本文選題：急性原發(fā)性閉角型青光眼 + 頻域光學相干斷層掃描��； 參考：《遵義醫(yī)學院》2017年碩士論文

【摘要】：目的:通過頻域光學相干斷層掃描(spectral domainoptical coherence tomography,SD-OCT)測量急性原發(fā)性閉角型青光眼(acute primary angle-closure glaucoma,APACG)大發(fā)作患者雙眼黃斑區(qū)視網(wǎng)膜神經(jīng)節(jié)細胞層和內(nèi)叢狀層厚度(ganglion cell-inner plexiform layer thickness,GCIPLT)、視網(wǎng)膜視神經(jīng)纖維層厚度(retinal nerve fibre layer thickness,RNFLT)的變化,探討高眼壓導致視網(wǎng)膜損害的部位,以期為探討APACG視神經(jīng)損害機制提供參考。方法:1、收集2015年7月-2016年5月在我科收治的APACG單眼發(fā)作患者20例(40眼),所有納入研究的APACG患者經(jīng)過治療后眼壓均控制在正常范圍。治療方法根據(jù)房角關(guān)閉情況選擇激光周邊虹膜切開術(shù)、小梁切除術(shù)、小梁切除聯(lián)合白內(nèi)障手術(shù)。2、檢查方法:用Cirrus HD-OCT(美國蔡司公司software version 8.0)行黃斑模塊(macular cube)且信號強度≥6的掃描,行神經(jīng)節(jié)細胞分析(Ganglion Cell OU Analysis,GCA)分析,參考以往文獻報道,選取GCIPLT參數(shù)和RNFLT參數(shù)中的黃斑區(qū)視網(wǎng)膜神經(jīng)節(jié)細胞層和內(nèi)叢狀層最小厚度(minimum ganglion cell-inner plexiform layer thickness,min GCIPLT)、黃斑區(qū)視網(wǎng)膜神經(jīng)節(jié)細胞層和內(nèi)叢狀層平均厚度(mean ganglion cell-inner plexiform layer thickness,m GCIPLT)和視網(wǎng)膜視神經(jīng)纖維層平均厚度(mean retinal nerve fibre layer thickness,m RNFLT),這三個診斷青光眼效能高的指標,作為主要研究指標。3、隨訪時間及指標:全部入選患者經(jīng)規(guī)范化治療后,隨訪眼壓維持在正常范圍的2天、15天、3個月、6個月,主要隨訪指標包括:眼壓,min GCIPLT、m GCIPLT和m RNFLT。4、統(tǒng)計學處理:采用SPSS19.0軟件進行數(shù)據(jù)統(tǒng)計分析,計量資料以?x±s表示,對發(fā)作眼與對側(cè)眼min GCIPLT、m GCIPLT、m RNFLT的比較,采用配對樣本t檢驗的統(tǒng)計學方法,P0.05表示差異具有統(tǒng)計學意義;對大發(fā)作眼治療前后min GCIPLT、m GCIPLT、m RNFLT分析采用重復測量方差分析的統(tǒng)計學方法,P0.05表示差異具有統(tǒng)計學意義。結(jié)果:1、眼壓:治療后15天、3個月、6個月的平均眼壓為12.98±2.76mm Hg、15.00±4.10mm Hg、13.50±3.12mm Hg均控制在正常范圍內(nèi)。2、大發(fā)作眼角膜透明2天、治療后15天與對側(cè)眼比較,min GCIPLT、m GCIPLT無統(tǒng)計學意義,m RNFLT變厚(P0.05);大發(fā)作眼治療后3個月、6個月與對側(cè)眼比較,min GCIPLT、m GCIPLT和m RNFLT均變薄(P0.05),且6個月時更明顯;大發(fā)作眼自身比較,m GCIPLT和m RNFLT在治療后3個月、6個月較角膜透明2天和治療后15天變薄(P0.05),且6個月時更明顯;min GCIPLT在治療后6個月較治療后3個月變薄(P0.05)。結(jié)論:急性眼壓增高可致min GCIPLT、m GCIPLT變薄,視網(wǎng)膜神經(jīng)節(jié)細胞(retinal ganglion cells,RGCs)損害;急性高眼壓所致的RGCs的損傷可能是逆行性的,即先導致視神經(jīng)纖維水腫,后引起RGCs凋亡。
[Abstract]:Objective: to measure the thickness of retinal ganglion cell layer and inner plexiform layer in macular area of eyes in patients with acute primary angle-closure glaucoma (ACG) with acute primary angle-closure glaucomaACG by frequency-domain optical coherence tomography (SD-OCT), and to measure the thickness of ganglion cell-inner plexiform layer thicknessnessus GCIPLTT, and to measure the thickness of retinal ganglion cell-inner plexiform layer thicknessnessus GCIPLTs in patients with acute primary angle-closure glaucoma (PCG). Changes of retinal nerve fibre layer thickness of optic nerve fiber layer, To explore the location of retinal damage caused by high intraocular pressure (IOP) and to provide reference for the study of optic nerve damage in APACG. Methods Twenty patients with monocular attack of APACG were collected from July 2015 to May 2016 in our department. The IOP of all the APACG patients in the study was controlled within normal range after treatment. Methods according to angle closure, laser peripheral iridotomy, trabeculectomy and cataract surgery were performed. Methods: Cirrus HD-OCT (software version 8.0) was used to scan macular module with signal intensity 鈮，

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