睫状体光凝术与小梁切除术治疗原发性急性闭角型青光眼持续性高眼压疗效比较  

Comparison of the efficacy between cyclophotocoagulation and trabeculectomy for primary acute angle-closure glaucoma with persistent ocular hypertension

作　　者：李维娜[1] 梁宗宝[2] 邓艺萍[2] 李学喜[2] 魏锐利[3] 

机构地区：[1]解放军第180医院眼科 [2]解放军第180医院眼科,泉州362000 [3]第二军医大学附属长征医院眼科,上海200003

出　　处：《中华实验眼科杂志》2014年第3期266-269,共4页Chinese Journal Of Experimental Ophthalmology

摘　　要：背景 经巩膜二极管激光睫状体光凝术（TDCP）既往仅用于视功能差的晚期青光眼患者的治疗,但随着技术的发展和设备的进步,目前其适应证逐步扩大,已有报道将其用于不同时期的多种类型青光眼,但相关临床疗效评价研究较少. 目的 比较TDCP和小梁切除术治疗原发性急性闭角型青光眼（PAACG）持续性高眼压的疗效.方法 采用回顾性病例对照设计.收集2009年1月至2010年12月在解放军第180医院眼科确诊为PAACG持续性高眼压的患者,根据治疗方式不同分为TDCP组56例62眼和小梁切除术组39例44眼.对两组患者治疗前,治疗后1周、3个月和末次随访时的视力、眼压、术后需用降眼压药物的数量以及后续治疗情况进行分析比较.结果 两组患者的人口基线特征差异无统计学意义（均P＞0.05）.TDCP组治疗前后不同时间点间视力改善眼数的总体比较差异有统计学意义（x2=30.927,P=0.002）,治疗后1周视力改善的眼数明显多于治疗前,差异有统计学意义（x2=16.778,P=0.002）,但治疗后各时间点间视力改善的眼数差异均无统计学意义（均P＞0.008）.小梁切除术组治疗前后不同时间点间视力改善眼数的总体比较差异有统计学意义（x2 =44.345,P＜0.001）,小、梁切除术后1周与术前相比视力提高的眼数明显增加,差异有统计学意义（x2=23.725,P＜0.001）,但术后各时间点间视力改善的眼数差异均无统计学意义（均P＞0.008）.治疗前后各时间点2个组间的眼压比较差异无统计学意义（F组别=3.836,P=0.053）,但手术前后不同时间点间的眼压变化差异有统计学意义（F时间=757.078,P＜0.001）,两组术眼术后各时间点的眼压均明显低于术前,差异均有统计学意义（均P＜0.001）.末次随访时TDCP组需用降眼压药物者占48.4％,小梁切除术组为27.3％,两组间差异有统计学意义（x2=4.796,P=0.029）.TDCP组中术后20眼再行睫状体光凝术或�Background Transscleral diode laser cyclophotocoagulation （TDCP） was used to later stage of glaucoma in the past.However,the indications of TDCP are expanding gradually over time and there are more and more reports about its application in different stages and different types of glaucoma.Objective This study was to compare the clinical efficacy of TDCP and trabeculectomy for primary acute angle-closure glaucoma （PAACG） with persistent ocular hypertension.Methods Ninety-five PAACG patients with persistent ocular hypertension were retrospectively analyzed.The patients were divided into TDGP group （62 eyes of 56 cases） and trabeculectomy group （44 eyes of 39 cases） based on the difference of treating fashions.The clinical outcomes were compared between the two groups with the evaluating indexes of visual acuity,intraocular pressure （IOP） before and 1 week,3 months and the end of following-up as well as the number of drug used and the re-treatment.Results The demography was matched between the two groups （all at P＞0.05）.The number of eyes with visual improvement was significantly different among the groups （x2 =30.927,P =0.002） in the TDCP group.Compared with before treatment,the number of visual improvement in 1 week after treatment was significantly raised （x2 =16.778,P =0.002）.No significant differences were seen in the eye number of visual improvement in various timepoints after treatment （all at P＞0.008）.Also,the eye number of visual improvement was significantly different among the different timepoints （x2 =44.345,P＜0.001）,and statistically significant change was found between the preoperation and postoperative 1 week （x2 =23.725,P＜0.001）.However,there were no significant differences in the eye number of visual improvement in various timepoints after operation each other （all at P＞0.008）.The IOP was insignificantly altered among the groups at various timepoints （Fgroup =3.836,P =0.053）,but the change was significantly different over time （Ftime =75

关 键 词：激光光凝 睫状体光凝术 小梁切除术 青光眼 闭角型 手术 急性疾病 

分 类 号：R779.6[医药卫生—眼科]