CAJ | 학술논문

目的探讨不同模式激光虹膜周边切除术对角膜内皮细胞的影响.方法临床病例对照研究.收集2011年1月至2013年12月在福建医科大学第一附属医院眼科诊断为闭角型青光眼,前房角关闭范围不超过180°的深色无隐窝的虹膜患者98例(134只眼),按数字表法随机分为三组:Nd∶YAG激光组,传统联合激光组,改良联合激光组.Nd∶ YAG激光组采用单独Nd∶ YAG激光行激光周边虹膜切开术;传统联合激光组先采用532 nm激光光凝,然后用Nd∶ YAG激光击穿;改良联合激光组先用Nd∶ YAG激光击射,再用532 nm激光崩紧或拉开,必要时最后再用Nd∶ YAG激光击穿.记录激光能量,术前和术后1周、1及3个月采用角膜内皮镜检测切口周围的角膜内皮,测量角膜内皮细胞的密度、六边形细胞比例和细胞面积.结果改良联合激光组使用的532 nm倍频激光能量明显低于传统联合激光组,改良联合激光组使用的Nd∶ YAG激光明显低于Nd∶ YAG激光组和传统联合激光组,组间差异具有统计学意义(532 nm倍频激光t=52.248,P＜0.01;Nd∶ YAG激光F=112.223,P ＜0.01).改良联合激光组术后切口周围角膜内皮细胞的密度较Nd∶ YAG激光组和传统联合激光组多(术前F =0.628,P=0.535;术后1周F=38.958,P＜0.01;术后1个月F=9.103,P＜0.01;术后3个月F =3.010,P=0.053),改良联合激光组术后切口周围角膜内皮六边形细胞比例较Nd∶ YAG激光组和传统联合激光组大(术前F =0.012,P=0.988;术后1周F=4.937,P＜0.01;术后1个月F=0.895,P=0.411;术后3个月F=1.370,P=0.258),改良联合激光组术后切口周围角膜内皮细胞面积较Nd∶ YAG激光组和传统联合激光组小(术前F=1.959,P=0.146;术后1周F=3.184,P=0.045;术后1个月F =35.184,P＜0.01;术后3个月F=27.160,P＜0.01).结论改良联合激光虹膜周边切除术减少激光能量,减轻角膜内皮细胞的损伤,对深色无隐窝的虹膜的闭角型青光眼患者是一种安全有效的治疗方式. 目的探討不同模式激光虹膜週邊切除術對角膜內皮細胞的影響.方法臨床病例對照研究.收集2011年1月至2013年12月在福建醫科大學第一附屬醫院眼科診斷為閉角型青光眼,前房角關閉範圍不超過180°的深色無隱窩的虹膜患者98例(134隻眼),按數字錶法隨機分為三組:Nd∶YAG激光組,傳統聯閤激光組,改良聯閤激光組.Nd∶ YAG激光組採用單獨Nd∶ YAG激光行激光週邊虹膜切開術;傳統聯閤激光組先採用532 nm激光光凝,然後用Nd∶ YAG激光擊穿;改良聯閤激光組先用Nd∶ YAG激光擊射,再用532 nm激光崩緊或拉開,必要時最後再用Nd∶ YAG激光擊穿.記錄激光能量,術前和術後1週、1及3箇月採用角膜內皮鏡檢測切口週圍的角膜內皮,測量角膜內皮細胞的密度、六邊形細胞比例和細胞麵積.結果改良聯閤激光組使用的532 nm倍頻激光能量明顯低于傳統聯閤激光組,改良聯閤激光組使用的Nd∶ YAG激光明顯低于Nd∶ YAG激光組和傳統聯閤激光組,組間差異具有統計學意義(532 nm倍頻激光t=52.248,P＜0.01;Nd∶ YAG激光F=112.223,P ＜0.01).改良聯閤激光組術後切口週圍角膜內皮細胞的密度較Nd∶ YAG激光組和傳統聯閤激光組多(術前F =0.628,P=0.535;術後1週F=38.958,P＜0.01;術後1箇月F=9.103,P＜0.01;術後3箇月F =3.010,P=0.053),改良聯閤激光組術後切口週圍角膜內皮六邊形細胞比例較Nd∶ YAG激光組和傳統聯閤激光組大(術前F =0.012,P=0.988;術後1週F=4.937,P＜0.01;術後1箇月F=0.895,P=0.411;術後3箇月F=1.370,P=0.258),改良聯閤激光組術後切口週圍角膜內皮細胞麵積較Nd∶ YAG激光組和傳統聯閤激光組小(術前F=1.959,P=0.146;術後1週F=3.184,P=0.045;術後1箇月F =35.184,P＜0.01;術後3箇月F=27.160,P＜0.01).結論改良聯閤激光虹膜週邊切除術減少激光能量,減輕角膜內皮細胞的損傷,對深色無隱窩的虹膜的閉角型青光眼患者是一種安全有效的治療方式.
목적 탐토불동모식격광홍막주변절제술대각막내피세포적영향.방법 림상병례대조연구.수집2011년1월지2013년12월재복건의과대학제일부속의원안과진단위폐각형청광안,전방각관폐범위불초과180°적심색무은와적홍막환자98례(134지안),안수자표법수궤분위삼조:Nd∶YAG격광조,전통연합격광조,개량연합격광조.Nd∶ YAG격광조채용단독Nd∶ YAG격광행격광주변홍막절개술;전통연합격광조선채용532 nm격광광응,연후용Nd∶ YAG격광격천;개량연합격광조선용Nd∶ YAG격광격사,재용532 nm격광붕긴혹랍개,필요시최후재용Nd∶ YAG격광격천.기록격광능량,술전화술후1주、1급3개월채용각막내피경검측절구주위적각막내피,측량각막내피세포적밀도、륙변형세포비례화세포면적.결과 개량연합격광조사용적532 nm배빈격광능량명현저우전통연합격광조,개량연합격광조사용적Nd∶ YAG격광명현저우Nd∶ YAG격광조화전통연합격광조,조간차이구유통계학의의(532 nm배빈격광t=52.248,P＜0.01;Nd∶ YAG격광F=112.223,P ＜0.01).개량연합격광조술후절구주위각막내피세포적밀도교Nd∶ YAG격광조화전통연합격광조다(술전F =0.628,P=0.535;술후1주F=38.958,P＜0.01;술후1개월F=9.103,P＜0.01;술후3개월F =3.010,P=0.053),개량연합격광조술후절구주위각막내피륙변형세포비례교Nd∶ YAG격광조화전통연합격광조대(술전F =0.012,P=0.988;술후1주F=4.937,P＜0.01;술후1개월F=0.895,P=0.411;술후3개월F=1.370,P=0.258),개량연합격광조술후절구주위각막내피세포면적교Nd∶ YAG격광조화전통연합격광조소(술전F=1.959,P=0.146;술후1주F=3.184,P=0.045;술후1개월F =35.184,P＜0.01;술후3개월F=27.160,P＜0.01).결론 개량연합격광홍막주변절제술감소격광능량,감경각막내피세포적손상,대심색무은와적홍막적폐각형청광안환자시일충안전유효적치료방식.
Objective To investigate the effect of different modes of laser peripheral iridectomy on corneal endothelial cells.Methods A total of 98 cases (134 eyes) of angle-closure glaucoma patients,whose anterior chamber angle closure did not exceed 180 ° and iris was dark brown without crypt were collected from January 2011 to December 2013 in our hospital.Patients were randomly divided into three groups:the Nd∶YAG group,the traditional combined laser group and the modified combined laser group.Patients in the Nd∶YAG group were performed Nd∶YAG laser only.Patients in the traditional combined laser group were firstly performed 532nm Argon laser,followed by Nd∶YAG laser.Patients in the modified combined laser group were firstly performed Nd∶YAG laser,followed by 532nm Argon laser,when necessary using Nd∶YAG laser for breakdown.Laser energy was recorded.The corneal endothelial cells were measured using corneal endothelial microscope preoperative and 1 week,1 month and 3 months postoperatively.The corneal endothelial cell density,hexagonal cell ratio and cell area were calculated.Results The 532nm Argon laser energy used in the modified combined laser group was significantly lower than that in the traditional combined laser group.The Nd∶YAG laser energy used in the modified combined laser group was significantly lower than that in the Nd∶YAG group and the traditional combined laser group.The differences were statistical significances (532nm Argon laser t=52.248,P ＜0.01;Nd∶YAG laser F =112.223,P ＜0.01).The corneal endothelial cell density in the modified combined laser group was more than that in the Nd∶ YAG group and the traditional combined laser group (pre-operation F =0.628,P =0.535;1 week after operation F =38.958,P ＜0.01;1 month after operation F =9.103,P ＜0.01;3 months after operation F =3.010,P =0.053).The hexagonal cell ratio in the modified combined laser group was higher than that in the Nd∶YAG group and the traditional combined laser group (pre-operation F =0.012,P =0.988;1 week after operation F =4.937,P ＜0.01;1 month after operation F =0.895,P =0.411;3 months after operation F =1.370,P =0.258).The corneal endothelial cell area in the modified combined laser group was smaller than that in the Nd∶YAG group and the traditional combined laser group (pre-operation F =1.959,P =0.146;1 week after operation F =3.184,P =0.045;1 month after operation F =35.184,P ＜0.01;3 months after operation F =27.160,P ＜0.01).The differences were statistical significances.Conclusions Modified combined laser peripheral iridotomy can reduce laser energy;relieve the corneal endothelial cell injury induced by the operation.It is a safe and effective treatment for angle-closure glaucoma patients whose iris is dark brown without crypt.