经巩膜睫状体光凝术治疗难治性青光眼的临床研究  

A clinical study of using transscleral diode laser cyclophotocoagulation in the treatment of refractory glaucoma

作　　者：朱银花[1,2] 刘升强[2] 王帅[1] 李静敏[1] 

机构地区：[1]大连医科大学,辽宁大连116027 [2]大连医科大学附属第二医院眼科

出　　处：《中国实用眼科杂志》2015年第6期630-634,共5页Chinese Journal of Practical Ophthalmology

摘　　要：目的探讨不同病因及手术方式对经巩膜睫状体光凝术（transscleraldiodelasercyclo—photocoagulation，TSCP）治疗难治性青光眼的疗效影响。方法前瞻性临床研究。对2010年12月至2013年12月在大连医科大学附属第二医院眼科就诊的难治性青光眼患者60例（63只眼），根据病因分为原发性青光眼非绝对期组（A组），原发性青光眼绝对期组（B组）及继发性青光眼组（C组）；再根据术后听到爆破音后是否降低0．05w功率作为确定功率将A组、B组及C组的患者根据随机原则分别分为两组，即第一组和第二组。观察术后视力、眼压变化、疼痛感及并发症等。结果（1）眼压由术前（49．13＋14．44）mmHg降至术后（26．40-＋11．57）mmHg，与术前眼压值比较P=0．000〈0．05，差异有统计学意义。A组、B组及C组眼压降低值比较差异有统计学意义（P〈0．05），且C组眼压降低幅度较其他组大。而第一、二两组之间比较差异无统计学意义（P〉0．05）。（2）TSCP术后视力不变者47只眼、视力提高者10只眼、视力降低者6只眼。其中A组视力变化波动最大。（3）术后1、2、3天疼痛程度与术前比较差异均具有统计学意义（U=5．729，P〈O．05；U=7．347，P〈0．05；U=8．294，P〈0．05）。术后并发症发生率低、程度轻。（4）经Pearson相关性分析可知术后眼压降低值与病因相关，其相关系数r=0．417，P=0．001〈0．05，差异有统计学意义；与术前眼压相关，其相关系数r=0．879，P=0．000〈0．05，差异有统计学意义。与年龄、性别及听到爆破音后能量的选择无明显相关。（5）绘制眼压变化折线图，得出第7天达到最低值，此后略波动，1个月达平稳期。结论（1）TSCP治疗难治性青光眼在降眼压方面疗效确切，对视力影响小，具有并发症少，操作简单，耐受性好等优点。（2）TSCP治疗难治性青光眼术后眼压�Objective Toinvestigatethe effects of differentcauses andintraoperative surgical ap- proach and methods, finally, in order to improve the clinical efficacy of （transscleral diode laser cy- clophotocoagulation, TSCP）. Methods According to the etiology, a total of 60 patients （63eyes）pa- tients withrefractory glaucomawas divided into the group of non-absolute primary glaucoma （group A）, the group of absolute primary glaucoma （group B） and the group of secondary glaucoma （group C）. Furthermore, according to the different ways to select the laser-determined power, these three groups were sub-divided into two groups. Results The intraocular pressure was ranged from （49.13±14.44）mmHgto（26.40±11.57）mmHg, and showed significant difference between the values （P 〈 0.05）.Postoperative IOP of group A, B and C showed statistically significant difference between the values （P 〈0.05）, and in group C, IOP had tower magnitude than the other two groups, while no significant difference was revealed between the first and second group （P 〉0.05）.There were 47 eyes in visual acuityunchanged, 10 improved, and 6 reduced.In groupA, vision changedmost volatile.The re- sults showed that significant difference between the first, second, and third day and preoperative in comparison of pain symptom （U=5.729, P 〈0.05; U=7.347, P 〈0.05; U=8.294, P 〈0.05）.And the com- plication was under the low degree.Pearson correlation analysis showed thatintraocular pressure differ- ence associated with etiology, with the correlation coefficient r =0.417, P =0.001〈0.05. Positive corre- lation betweenpreoperative pressure, and its related coefficient r =0.879, P =0.000〈0.05. But age, gen- der and choice to energy appeared to be not associated with effect. Plotted line chart of IOP chang- es over time, showed that as postoperative IOP at the end of the first seven days, it reached its low- est value, and remained stable up to a month period. Conclusions Good results and fewer complica- tions are achi

关 键 词：半导体激光 睫状体光凝 青光眼 眼内压 

分 类 号：R775.9[医药卫生—眼科]