中华眼科杂志
中華眼科雜誌
중화안과잡지
Chinese Journal of Ophthalmology
2009年
4期
338-343
,共6页
王梅%葛坚%林明楷%卓业鸿%凌运兰%方敏%刘杏%彭寿雄%余敏斌
王梅%葛堅%林明楷%卓業鴻%凌運蘭%方敏%劉杏%彭壽雄%餘敏斌
왕매%갈견%림명해%탁업홍%릉운란%방민%류행%팽수웅%여민빈
青光眼,闭角型%小梁切除术%眼内压
青光眼,閉角型%小樑切除術%眼內壓
청광안,폐각형%소량절제술%안내압
Glaucoma,angle closure%Trabeculectomy%Intraocular pressure
目的 了解复合式小梁切除术治疗原发性闭角型青光眼(PACG)的眼压控制情况及并发症.方法 回顺性系列病例研究.将PACG分为原发性急性闭角型青光眼(APACG)急性发作期、慢性期及原发性慢性闭角型青光眼(CPACG)慢性期和晚期,分别对复合式小梁切除术患者手术前后眼压、最佳矫正视力、手术并发症等指标进行观察,分析复合式小梁切除术治疗APACG与CPACG的眼压控制情况.采用SPSS 12.0统计学软件进行数据处理.手术后患者视力变化及转归情况的等级资料分析采用秩和检验,组间年龄、眼压等定量资料比较采用独立样本的t检验,手术前后不同时期眼压值的比较采用单因素重复测量资料的方差分析.结果 接受复合式小梁切除术的PACG患者共82例(96只眼).其中APACG患者37例(40只眼),CPACG患者45例(56只眼);术后随访时间(中位数)分别是24个月和25个月,APACG与CPACG患者术后随访时间差异无统计学意义(Z=-0.146,P=0.886).APACG患者术前眼压(53.6±17.9)mm Hg(1 mm Hg=0.133 kPa),术后出院时眼压(10.5±4.9)mm Hg,最终随访时眼压降至(14.0±10.3)mm Hg.CPACG患者的术前眼压(36.8±13.8)mm Hg,术后出院时眼压(11.7±4.2)mm Hg,最终随访时眼压(13.8±4.5)mm Hg.APACG患者(F=100.783)和CPACG患者(F=54.383)手术前与手术后眼压差异均有统计学意义(P<0.01).APACG患者中,有38只眼(95.0%)手术后无需使用降眼压药物,眼压即可控制在21 mm Hg以下;其中急性发作期33只眼,慢性期5只眼.CPACG患者中有50只眼(89.3%)手术后无需使用降眼压药物,眼压即可控制在21 mm Hg以下;其中进展期45只眼,晚期6只眼.所有PACG患者在小梁切除术后均以视力下降比例为高,手术后最常见的并发症为浅前房.结论 复合式小梁切除术后,APACG急性发作期和慢性期及CPACG进展期和晚期的眼压控制均较好,表明小梁切除术是治疗PACG和控制眼压的有效方式之一.但是复合式小梁切除术后视力降低比例较高是不可忽视的重要问题.
目的 瞭解複閤式小樑切除術治療原髮性閉角型青光眼(PACG)的眼壓控製情況及併髮癥.方法 迴順性繫列病例研究.將PACG分為原髮性急性閉角型青光眼(APACG)急性髮作期、慢性期及原髮性慢性閉角型青光眼(CPACG)慢性期和晚期,分彆對複閤式小樑切除術患者手術前後眼壓、最佳矯正視力、手術併髮癥等指標進行觀察,分析複閤式小樑切除術治療APACG與CPACG的眼壓控製情況.採用SPSS 12.0統計學軟件進行數據處理.手術後患者視力變化及轉歸情況的等級資料分析採用秩和檢驗,組間年齡、眼壓等定量資料比較採用獨立樣本的t檢驗,手術前後不同時期眼壓值的比較採用單因素重複測量資料的方差分析.結果 接受複閤式小樑切除術的PACG患者共82例(96隻眼).其中APACG患者37例(40隻眼),CPACG患者45例(56隻眼);術後隨訪時間(中位數)分彆是24箇月和25箇月,APACG與CPACG患者術後隨訪時間差異無統計學意義(Z=-0.146,P=0.886).APACG患者術前眼壓(53.6±17.9)mm Hg(1 mm Hg=0.133 kPa),術後齣院時眼壓(10.5±4.9)mm Hg,最終隨訪時眼壓降至(14.0±10.3)mm Hg.CPACG患者的術前眼壓(36.8±13.8)mm Hg,術後齣院時眼壓(11.7±4.2)mm Hg,最終隨訪時眼壓(13.8±4.5)mm Hg.APACG患者(F=100.783)和CPACG患者(F=54.383)手術前與手術後眼壓差異均有統計學意義(P<0.01).APACG患者中,有38隻眼(95.0%)手術後無需使用降眼壓藥物,眼壓即可控製在21 mm Hg以下;其中急性髮作期33隻眼,慢性期5隻眼.CPACG患者中有50隻眼(89.3%)手術後無需使用降眼壓藥物,眼壓即可控製在21 mm Hg以下;其中進展期45隻眼,晚期6隻眼.所有PACG患者在小樑切除術後均以視力下降比例為高,手術後最常見的併髮癥為淺前房.結論 複閤式小樑切除術後,APACG急性髮作期和慢性期及CPACG進展期和晚期的眼壓控製均較好,錶明小樑切除術是治療PACG和控製眼壓的有效方式之一.但是複閤式小樑切除術後視力降低比例較高是不可忽視的重要問題.
목적 료해복합식소량절제술치료원발성폐각형청광안(PACG)적안압공제정황급병발증.방법 회순성계렬병례연구.장PACG분위원발성급성폐각형청광안(APACG)급성발작기、만성기급원발성만성폐각형청광안(CPACG)만성기화만기,분별대복합식소량절제술환자수술전후안압、최가교정시력、수술병발증등지표진행관찰,분석복합식소량절제술치료APACG여CPACG적안압공제정황.채용SPSS 12.0통계학연건진행수거처리.수술후환자시력변화급전귀정황적등급자료분석채용질화검험,조간년령、안압등정량자료비교채용독립양본적t검험,수술전후불동시기안압치적비교채용단인소중복측량자료적방차분석.결과 접수복합식소량절제술적PACG환자공82례(96지안).기중APACG환자37례(40지안),CPACG환자45례(56지안);술후수방시간(중위수)분별시24개월화25개월,APACG여CPACG환자술후수방시간차이무통계학의의(Z=-0.146,P=0.886).APACG환자술전안압(53.6±17.9)mm Hg(1 mm Hg=0.133 kPa),술후출원시안압(10.5±4.9)mm Hg,최종수방시안압강지(14.0±10.3)mm Hg.CPACG환자적술전안압(36.8±13.8)mm Hg,술후출원시안압(11.7±4.2)mm Hg,최종수방시안압(13.8±4.5)mm Hg.APACG환자(F=100.783)화CPACG환자(F=54.383)수술전여수술후안압차이균유통계학의의(P<0.01).APACG환자중,유38지안(95.0%)수술후무수사용강안압약물,안압즉가공제재21 mm Hg이하;기중급성발작기33지안,만성기5지안.CPACG환자중유50지안(89.3%)수술후무수사용강안압약물,안압즉가공제재21 mm Hg이하;기중진전기45지안,만기6지안.소유PACG환자재소량절제술후균이시력하강비례위고,수술후최상견적병발증위천전방.결론 복합식소량절제술후,APACG급성발작기화만성기급CPACG진전기화만기적안압공제균교호,표명소량절제술시치료PACG화공제안압적유효방식지일.단시복합식소량절제술후시력강저비례교고시불가홀시적중요문제.
Objective To evaluate the effect of trabeculectomy on intraocular pressure (IOP) and complications in eyes with primary angle closure glaucoma (PACG). Methods It was retrospective clinical study. PACG was classified as acute primary angle closure glaucoma (APACG) group and chronic primary angle closure glaucoma (CPACG) group. APACG was then divided into acute attack phase and chronic phase, and CPACG was divided into chronic phase and late phase, IOP, best corrected visual acuity were compared before and after trabeculectomy in different subgroup of PACG. In addition, the incidence of complications of trabeculectomy was assessed. Statistical analyses were performed using SPSS 12.0 statistics software. Categorical variables such as best corrected visual acuity were compared using nonparametric test, continuous variables such as age and IOP were compared between the two groups using independent two-sample t-tests. Pre-and postoperative IOP were compared using one-way analysis of variance of repeated measures. Results 40 eyes (37 cases) of APACG and 56 eyes (45 cases) of CPACG were enrolled in this study. The median follow-up period was 24 and 25 months, respectively, IOP was significantly decreased from (53.6±17.9)mm Hg (1 mm Hg = 0.133 kPa, preoperation) to (10.5±4.9)nun Hg (postoperation)at time of discharging from hospital and (14.0±10.3) nun Hg at time of final follow up in APACG(F =100.783,P<0.01), respectively, and from (36.8±13.8) nun Hg to (11.7±4.2) mm Hg at time of discharging from hospital and (13.8±4.5) mm Hg at time of final follow up in CPACG(F = 54.383 ,P <0.01), respectively. The IOP remained eontrolled (≤21 mm Hg) without antiglaucomatous medication in 38 eyes (95.0%) of APACG and in 50 eyes (89.3%) of CPACG. Visual acuity was significantly (H =12.316,P < 0.01) decreased after trabeeulectomy in all sub-types of PACG by Kruskal-wallis analysis. Shallow anterior chamber was conunonly occurred after trabeculectomy. Conclusions Trabeclectomy is an effective method to control IOP in APACG and CPACG. However, the high proportion of impaired vision was found following trabeculectomy in this study and warranted further clinical investigation.
