中华实验眼科杂志
中華實驗眼科雜誌
중화실험안과잡지
CHINESE JOURNAL OF EXPERIMENTAL OPHTHALMOLOGY
2014年
3期
266-269
,共4页
李维娜%梁宗宝%邓艺萍%李学喜%魏锐利
李維娜%樑宗寶%鄧藝萍%李學喜%魏銳利
리유나%량종보%산예평%리학희%위예리
激光光凝/睫状体光凝术%小梁切除术%青光眼,闭角型/手术%急性疾病
激光光凝/睫狀體光凝術%小樑切除術%青光眼,閉角型/手術%急性疾病
격광광응/첩상체광응술%소량절제술%청광안,폐각형/수술%급성질병
Laser coagulation/cyclophotocoagulation%Trabeculectomy%Glaucoma,angle-closure/surgery%Acute disease
背景 经巩膜二极管激光睫状体光凝术(TDCP)既往仅用于视功能差的晚期青光眼患者的治疗,但随着技术的发展和设备的进步,目前其适应证逐步扩大,已有报道将其用于不同时期的多种类型青光眼,但相关临床疗效评价研究较少. 目的 比较TDCP和小梁切除术治疗原发性急性闭角型青光眼(PAACG)持续性高眼压的疗效.方法 采用回顾性病例对照设计.收集2009年1月至2010年12月在解放军第180医院眼科确诊为PAACG持续性高眼压的患者,根据治疗方式不同分为TDCP组56例62眼和小梁切除术组39例44眼.对两组患者治疗前,治疗后1周、3个月和末次随访时的视力、眼压、术后需用降眼压药物的数量以及后续治疗情况进行分析比较.结果 两组患者的人口基线特征差异无统计学意义(均P＞0.05).TDCP组治疗前后不同时间点间视力改善眼数的总体比较差异有统计学意义(x2=30.927,P=0.002),治疗后1周视力改善的眼数明显多于治疗前,差异有统计学意义(x2=16.778,P=0.002),但治疗后各时间点间视力改善的眼数差异均无统计学意义(均P＞0.008).小梁切除术组治疗前后不同时间点间视力改善眼数的总体比较差异有统计学意义(x2 =44.345,P＜0.001),小、梁切除术后1周与术前相比视力提高的眼数明显增加,差异有统计学意义(x2=23.725,P＜0.001),但术后各时间点间视力改善的眼数差异均无统计学意义(均P＞0.008).治疗前后各时间点2个组间的眼压比较差异无统计学意义(F组别=3.836,P=0.053),但手术前后不同时间点间的眼压变化差异有统计学意义(F时间=757.078,P＜0.001),两组术眼术后各时间点的眼压均明显低于术前,差异均有统计学意义(均P＜0.001).末次随访时TDCP组需用降眼压药物者占48.4％,小梁切除术组为27.3％,两组间差异有统计学意义(x2=4.796,P=0.029).TDCP组中术后20眼再行睫状体光凝术或小梁切除术,占32.3％,小梁切除术组为2眼,占4.5％.结论 TDCP治疗PAACG持续性高眼压与小梁切除术的短期降眼压效果无明显差别,且其操作更为简便,手术持续时间短.TDCP治疗后的远期降眼压效果较小梁切除术差,需用降眼压药物和重复手术治疗的患者比例高于小梁切除术.
揹景 經鞏膜二極管激光睫狀體光凝術(TDCP)既往僅用于視功能差的晚期青光眼患者的治療,但隨著技術的髮展和設備的進步,目前其適應證逐步擴大,已有報道將其用于不同時期的多種類型青光眼,但相關臨床療效評價研究較少. 目的 比較TDCP和小樑切除術治療原髮性急性閉角型青光眼(PAACG)持續性高眼壓的療效.方法 採用迴顧性病例對照設計.收集2009年1月至2010年12月在解放軍第180醫院眼科確診為PAACG持續性高眼壓的患者,根據治療方式不同分為TDCP組56例62眼和小樑切除術組39例44眼.對兩組患者治療前,治療後1週、3箇月和末次隨訪時的視力、眼壓、術後需用降眼壓藥物的數量以及後續治療情況進行分析比較.結果 兩組患者的人口基線特徵差異無統計學意義(均P＞0.05).TDCP組治療前後不同時間點間視力改善眼數的總體比較差異有統計學意義(x2=30.927,P=0.002),治療後1週視力改善的眼數明顯多于治療前,差異有統計學意義(x2=16.778,P=0.002),但治療後各時間點間視力改善的眼數差異均無統計學意義(均P＞0.008).小樑切除術組治療前後不同時間點間視力改善眼數的總體比較差異有統計學意義(x2 =44.345,P＜0.001),小、樑切除術後1週與術前相比視力提高的眼數明顯增加,差異有統計學意義(x2=23.725,P＜0.001),但術後各時間點間視力改善的眼數差異均無統計學意義(均P＞0.008).治療前後各時間點2箇組間的眼壓比較差異無統計學意義(F組彆=3.836,P=0.053),但手術前後不同時間點間的眼壓變化差異有統計學意義(F時間=757.078,P＜0.001),兩組術眼術後各時間點的眼壓均明顯低于術前,差異均有統計學意義(均P＜0.001).末次隨訪時TDCP組需用降眼壓藥物者佔48.4％,小樑切除術組為27.3％,兩組間差異有統計學意義(x2=4.796,P=0.029).TDCP組中術後20眼再行睫狀體光凝術或小樑切除術,佔32.3％,小樑切除術組為2眼,佔4.5％.結論 TDCP治療PAACG持續性高眼壓與小樑切除術的短期降眼壓效果無明顯差彆,且其操作更為簡便,手術持續時間短.TDCP治療後的遠期降眼壓效果較小樑切除術差,需用降眼壓藥物和重複手術治療的患者比例高于小樑切除術.
배경 경공막이겁관격광첩상체광응술(TDCP)기왕부용우시공능차적만기청광안환자적치료,단수착기술적발전화설비적진보,목전기괄응증축보확대,이유보도장기용우불동시기적다충류형청광안,단상관림상료효평개연구교소. 목적 비교TDCP화소량절제술치료원발성급성폐각형청광안(PAACG)지속성고안압적료효.방법 채용회고성병례대조설계.수집2009년1월지2010년12월재해방군제180의원안과학진위PAACG지속성고안압적환자,근거치료방식불동분위TDCP조56례62안화소량절제술조39례44안.대량조환자치료전,치료후1주、3개월화말차수방시적시력、안압、술후수용강안압약물적수량이급후속치료정황진행분석비교.결과 량조환자적인구기선특정차이무통계학의의(균P＞0.05).TDCP조치료전후불동시간점간시력개선안수적총체비교차이유통계학의의(x2=30.927,P=0.002),치료후1주시력개선적안수명현다우치료전,차이유통계학의의(x2=16.778,P=0.002),단치료후각시간점간시력개선적안수차이균무통계학의의(균P＞0.008).소량절제술조치료전후불동시간점간시력개선안수적총체비교차이유통계학의의(x2 =44.345,P＜0.001),소、량절제술후1주여술전상비시력제고적안수명현증가,차이유통계학의의(x2=23.725,P＜0.001),단술후각시간점간시력개선적안수차이균무통계학의의(균P＞0.008).치료전후각시간점2개조간적안압비교차이무통계학의의(F조별=3.836,P=0.053),단수술전후불동시간점간적안압변화차이유통계학의의(F시간=757.078,P＜0.001),량조술안술후각시간점적안압균명현저우술전,차이균유통계학의의(균P＜0.001).말차수방시TDCP조수용강안압약물자점48.4％,소량절제술조위27.3％,량조간차이유통계학의의(x2=4.796,P=0.029).TDCP조중술후20안재행첩상체광응술혹소량절제술,점32.3％,소량절제술조위2안,점4.5％.결론 TDCP치료PAACG지속성고안압여소량절제술적단기강안압효과무명현차별,차기조작경위간편,수술지속시간단.TDCP치료후적원기강안압효과교소량절제술차,수용강안압약물화중복수술치료적환자비례고우소량절제술.
Background Transscleral diode laser cyclophotocoagulation (TDCP) was used to later stage of glaucoma in the past.However,the indications of TDCP are expanding gradually over time and there are more and more reports about its application in different stages and different types of glaucoma.Objective This study was to compare the clinical efficacy of TDCP and trabeculectomy for primary acute angle-closure glaucoma (PAACG) with persistent ocular hypertension.Methods Ninety-five PAACG patients with persistent ocular hypertension were retrospectively analyzed.The patients were divided into TDGP group (62 eyes of 56 cases) and trabeculectomy group (44 eyes of 39 cases) based on the difference of treating fashions.The clinical outcomes were compared between the two groups with the evaluating indexes of visual acuity,intraocular pressure (IOP) before and 1 week,3 months and the end of following-up as well as the number of drug used and the re-treatment.Results The demography was matched between the two groups (all at P＞0.05).The number of eyes with visual improvement was significantly different among the groups (x2 =30.927,P =0.002) in the TDCP group.Compared with before treatment,the number of visual improvement in 1 week after treatment was significantly raised (x2 =16.778,P =0.002).No significant differences were seen in the eye number of visual improvement in various timepoints after treatment (all at P＞0.008).Also,the eye number of visual improvement was significantly different among the different timepoints (x2 =44.345,P＜0.001),and statistically significant change was found between the preoperation and postoperative 1 week (x2 =23.725,P＜0.001).However,there were no significant differences in the eye number of visual improvement in various timepoints after operation each other (all at P＞0.008).The IOP was insignificantly altered among the groups at various timepoints (Fgroup =3.836,P =0.053),but the change was significantly different over time (Ftime =757.078,P＜0.001).The postoperative IOP was significantly higher than that of preoperation in both groups (all at P＜0.001).The proportion of eyes using lowering-IOP drugs was 48.4％ in the TDCP group,and that in the trabeculectomy group was 27.3％,showing a significant difference between them (x2 =4.796,P =0.029).The retherapy was performed in 20 eyes (32.3％) and 2 eyes (4.5％) in the TDCP group and the trabeculectomy group,respectively.Conclusions The short-term lowing-IOP effecacy of TDCP is similar to trabeculectomy,but the longterm lowing-IOP efficacy of TDCP is not good.Compared with the trabeculectomy,TDCP shows more simple operation,less time-consuming during the surgery and milder tissue damage,but the eyes continuing to use anti-glaucomatous drugs or re-therapy are increased.
