本文選題：激光　切入點(diǎn)：青光眼　出處：《延安大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:本研究主要通過(guò)577nm與532nm兩種波長(zhǎng)的激光周邊虹膜成形術(shù)(Laser peripheral iridoplasty,ALPI)聯(lián)合YAG激光周邊虹膜切除術(shù)(Laser peripheral iridotomy,LPI)治療原發(fā)性急性閉角型青光眼,評(píng)價(jià)其差異性、臨床療效及安全性,為今后激光治療原發(fā)性急性閉角型青光眼提供數(shù)據(jù)支持。方法:隨機(jī)選取2015年9月至2017年2月在延安大學(xué)附屬醫(yī)院治療的原發(fā)性急性閉角型青光眼患者28例30只眼,其中15只眼行577nm波長(zhǎng)激光周邊虹膜成形術(shù)聯(lián)合YAG激光周邊虹膜切除術(shù)(A組),15只眼行532nm波長(zhǎng)激光周邊虹膜成形術(shù)聯(lián)合YAG激光周邊虹膜切除術(shù)(B組)。所有治療均征得患者及家屬同意,并在治療前簽署知情同意書。使用天津索維活體超聲生物顯微鏡(UBM)測(cè)得術(shù)前、術(shù)后3d、術(shù)后3mo相關(guān)參數(shù):ACD(前房深度)、AOD500(500μm處房角開(kāi)放距離)、ACA500(500μm處房角開(kāi)放距離對(duì)應(yīng)的前房角)、IT3(周邊虹膜厚度)。使用德國(guó)海德堡角膜共焦顯微鏡測(cè)得術(shù)前及術(shù)后3d角膜內(nèi)皮計(jì)數(shù)。用日本TOPCON非接觸眼壓計(jì)監(jiān)測(cè)術(shù)前、術(shù)后1h、術(shù)后1d、術(shù)后1wk、術(shù)后1mo、術(shù)后3mo眼壓。觀察術(shù)后并發(fā)癥,滴眼液使用情況。使用全自動(dòng)電腦視野檢查分析系統(tǒng)(TEC-3F)分析患眼術(shù)后3d與術(shù)后3mo視野。以上所有操作及檢查均由專人完成,所有數(shù)據(jù)均采用SPSS 20.0軟件進(jìn)行分析。其中眼壓與UBM相關(guān)參數(shù)等時(shí)間依賴性變量間比較用重復(fù)測(cè)量資料的方差分析,進(jìn)一步分析組內(nèi)兩個(gè)時(shí)間點(diǎn)間變化采用配對(duì)t檢驗(yàn),組內(nèi)治療前后角膜內(nèi)皮計(jì)數(shù)的變化、組內(nèi)術(shù)后視野變化采用配對(duì)t檢驗(yàn),而組間內(nèi)皮損失對(duì)比、組間視野變化對(duì)比用獨(dú)立樣本t檢驗(yàn)。結(jié)果:1.眼壓:2組患者在術(shù)前、術(shù)后1h,術(shù)后1d,術(shù)后1mo,術(shù)后3mo的眼壓運(yùn)用重復(fù)測(cè)量資料的方差分析得出:各組內(nèi)不同時(shí)間段眼壓變化有統(tǒng)計(jì)學(xué)意義(P0.05),總體呈下降趨勢(shì);而2組間眼壓變化差異無(wú)統(tǒng)計(jì)學(xué)意義(p0.05)。2.角膜內(nèi)皮計(jì)數(shù):測(cè)得2組患者在術(shù)前、術(shù)后3d的角膜內(nèi)皮計(jì)數(shù)。組內(nèi)治療前后角膜內(nèi)皮計(jì)數(shù)變化采用配對(duì)t檢驗(yàn)得出:各組內(nèi)術(shù)前術(shù)后角膜內(nèi)皮計(jì)數(shù)差異無(wú)統(tǒng)計(jì)學(xué)意義(p0.05);兩組間角膜內(nèi)皮損失比較采用獨(dú)立樣本t檢驗(yàn)得出:2組間角膜內(nèi)皮損失量差異無(wú)統(tǒng)計(jì)學(xué)意義(p0.05)。3.ubm相關(guān)參數(shù):3.1測(cè)得2組患者在術(shù)前、術(shù)后3d、術(shù)后3mo的acd、aod500、aca500、it3,運(yùn)用重復(fù)測(cè)量資料的方差分析得出:(1)各組內(nèi)不同時(shí)間段acd值變化均有統(tǒng)計(jì)學(xué)意義(p0.05),而2組間acd值變化差異均無(wú)統(tǒng)計(jì)學(xué)意義(p0.05)。(2)各組內(nèi)不同時(shí)間段aod500值變化均有統(tǒng)計(jì)學(xué)意義(p0.05),而2組間aod500值變化差異均無(wú)統(tǒng)計(jì)學(xué)意義(p0.05)。(3)各組內(nèi)不同時(shí)間段aca500值變化均有統(tǒng)計(jì)學(xué)意義(p0.05),而2組間aca500值變化差異均無(wú)統(tǒng)計(jì)學(xué)意義(p0.05)。(4)各組內(nèi)不同時(shí)間段it3值變化均有統(tǒng)計(jì)學(xué)意義(p0.05),而2組間it值變化差異均無(wú)統(tǒng)計(jì)學(xué)意義(p0.05)。3.2a組:(1)acd術(shù)后3d較術(shù)前明顯增大,有統(tǒng)計(jì)學(xué)意義(p0.05);術(shù)后3mo較術(shù)后3d變化無(wú)統(tǒng)計(jì)學(xué)意義(p0.05)。(2)aod500術(shù)后3d較術(shù)前明顯增大,有統(tǒng)計(jì)學(xué)意義(p0.05);術(shù)后3mo較術(shù)后3d變化沒(méi)有統(tǒng)計(jì)學(xué)意義(p0.05)。(3)aca500術(shù)后3d較術(shù)前明顯增大,有統(tǒng)計(jì)學(xué)意義(p0.05);術(shù)后3mo較術(shù)后3d變化沒(méi)有統(tǒng)計(jì)學(xué)意義(p0.05)。(4)it3術(shù)后3d較術(shù)前減小,有統(tǒng)計(jì)學(xué)意義(p0.05);術(shù)后3mo較術(shù)后3d增大,有統(tǒng)計(jì)學(xué)意義(p0.05);術(shù)后3mo較術(shù)前減小,其中三個(gè)象限(鼻側(cè)、上方、下方)無(wú)統(tǒng)計(jì)學(xué)意義(p0.05),一個(gè)象限(顳側(cè))有統(tǒng)計(jì)學(xué)意義(p0.05)。3.3b組:(1)acd術(shù)后3d較術(shù)前明顯增大,有統(tǒng)計(jì)學(xué)意義(p0.05)),術(shù)后3mo較術(shù)后3d變化無(wú)統(tǒng)計(jì)學(xué)意義(p0.05)。(2)aod500術(shù)后3d較術(shù)前明顯增大,有統(tǒng)計(jì)學(xué)意義(p0.05),術(shù)后3mo較術(shù)后3d變化沒(méi)有統(tǒng)計(jì)學(xué)意義(p0.05)。(3)aca500術(shù)后3d較術(shù)前明顯增大,有統(tǒng)計(jì)學(xué)意義(p0.05),術(shù)后3mo較術(shù)后3d變化沒(méi)有統(tǒng)計(jì)學(xué)意義(p0.05)。(4)it3術(shù)后3d較術(shù)前減小,有統(tǒng)計(jì)學(xué)意義(p0.05),術(shù)后3mo較術(shù)后3d增大,有統(tǒng)計(jì)學(xué)意義(p0.05),術(shù)后3mo較術(shù)前減小,有統(tǒng)計(jì)學(xué)意義(P0.05)。4.觀察兩組術(shù)后3mo較術(shù)后3d視野無(wú)差異。5.本次研究30只眼均無(wú)嚴(yán)重并發(fā)癥,術(shù)后1h前房炎癥細(xì)胞分級(jí)為0.5+。6.術(shù)后根據(jù)情況逐次停用降眼壓滴眼液,入選30只眼,除1只眼(A組)術(shù)后因停用降眼壓滴眼液后眼壓升高,后又加用降眼壓滴眼液得以控制,余均能于術(shù)后1wk停藥。結(jié)論:1.577nm波長(zhǎng)與532nm波長(zhǎng)激光周邊虹膜成形術(shù)聯(lián)合YAG激光周邊虹膜切除術(shù)治療原發(fā)性急性閉角型青光眼在療效、安全性方面無(wú)差異。2.577nm波長(zhǎng)與532nm波長(zhǎng)激光周邊虹膜成形術(shù)聯(lián)合YAG激光周邊虹膜切除術(shù)治療原發(fā)性急性閉角型青光眼,能有效加深患者的前房深度、房角開(kāi)放度,前房開(kāi)放距離,從而減少臨床用藥,控制眼壓,保護(hù)視功能。3.577nm波長(zhǎng)與532nm波長(zhǎng)激光周邊虹膜成形術(shù)聯(lián)合YAG激光周邊虹膜切除術(shù)治療原發(fā)性急性閉角型青光眼前后角膜內(nèi)皮計(jì)數(shù)無(wú)顯著減少,術(shù)后無(wú)嚴(yán)重并發(fā)癥,安全性較高。
[Abstract]:Objective: This study mainly through 577nm and 532nm laser peripheral iridectomy two wavelength plasty (Laser peripheral iridoplasty, ALPI) combined with YAG laser peripheral iridectomy (Laser peripheral, iridotomy, LPI) for the treatment of primary acute angle closure glaucoma, evaluation of the differences, the clinical efficacy and safety, for the future of laser treatment provide data support of primary acute angle closure glaucoma. Methods: randomly selected from September 2015 to February 2017 in Affiliated Hospital of Yan'an University for treatment of primary acute angle closure glaucoma and 28 eyes of 30 cases, of which 15 eyes underwent 577nm laser peripheral iridoplasty combined with YAG laser peripheral iridectomy (A group), 15 eyes 532nm the wavelength of laser peripheral iridoplasty combined with YAG laser iridectomy (group B) were treated. All patients and their family members consent, and signed informed consent before treatment. Sovi in vivo ultrasound biomicroscopy (UBM) in Tianjin was measured before surgery, postoperative 3D, postoperative 3Mo related parameters: ACD (anterior chamber depth), AOD500 (500 m angle opening distance (500 m), ACA500 at the anterior chamber angle opening distance corresponding angle), IT3 (peripheral iris the thickness of 3D). Corneal endothelial cell counting using Germany Heidelberg corneal confocal microscope measured before and after the surgery. With Japanese TOPCON non-contact tonometer monitoring before surgery, postoperative 1H, postoperative 1D, postoperative 1wk, postoperative 1Mo, postoperative intraocular pressure 3Mo. Postoperative complications, the use of eye drops. The use of automatic analysis system of computer vision inspection (TEC-3F) of eyes with postoperative 3D with 3Mo vision. All of the above operations and check by hand to complete, all the data were analyzed with SPSS 20 software. The IOP and UBM parameters related to time dependent variables were compared using repeated measurement data analysis of variance further, Analysis of two time points within the group were compared by paired t test before and after treatment, changes of corneal endothelial counts within the group, group of postoperative vision were compared by paired t test, and between groups of endothelial loss comparison, comparison between the two groups in perspective with the independent sample t test. Results: 1. hypertension patients in the 2 groups before operation after the operation, 1H, 1D after surgery, postoperative 1Mo, postoperative intraocular pressure using the 3Mo variance of repeated measurement data analysis: there were significant changes of intraocular pressure within each group at different time (P0.05), the overall downward trend; while the difference of intraocular pressure between the 2 groups was statistically significant (P0.05).2. corneal endothelial cell counting measured: 2 groups of patients before surgery, corneal endothelial cell counting 3D after surgery. The treatment group before and after the change of corneal endothelial cell counting using a paired t test showed that within each group of differences in corneal endothelium before and after surgery was not statistically significant between the two groups (P0.05); corneal endothelial loss compared with independent 鏍鋒湰t媯，

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