基于房角关闭程度的手术方法治疗闭角型青光眼的临床疗效观察
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摘要
目的探讨基于房角关闭程度的手术方法治疗闭角型青光眼的临床疗效。方法分析2012年8月到2014年9月收治的闭角型青光眼患者140例的临床资料,房角关闭>180°患者50例作为治疗组,而房角关闭≤180°患者90例作为对照组。对照组选择单纯小梁切除术,治疗组选择小梁切除术+白内障超声乳化吸出术。比较治疗后两组房角关闭程度、视力、眼压改善程度和并发症发生情况。结果所有患者均手术成功,两组治疗后的房角关闭程度均明显下降(P<0.05),且治疗组术后房角关闭程度较对照组对比下降更明显(P<0.05)。两组术后视力均明显提高,术后眼压均较术前有所下降,与术前比较,差异有统计学意义(P<0.05);但组间术后视力比较差异均无统计学意义(P>0.05),治疗组术后眼压明显低于对照组(P<0.05)。术后随访3个月,两组角膜水肿、一过性高眼压等并发症发生率差异无统计学意义(P>0.05)。结论小梁切除术+白内障超声乳化吸出术治疗闭角型青光眼患者能在提高视力与不增加并发症的基础上,更加有利于降低眼压与改善房角关闭程度,值得推广应用。
Objective To investigate the effects of different surgery for treating angle- closure glaucoma based on the angle closure situation. Methods Selected 140 angle- closure glaucoma patients from August 2012 to September 2014 in our hospital for treatment,and the angle closure > 180° as the treatment group of 50 patients,and the angle closure ≤180 ° as the control group of 90 patients,the control group were selected trabeculectomy,and the treatment group were selected trabeculectomy + phacoemulsification cataract surgery. Results All patients were successful surgery,the degree of angle closure after treatment were significantly decreased( P < 0. 05),while the decreased values of angle closure in the two groups compared were significant difference( P < 0. 05). The postoperative visual acuity and intraocular pressure were significantly improved and compared with preoperative were significant differences( P < 0. 05),and the postoperative visual acuity compared between the two groups were showed no significant difference( P > 0. 05). The postoperative intraocular pressure compared between the two groups were showed significant difference( P < 0. 05). Patients were followed up for 3 months,there were serious complications of hyphema,choroidal detachment.The corneal edema,transient ocular hypertension and other complications were no statistically significant differences compared in the two groups(P > 0. 05),after symptomatic treatment were significantly improved. Conclusion Trabeculectomy + phacoemulsification cataract surgery in patients with angle- closure glaucoma therapy can improve visual acuity and do no increase in complications,it can more help reduce intraocular pressure and improve the degree of angle closure that should be widely applied.
Objective To investigate the effects of different surgery for treating angle- closure glaucoma based on the angle closure situation. Methods Selected 140 angle- closure glaucoma patients from August 2012 to September 2014 in our hospital for treatment,and the angle closure > 180° as the treatment group of 50 patients,and the angle closure ≤180 ° as the control group of 90 patients,the control group were selected trabeculectomy,and the treatment group were selected trabeculectomy + phacoemulsification cataract surgery. Results All patients were successful surgery,the degree of angle closure after treatment were significantly decreased( P < 0. 05),while the decreased values of angle closure in the two groups compared were significant difference( P < 0. 05). The postoperative visual acuity and intraocular pressure were significantly improved and compared with preoperative were significant differences( P < 0. 05),and the postoperative visual acuity compared between the two groups were showed no significant difference( P > 0. 05). The postoperative intraocular pressure compared between the two groups were showed significant difference( P < 0. 05). Patients were followed up for 3 months,there were serious complications of hyphema,choroidal detachment.The corneal edema,transient ocular hypertension and other complications were no statistically significant differences compared in the two groups(P > 0. 05),after symptomatic treatment were significantly improved. Conclusion Trabeculectomy + phacoemulsification cataract surgery in patients with angle- closure glaucoma therapy can improve visual acuity and do no increase in complications,it can more help reduce intraocular pressure and improve the degree of angle closure that should be widely applied.
引文
[1]吴若欣,李金瑛.预测及筛查原发性闭角型青光眼高危人群的研究进展[J].国际眼科纵览,2013,37(5):311-316.
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[9]Nitta Y,Kamekura N,Takuma S,et al.Acute angle-closure glaucoma after general anesthesia for bone grafting[J].Anesth Prog,2014,61(4):162-164.
[10]马宇,刘意,王树林,等.双切口联合手术治疗青光眼合并白内障54例[J].中国老年学杂志,2013,33(3):664-665.
[11]赵斌,栗红生.闭角性青光眼并发白内障38例临床分析[J].中华实用诊断与治疗杂志,2013,27(7):723-724.
[12]庄立,赵博,原文新,等.根据房角关闭程度选择不同手术方式治疗白内障合并青光眼的临床疗效观察[J].实用医技杂志,2013,20(4):441-443.
[13]曾琨,冯其高,林宝涛,等.超声乳化白内障摘除治疗合并白内障的可疑房角关闭和房角关闭及原发性闭角型青光眼[J].国际眼科杂志,2013,13(8):1606-1608.
[14]李彬彬,胡莉群.小切口白内障摘除联合房角分离术治疗ACG合并白内障[J].国际眼科杂志,2013,13(5):941-943.
[15]Yuksel K,Goker YS,Yazici AT,et al.Can Perifoveal Pseudocyst Area be a Prognostic Factor in Macular Hole Surgery?A Prospective Study With Quantitative Data[J].Medicine(Baltimore),2014,93(28):e182.
[16]岳江,岳辉,周清,等.白内障超声乳化吸除联合房角分离术治疗闭角型青光眼的临床观察[J].临床眼科杂志,2013,21(5):416-418.
[2]朱萍,姚克.白内障超声乳化联合人工晶状体植入术治疗闭角型青光眼合并白内障的疗效观察[J].中国现代医生,2012,50(27):70-72.
[3]单宝财.超声乳化白内障手术治疗急性闭角型青光眼合并白内障[J].中国医疗前沿,2012,7(2):54-55.
[4]李春玲.白内障超声乳化吸除治疗原发性闭角型青光眼合并白内障观察[J].中国实用眼科杂志,2012,30(2):156-159.
[5]吕宏伟,曾忠玲.超声乳化术治疗急慢性闭角型青光眼的优越性[J].中华眼外伤职业眼病杂志,2014,36(9):692-695.
[6]Saban Y,Javier de B,Massa M.Nasal lift-nasal valve lift and nasal tip lift-preliminary results of a new technique using noninvasive selfretaining unidirectional nasal suspension with threads[J].Facial Plast Surg,2014,30(6):661-669.
[7]禤中宁,陈洁,刘晶.白内障超声乳化吸除联合房角分离术治疗原发性闭角型青光眼的远期疗效观察[J].广西医学,2014,10(8):1452-1453.
[8]陆滨,杜新华.原发性闭角型青光眼合并白内障超声乳化术治疗的临床观察[J].浙江创伤外科,2013,18(4):548-549.
[9]Nitta Y,Kamekura N,Takuma S,et al.Acute angle-closure glaucoma after general anesthesia for bone grafting[J].Anesth Prog,2014,61(4):162-164.
[10]马宇,刘意,王树林,等.双切口联合手术治疗青光眼合并白内障54例[J].中国老年学杂志,2013,33(3):664-665.
[11]赵斌,栗红生.闭角性青光眼并发白内障38例临床分析[J].中华实用诊断与治疗杂志,2013,27(7):723-724.
[12]庄立,赵博,原文新,等.根据房角关闭程度选择不同手术方式治疗白内障合并青光眼的临床疗效观察[J].实用医技杂志,2013,20(4):441-443.
[13]曾琨,冯其高,林宝涛,等.超声乳化白内障摘除治疗合并白内障的可疑房角关闭和房角关闭及原发性闭角型青光眼[J].国际眼科杂志,2013,13(8):1606-1608.
[14]李彬彬,胡莉群.小切口白内障摘除联合房角分离术治疗ACG合并白内障[J].国际眼科杂志,2013,13(5):941-943.
[15]Yuksel K,Goker YS,Yazici AT,et al.Can Perifoveal Pseudocyst Area be a Prognostic Factor in Macular Hole Surgery?A Prospective Study With Quantitative Data[J].Medicine(Baltimore),2014,93(28):e182.
[16]岳江,岳辉,周清,等.白内障超声乳化吸除联合房角分离术治疗闭角型青光眼的临床观察[J].临床眼科杂志,2013,21(5):416-418.