens thickness/axial length coefficients were 0.2319 (+0.0121) and 0.2321 (+0.0125) (P = 0.944) in the angle group, and 0.0446 (+0.0113) and 0.0447 (+0.0115) (P = 0.967) in the trabecular lens thickness/axial length coefficients in the angle group and the angle group respectively.
6 Postoperative complications: corneal edema in 5 eyes (15.2%) in trabecular group, anterior chamber angle in 5 eyes (13.5%); iris cellulose exudation and anterior chamber inflammation in 9 eyes (27.3%) in trabecular group, anterior chamber angle in 2 eyes (5.4%); ciliary ring block glaucoma in 2 eyes (6.1%) in trabecular group, anterior chamber angle in 1 eye (2.7%); superficial anterior chamber trabecular group in 6 eyes (18.2%) and anterior chamber angle in 1 eye (2.7%); Trabecular group 2 eyes (6.1%), choroidal detachment trabecular group 3 eyes (9.1%), angle group no; pupil intraocular lens adhesion trabecular group 3 eyes (9.1%), angle group 2 eyes (5.4%); posterior cataract trabecular group 2 eyes (6.1%) and angle group 1 eye (2.7%).
7. Successful rate of surgery: 70 cases of complete success in 60 eyes (85.71%), conditional success in 7 eyes (10.00%) and failure in 3 eyes (4.29%); Trabecular group (33 eyes) complete success in 30 eyes (90.91%), conditional success in 2 eyes (6.06%), failure in 1 eye (3.03%); angle group (37 eyes) complete success in 30 eyes (81.08%), conditional success in 5 eyes (13.51%) and failure in 2 eyes (5.41%).
Conclusion: Phacoemulsification and intraocular lens implantation combined with trabeculectomy and angle separation are safe and effective methods for primary acute angle closure glaucoma with cataract. The postoperative effect of the state change is better than that of the trabecular group, and the postoperative complications of the trabecular group are more than those of the atrial angle group.
【學位授予單位】：重慶醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2011
【分類號】：R779.6
本文編號：2190775
[Abstract]:Objective: To observe and compare the clinical efficacy and safety of phacoemulsification combined with trabeculectomy and phacoemulsification combined with angle separation in the treatment of primary acute angle closure glaucoma with cataract.
PARTICIPANTS AND METHODS: From August 2006 to August 2009, 67 patients (70 eyes) with primary acute angle-closure glaucoma and cataract admitted to the Ophthalmology Department of Chongqing Ninth People's Hospital were retrospectively analyzed, including 25 males (26 eyes), one female (44 eyes) and 42 females (two eyes). Intraocular lens implantation combined with trabeculectomy (trabeculectomy group), 37 eyes underwent phacoemulsification and intraocular lens implantation combined with angle separation (angle group); the follow-up time was 3-12 months. The intraocular pressure, visual acuity, central anterior chamber depth, peripheral anterior chamber depth, and chamber depth were observed before and after operation in the two groups. Angle, lens thickness, axial length, lens thickness/axial length coefficient, postoperative medication and complications were analyzed for the clinical efficacy of two different surgical methods in the treatment of primary acute angle-closure glaucoma with cataract.
Result:
IOP: The intraocular pressure of trabecular group was 45.83 (+ 15.97 mmHg) before operation and 15.18 (+ 5.62 mmHg) after operation (P 0.01); the intraocular pressure of angle group was 41.36 (+ 13.06mmHg) before operation and 17.09 (+ 7.66 mmHg) (P 0.01). The intraocular pressure of trabecular group decreased by 30.66 (+ 14.15 mmHg) and angle group by 22.35 (+ 8.72 mmHg) after operation (P 0.01). 05).
Visual acuity: 12 months after surgery: 27 eyes (81.8%) in trabecular meshwork group had improved their last visual acuity by more than one line, 4 eyes (12.1%) had no change in the last visual acuity after surgery (according to preoperative visual acuity, 1 line above and below the international standard visual acuity scale), 1 eye (3.1%) had decreased visual acuity by more than one line after surgery. The final visual acuity of 34 eyes (91.9%) in the angle group was improved by more than one line, 2 eyes (5.4%) had no change, and 1 eye (2.7%) had more than one line of decreased visual acuity. There was a significant difference in the ratio of postoperative visual acuity between the trabecular group and the angle group (_2=32.996, P 0.01). Significance (chi 2=4.863, P=0.677).
Central anterior chamber depth: trabecular group before surgery, the central anterior chamber depth was 1.4706 (+ 0.2034 mm), 3.2794 (+ 0.3772 mm) (P 0.01); angle group before surgery, the postoperative central anterior chamber depth were 1.5168 (+ 0.1879 mm), 3.5832 (+ 0.3186 mm) (P 0.01); trabecular group and angle group after surgery central anterior chamber depth were 1.8088 (+ 0.3879 mm) and 2.0665 (+ 0.2784 mm), the difference was statistically significant. Academic meaning (P0.01).
4 peripheral anterior chamber depth and angle:
4.1 Peripheral anterior chamber depth: Peripheral anterior chamber depth grading was regarded as a grading variable. Before trabecular surgery, the peripheral anterior chamber depth was 1.1515 (+ 0.3641), 2.9091 (+ 0.2919) (P 0.01) in trabecular group, and 1.1081 (+ 0.3148), 3.9730 (+ 0.1644) (P 0.01) in angle group.
4.2 Angle: A, B, C, D were classified as grade variables 1, 2, 3, 4 by Spaeth Angle Classification. The angle of trabecular group was 1.060606.2423, 3.6061.4962 (P 0.01), 1.1078.3145, 3.9149.2767 (P 0.01) before operation and 3.9149.2767 (P 0.01) after operation. The angle of the atrial horn group was 3.6061 + 0.4962 and 3.9189 + 0.2767 respectively, the difference was statistically significant (P=0.002).
5 lens thickness, axial length, lens thickness / axial length coefficient:
5.1 Lens thickness: Preoperative trabecular lens thickness, anterior chamber angle group lens thickness were 5.0482 (+ 0.2311 mm), 5.0584 (+ 0.2274 mm) (P = 0.853); postoperative trabecular lens thickness and anterior chamber angle group intraocular lens thickness were less than 1 mm, the difference between the two surgical methods of preoperative and postoperative lens thickness was statistically significant (P 0.01).
5.2 Axial Length: Before and after trabecular surgery, the axial length of trabecular surgery was 21.7858 (+ 0.5374 mm) and 21.8176 (+ 0.5209mm) (P = 0.102), respectively; before and after surgery, the axial length of angle group was 21.8138 (+ 0.5526 mm) and 21.8543 (+ 0.4808mm) (P = 0.086).
5.3 Lens thickness/axial length coefficients: The preoperative trabecular lens thickness/axial length coefficients were 0.2319 (+0.0121) and 0.2321 (+0.0125) (P = 0.944) in the angle group, and 0.0446 (+0.0113) and 0.0447 (+0.0115) (P = 0.967) in the trabecular lens thickness/axial length coefficients in the angle group and the angle group respectively.
6 Postoperative complications: corneal edema in 5 eyes (15.2%) in trabecular group, anterior chamber angle in 5 eyes (13.5%); iris cellulose exudation and anterior chamber inflammation in 9 eyes (27.3%) in trabecular group, anterior chamber angle in 2 eyes (5.4%); ciliary ring block glaucoma in 2 eyes (6.1%) in trabecular group, anterior chamber angle in 1 eye (2.7%); superficial anterior chamber trabecular group in 6 eyes (18.2%) and anterior chamber angle in 1 eye (2.7%); Trabecular group 2 eyes (6.1%), choroidal detachment trabecular group 3 eyes (9.1%), angle group no; pupil intraocular lens adhesion trabecular group 3 eyes (9.1%), angle group 2 eyes (5.4%); posterior cataract trabecular group 2 eyes (6.1%) and angle group 1 eye (2.7%).
7. Successful rate of surgery: 70 cases of complete success in 60 eyes (85.71%), conditional success in 7 eyes (10.00%) and failure in 3 eyes (4.29%); Trabecular group (33 eyes) complete success in 30 eyes (90.91%), conditional success in 2 eyes (6.06%), failure in 1 eye (3.03%); angle group (37 eyes) complete success in 30 eyes (81.08%), conditional success in 5 eyes (13.51%) and failure in 2 eyes (5.41%).
Conclusion: Phacoemulsification and intraocular lens implantation combined with trabeculectomy and angle separation are safe and effective methods for primary acute angle closure glaucoma with cataract. The postoperative effect of the state change is better than that of the trabecular group, and the postoperative complications of the trabecular group are more than those of the atrial angle group.
【學位授予單位】：重慶醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2011
【分類號】：R779.6
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相關(guān)期刊論文 前3條
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2 王寧利!510060,歐陽潔,周文炳!510060,賴銘瑩,葉天才!510060,曾明兵!510060,陳靜嫦!510060;中國人閉角型青光眼房角關(guān)閉機制的研究[J];中華眼科雜志;2000年01期
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