CAJ | 학술논문

目的分析原发性闭角型青光眼(PACG)患者小梁切除术后视盘结构、视神经纤维层厚度与视野的变化规律及相关性,从而为PACG的治疗提供理论依据.方法临床病例系列研究.对2011年1月到2013年1月在吉林大学二院眼科医院就诊的50例单眼首次急性发作的PACG患者药物治疗,依据术前眼压分为3组,第1组:2～3天内眼压降至正常(＜21 mmHg),第2组:2～3天内眼压控制在21～40 mmHg之间;第3组:≥5天眼压仍＞40 mmHg.术前、术后2周、术后6个月行海德堡视网膜断层扫描(HRT-Ⅲ)、视野检查,分析二者的变化规律及与术前眼压的关系.结果术后6个月第1组盘沿增宽,鼻侧和鼻下侧视网膜神经纤维层(RNFL)增厚,鼻上、鼻下、颞上视野好转,差异有统计学意义(P＜0.05);第2组鼻侧和鼻下侧RNFL增厚,颞上视野好转,差异有统计学意义(P＜0.05);第3组颞侧、颞下、颞上RNFL变薄,差异有统计学意义(P＜0.05),视野无明显变化.术后2周第3组RNFL增厚、盘沿增宽、视杯缩小,差异有统计学意义(P＜0.05).结论原发性急性闭角型青光眼术前高眼压持续3天以下的患者,术后视野和视神经损害可逆转.术前高眼压持续5天以上的患者,术后早期出现视盘水肿、视野和视神经损害不可逆转.因此,应最大程度降低眼压,尽量缩短高眼压持续时间.
목적 분석원발성폐각형청광안(PACG)환자소량절제술후시반결구、시신경섬유층후도여시야적변화규률급상관성,종이위PACG적치료제공이론의거.방법 림상병례계렬연구.대2011년1월도2013년1월재길림대학이원안과의원취진적50례단안수차급성발작적PACG환자약물치료,의거술전안압분위3조,제1조:2～3천내안압강지정상(＜21 mmHg),제2조:2～3천내안압공제재21～40 mmHg지간;제3조:≥5천안압잉＞40 mmHg.술전、술후2주、술후6개월행해덕보시망막단층소묘(HRT-Ⅲ)、시야검사,분석이자적변화규률급여술전안압적관계.결과 술후6개월제1조반연증관,비측화비하측시망막신경섬유층(RNFL)증후,비상、비하、섭상시야호전,차이유통계학의의(P＜0.05);제2조비측화비하측RNFL증후,섭상시야호전,차이유통계학의의(P＜0.05);제3조섭측、섭하、섭상RNFL변박,차이유통계학의의(P＜0.05),시야무명현변화.술후2주제3조RNFL증후、반연증관、시배축소,차이유통계학의의(P＜0.05).결론 원발성급성폐각형청광안술전고안압지속3천이하적환자,술후시야화시신경손해가역전.술전고안압지속5천이상적환자,술후조기출현시반수종、시야화시신경손해불가역전.인차,응최대정도강저안압,진량축단고안압지속시간.
Objective To analyze the changes of optic disk structures,the depth of retinal nerve fiber layer,and visual field after trabeculectomy and the relations between these three parameters to provide some theoretical evidences for the surgery of PACG.Methods Fifty patients diagnosed as primary acute closed glaucoma(PACG)in one eye were studied.According to IOP the patients were divided into three groups.The first group:IOP dropped to normal in 2 to 3 days(＜21mmHg); The second group:IOP was controlled between 21 and 40 mmHg; The third group:IOP was still ＞40 mmHg over 5 days.The structure of optic disk,the depth of retinal nerve fiber,and the visual field were measured using HRT-Ⅲ and Humphrey 750 equipment at the time points of before surgery,two weeks after surgery,and six months after surgery.Results Six months after surgery:In the first group,the rim volume became wider and the RNFL of nasal and nasal inferior became thicker,nasal superior,nasal inferior,and temporal superior of version field,the sphere map was also improved(P ＜ 0.05).In the secondary group,the RNFL of nasal and nasal inferior became thicker,temporal superior of version field,the sphere map was also improved(P ＜0.05).In the third group,the RNFL in the quadrants of temporal lateral became thinner(P ＜0.05),but the vision deficiency did not changed obviously.Also,RNFL became thicker,the rim volume became wider,and the optic cup became smaller at two weeks after surgery in the third group,(P ＜0.05).Conclusions Controlling the preoperative IOP and shorting the time of high IOP in PACG patients can reverse the damage of visual field and optic nerve fiber.Optic and retinal edema can be found in PACG patients with persistent high level of IOP,while this kind of edema is reversible.The level of IOP should be decreased as much as possible and also shorten the duration of higher level IOP.