论文部分内容阅读
目的探讨治疗原发性闭角型青光眼三种手术方式的适应症和初步临床疗效观察。方法采用非随机临床对照研究方法。拟订手术适应症,对临床收治的63例72眼原发性闭角型青光眼进行手术处理:单纯抗青光眼手术——复合式小梁切除术(Trabeculectomy,Trab)、青-白联合手术——复合式小梁切除联合超声乳化白内障吸除+晶体囊袋折叠式人工晶体植入术(Phacotrabeculectomy+IOL,PhacoTrab+IOL)和单纯白内障手术——超声乳化白内障吸除+晶体囊袋折叠式人工晶体植入术(Phaco+IOL)。比较不同适应症下三种手术方式初步的临床疗效。包括眼压控制情况、前房深度和房水流畅系数(C值)的变化,超声生物显微镜(UBM)观察房角和滤过泡,以及用抗青光药物辅助情况及并发症等。随访时间平均(11.7±4.9)个月。结果均经统计学处理。结果三组术后在随访期内均能将眼压控制在理想范围,术后眼压较术前明显降低(三组P值均<0.001),前房深度:PhacoTrab+IOL和Phaco+IOL组术后明显较术前加深,差异有统计学意义(P值均<0.001),但Trab组术前后改变不明显(P>0.05);UBM观察房角:PhacoTrab+IOL和Phaco+IOL组明显较术前加宽或重新开放,相应组C值术后较术前提高,差异有统计学意义(P分别<0.001和<0.01),Trab组房角变化不明显,但术后C值较术前亦有改善(P<0.001);三组均未见严重术中并发症;术后早期炎症反应最轻者为Phaco+IOL组;远期并发症Trab组有5眼发生低眼压。最后对视力的变化也作了讨论。结论不同手术方式适合不同的病人情况。超声乳化白内障吸除术因其具有相对房角开放和C值改善以及视力提高等优势,可考虑作为原发性闭角型青光眼治疗的选择性手段之一,但要注意适应症的选择。
Objective To investigate the indications and primary clinical curative effects of three kinds of surgical methods for treatment of primary angle-closure glaucoma. Methods Non-randomized controlled clinical study. Sixty-seven eyes of 72 patients with primary angle-closure glaucoma were enrolled in this study. They were treated with trabeculectomy (Trabeculectomy, Trab), cyan-white combined surgery-composite Phacoemulsification cataract surgery combined with phacoemulsification cataract surgery and phacoemulsification cataract surgery (PhacoTrab + IOL) and simple cataract surgery - phacoemulsification cataract surgery + capsular bag foldable intraocular lens implantation Surgery (Phaco + IOL). Comparison of different indications under the three kinds of surgical preliminary clinical efficacy. Including intraocular pressure control, anterior chamber depth and aqueous fluid coefficient (C value) changes, ultrasound biomicroscopy (UBM) observed angle and filtration bleb, and the use of anti-glaucoma-assisted conditions and complications. Follow-up time averaged (11.7 ± 4.9) months. The results were statistically processed. Results The intraocular pressure (IOP) in the three groups were controlled within the ideal range during the follow-up period. The postoperative IOP was significantly lower than that before the operation (P <0.001 for all three groups). The depth of the anterior chamber was significantly lower in the PhacoTrab + IOL and Phaco + IOL groups PhacoTrab + IOL group and Phaco + IOL group were significantly higher than UBM group (P <0.05), and the difference was statistically significant (P <0.001), but the change in Trab group was not significant (P> 0.05) Compared with the preoperation, the values of C in the corresponding group increased significantly (P <0.001 and <0.01, respectively), while the changes in the angle of Trab did not change significantly (P <0.001). No serious intraoperative complications were found in the three groups. Phaco + IOL group had the lowest inflammatory reaction in the early postoperative period. Ocular hypertension was observed in 5 of the long-term complications Trab group. Finally, changes in vision have also been discussed. Conclusion Different surgical methods are suitable for different patient situations. Phacoemulsification cataract surgery due to its relative open angle and C value improvement and vision improvement and other advantages, can be considered as primary angle-closure glaucoma treatment of one of the options, but pay attention to the choice of indications.