PACG小梁切除术后视盘结构及视野改变的研究  

The changes of the optic disk structure and visual field after surgery of trabeculectomy in patients with primary acute angle-closure glaucoma（PACG）

作　　者：孙丽霞[1] 尹元[1] 张文松[1] 汪艳[1] 郑雅娟[1] 

机构地区：[1]吉林大学二院眼科医院青光眼科,长春市133000

出　　处：《中国实用眼科杂志》2014年第10期1151-1155,共5页Chinese Journal of Practical Ophthalmology

摘　　要：目的 分析原发性闭角型青光眼（PACG）患者小梁切除术后视盘结构、视神经纤维层厚度与视野的变化规律及相关性,从而为PACG的治疗提供理论依据.方法 临床病例系列研究.对2011年1月到2013年1月在吉林大学二院眼科医院就诊的50例单眼首次急性发作的PACG患者药物治疗,依据术前眼压分为3组,第1组：2～3天内眼压降至正常（＜21 mmHg）,第2组：2～3天内眼压控制在21～40 mmHg之间;第3组：≥5天眼压仍＞40 mmHg.术前、术后2周、术后6个月行海德堡视网膜断层扫描（HRT-Ⅲ）、视野检查,分析二者的变化规律及与术前眼压的关系.结果 术后6个月第1组盘沿增宽,鼻侧和鼻下侧视网膜神经纤维层（RNFL）增厚,鼻上、鼻下、颞上视野好转,差异有统计学意义（P＜0.05）;第2组鼻侧和鼻下侧RNFL增厚,颞上视野好转,差异有统计学意义（P＜0.05）;第3组颞侧、颞下、颞上RNFL变薄,差异有统计学意义（P＜0.05）,视野无明显变化.术后2周第3组RNFL增厚、盘沿增宽、视杯缩小,差异有统计学意义（P＜0.05）.结论 原发性急性闭角型青光眼术前高眼压持续3天以下的患者,术后视野和视神经损害可逆转.术前高眼压持续5天以上的患者,术后早期出现视盘水肿、视野和视神经损害不可逆转.因此,应最大程度降低眼压,尽量缩短高眼压持续时间.Objective To analyze the changes of optic disk structures,the depth of retinal nerve fiber layer,and visual field after trabeculectomy and the relations between these three parameters to provide some theoretical evidences for the surgery of PACG.Methods Fifty patients diagnosed as primary acute closed glaucoma（PACG）in one eye were studied.According to IOP the patients were divided into three groups.The first group：IOP dropped to normal in 2 to 3 days（〈21mmHg）; The second group：IOP was controlled between 21 and 40 mmHg; The third group：IOP was still 〉40 mmHg over 5 days.The structure of optic disk,the depth of retinal nerve fiber,and the visual field were measured using HRT-Ⅲ and Humphrey 750 equipment at the time points of before surgery,two weeks after surgery,and six months after surgery.Results Six months after surgery：In the first group,the rim volume became wider and the RNFL of nasal and nasal inferior became thicker,nasal superior,nasal inferior,and temporal superior of version field,the sphere map was also improved（P 〈 0.05）.In the secondary group,the RNFL of nasal and nasal inferior became thicker,temporal superior of version field,the sphere map was also improved（P 〈0.05）.In the third group,the RNFL in the quadrants of temporal lateral became thinner（P 〈0.05）,but the vision deficiency did not changed obviously.Also,RNFL became thicker,the rim volume became wider,and the optic cup became smaller at two weeks after surgery in the third group,（P 〈0.05）.Conclusions Controlling the preoperative IOP and shorting the time of high IOP in PACG patients can reverse the damage of visual field and optic nerve fiber.Optic and retinal edema can be found in PACG patients with persistent high level of IOP,while this kind of edema is reversible.The level of IOP should be decreased as much as possible and also shorten the duration of higher level IOP.

关 键 词：青光眼急性发作 眼压 小梁切除术 视盘结构 神经纤维层厚度 视野 

分 类 号：R779.6[医药卫生—眼科]