中华眼视光学与视觉科学杂志
中華眼視光學與視覺科學雜誌
중화안시광학여시각과학잡지
CHINESE JOURNAL OF OPTOMETRY OPHTHALMOLOGY AND VISUAL SCIENCE
2014年
10期
589-593
,共5页
青光眼,闭角型%小梁切除术%超声乳化白内障吸除术%青白联合手术%晶状体厚度%眼轴长度
青光眼,閉角型%小樑切除術%超聲乳化白內障吸除術%青白聯閤手術%晶狀體厚度%眼軸長度
청광안,폐각형%소량절제술%초성유화백내장흡제술%청백연합수술%정상체후도%안축장도
Glaucoma,angle-closure%Trabeculectomy%Phacoemulsification%Phacotrabeculectomy%Lens thickness%Axial length
目的 将解剖学特征纳入手术方式选择的参考条件,观察3种手术治疗PACG的临床效果,探讨其手术适应证选择及其相关影响因素,为临床治疗提供参考.方法 回顾性系列病例研究.排除高血压病、糖尿病等其他引起眼部病变的疾病,选择2008年2月至2009年1月于青岛眼科医院就诊并诊断为PACG患者164例(191眼),根据发病性质分为急性组与慢性组,急性组91例(91眼),慢性组73例(100眼),每次随访失访患者比例小于3.2％.按照青光眼诊断及治疗专家共识及解剖学参数[晶状体厚度(LT)、眼轴长度]作为手术方式选择的参考条件分别行单纯小梁切除术[54例,LT=(4.77±0.50)mm]、青白联合术[57例,LT=(5.02±0.61) mm]、单纯白内障手术[53例,LT=(5.02 ±0.37) mm],平均随访(3.05±0.12)年,观察术后眼压、BCVA、视野、术后滤过泡、并发症等.3种术式解剖学参数及术后眼压波动比较采用Kruskal-Wallis检验;3种术式术前与术后各观察指标比较采用配对样本秩和检验;定性资料采用Fisher's确切概率法及卡方检验.结果 急性组与慢性组术后眼压均较术前明显下降,差异有统计学意义(Z=2.201,P＜0.05),联合手术术后眼压控制水平低于其他2种术式,差异有统计学意义(P＜0.05).3种手术术后眼压波动差异无统计学意义.急性组行单纯白内障及青白联合手术术后分别有38％、22％的房角进一步开放,高于慢性组,差异有统计学意义(x2=6.310,P＜0.05).平均视野缺损(MD)、模式标准差(PSD)术前与术后差异无统计学意义.术后各种并发症的发生率差异无统计学意义;青白联合手术与单纯小梁切除术后滤过泡形态差异无统计学意义,术后约1/2无滤过形态,但眼压控制低于21 mmHg.单纯小梁切除术急性组与慢性组分别有10％、6％,青白联合手术术后急性组与慢性组分别有4％、2％行2次小梁切除术,差异无统计学意义.结论 PACG患者若具有眼轴较短、晶状体相对偏厚的特点,行小梁切除术时可联合晶状体一并摘除,青白联合手术对术后眼压控制的效果更好.
目的 將解剖學特徵納入手術方式選擇的參攷條件,觀察3種手術治療PACG的臨床效果,探討其手術適應證選擇及其相關影響因素,為臨床治療提供參攷.方法 迴顧性繫列病例研究.排除高血壓病、糖尿病等其他引起眼部病變的疾病,選擇2008年2月至2009年1月于青島眼科醫院就診併診斷為PACG患者164例(191眼),根據髮病性質分為急性組與慢性組,急性組91例(91眼),慢性組73例(100眼),每次隨訪失訪患者比例小于3.2％.按照青光眼診斷及治療專傢共識及解剖學參數[晶狀體厚度(LT)、眼軸長度]作為手術方式選擇的參攷條件分彆行單純小樑切除術[54例,LT=(4.77±0.50)mm]、青白聯閤術[57例,LT=(5.02±0.61) mm]、單純白內障手術[53例,LT=(5.02 ±0.37) mm],平均隨訪(3.05±0.12)年,觀察術後眼壓、BCVA、視野、術後濾過泡、併髮癥等.3種術式解剖學參數及術後眼壓波動比較採用Kruskal-Wallis檢驗;3種術式術前與術後各觀察指標比較採用配對樣本秩和檢驗;定性資料採用Fisher's確切概率法及卡方檢驗.結果 急性組與慢性組術後眼壓均較術前明顯下降,差異有統計學意義(Z=2.201,P＜0.05),聯閤手術術後眼壓控製水平低于其他2種術式,差異有統計學意義(P＜0.05).3種手術術後眼壓波動差異無統計學意義.急性組行單純白內障及青白聯閤手術術後分彆有38％、22％的房角進一步開放,高于慢性組,差異有統計學意義(x2=6.310,P＜0.05).平均視野缺損(MD)、模式標準差(PSD)術前與術後差異無統計學意義.術後各種併髮癥的髮生率差異無統計學意義;青白聯閤手術與單純小樑切除術後濾過泡形態差異無統計學意義,術後約1/2無濾過形態,但眼壓控製低于21 mmHg.單純小樑切除術急性組與慢性組分彆有10％、6％,青白聯閤手術術後急性組與慢性組分彆有4％、2％行2次小樑切除術,差異無統計學意義.結論 PACG患者若具有眼軸較短、晶狀體相對偏厚的特點,行小樑切除術時可聯閤晶狀體一併摘除,青白聯閤手術對術後眼壓控製的效果更好.
목적 장해부학특정납입수술방식선택적삼고조건,관찰3충수술치료PACG적림상효과,탐토기수술괄응증선택급기상관영향인소,위림상치료제공삼고.방법 회고성계렬병례연구.배제고혈압병、당뇨병등기타인기안부병변적질병,선택2008년2월지2009년1월우청도안과의원취진병진단위PACG환자164례(191안),근거발병성질분위급성조여만성조,급성조91례(91안),만성조73례(100안),매차수방실방환자비례소우3.2％.안조청광안진단급치료전가공식급해부학삼수[정상체후도(LT)、안축장도]작위수술방식선택적삼고조건분별행단순소량절제술[54례,LT=(4.77±0.50)mm]、청백연합술[57례,LT=(5.02±0.61) mm]、단순백내장수술[53례,LT=(5.02 ±0.37) mm],평균수방(3.05±0.12)년,관찰술후안압、BCVA、시야、술후려과포、병발증등.3충술식해부학삼수급술후안압파동비교채용Kruskal-Wallis검험;3충술식술전여술후각관찰지표비교채용배대양본질화검험;정성자료채용Fisher's학절개솔법급잡방검험.결과 급성조여만성조술후안압균교술전명현하강,차이유통계학의의(Z=2.201,P＜0.05),연합수술술후안압공제수평저우기타2충술식,차이유통계학의의(P＜0.05).3충수술술후안압파동차이무통계학의의.급성조행단순백내장급청백연합수술술후분별유38％、22％적방각진일보개방,고우만성조,차이유통계학의의(x2=6.310,P＜0.05).평균시야결손(MD)、모식표준차(PSD)술전여술후차이무통계학의의.술후각충병발증적발생솔차이무통계학의의;청백연합수술여단순소량절제술후려과포형태차이무통계학의의,술후약1/2무려과형태,단안압공제저우21 mmHg.단순소량절제술급성조여만성조분별유10％、6％,청백연합수술술후급성조여만성조분별유4％、2％행2차소량절제술,차이무통계학의의.결론 PACG환자약구유안축교단、정상체상대편후적특점,행소량절제술시가연합정상체일병적제,청백연합수술대술후안압공제적효과경호.
Objective To use anatomical parameters as one of the references for primary angle-closure glaucoma (PACG) surgery; to discuss surgical indications by monitoring the clinical results from three surgical methods and related factors.Methods This was a retrospective case series study.One hundred ninety-one eyes of 164 patients who were diagnosed with PACG between February 2008 and January 2009 in Qingdao Eye Hospital were divided into an acute group (91 patients,91 eyes) and a chronic group (73 patients,100 eyes).Patients with conditions such as hypertension,diabetes,and other causes of eye disease were excluded from the study.Fewer than 3.2％ of the patients were lost at the time of any follow-up visit.Based on expert consensus and differences in anatomical parameters,all groups included patients who underwent trabeculectomy (54 cases,LT=4.77±0.50 mm),phacotrabeculectomy (57 cases,LT=5.02±0.61 mm) and phacoemulsification (53 cases,LT=5.02±0.37 mm).The mean follow-up period was 3.05±0.12 years.Statistical data included age,gender,course of disease,anatomical parameters,follow-up visual acuity,intraocular pressure,and complications after surgery.SPSS 17.0 was used to analyze the anatomical parameters,the Kruskal-Wallis test was used to analyze IOP fluctuation from the three surgeries,the Wilcoxon matched pairs signed-ranks test was used to compare preoperative and postoperative indices,a chi square test or Fisher's exact test were used to compare postoperative filtering bleb and complications.Results Postoperative intraocular pressure decreased significantly with the three surgeries,and the differences were statistically significant (Z=2.201,P＜0.05).Postoperative IOP with phacotrabeculectomy was lower than with the other two procedures and the difference was statistically significant (LSD-t:P＜0.05).There were no significant differences in postoperative IOP fluctuation for the three surgeries.The reopening angle accounted for 38％ (phacoemulsification) and 22％ (phacotrabeculectomy) and the acute group was higher than the chronic group (x2=6.310,P＜0.05).MD and PSD were not significantly different compared to preoperative levels.Complications were not significantly different among the three operations nor was bleb morphology different between phacotrabulectomy and trabulectomy.Although half the patients had no obvious filtering bleb,IOP was lower than 21 mmHg.Conclusion In PACG,with a shorter axial length and thicker lens,the lens can be removed when combined with trabeculectomy.IOP control is better in phacotrabeculectomy.The residual subscleral filtration tract may have a real function in the outflow of aqueous humor.
