玻璃体切除术中直视下睫状体光凝和经巩膜睫状体光凝治疗继发性青光眼的疗效比较  

Comparision of the clinical efficacy of vitrectomy combined with cyclophotocoagulation and trans-scleral cyclophotocoagulation to treat secondary glaucoma

作　　者：周丹[1] 何雷[1] 庞秀琴[1] ZHOU Dan HE Lei PANG Xiu-qin(Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing 100730, China)

机构地区：[1]首都医科大学附属北京同仁医院北京同仁眼科中心眼科学与视觉科学北京市重点实验室,100730

出　　处：《眼科》2016年第5期330-334,共5页Ophthalmology in China

摘　　要：目的 比较玻璃体切除术中直视下睫状体光凝和经巩膜睫状体光凝治疗继发青光眼的临床疗效。设计 回顾性病例系列。研究对象 2011年7月至2014年12月北京同仁医院眼科采用睫状体光凝治疗的继发性青光眼患者68例（68眼）。方法 玻璃体切除术中联合直视下睫状体光凝治疗37例，经巩膜睫状体光凝31例，术后随诊1-50个月。观察分析两组患者手术中激光参数，手术后最佳矫正视力、眼压变化及手术并发症，进行统计学分析。主要指标 激光参数、视力、眼压及并发症。结果 术前直视下光凝组患者眼压28-55 mmHg，平均（37.4±7.5）mmHg；经巩膜光凝组30-53 mmHg，平均（39.8±6.0）mmHg（t=-1.413，P=0.162）。手术前后直视下光凝组视力提高20例（54.1%），多于经巩膜光凝组（8例，25.8%）（χ^2=23.92，P〈0.001）。术后第1日直视下光凝组眼压下降10-29 mmHg，平均（19.4±5.3）mmHg，少于经巩膜光凝组12-33 mmHg，平均（23.9±5.9）mmHg（t=-3.246，P=0.002）；末次随诊直视下光凝组眼压12-30 mmHg，平均（17.6±3.8） mmHg，低于经巩膜光凝组16-32 mmHg，平均（20.4±4.1）mmHg（t=-2.542，P=0.013）。两组术中激光参数选用不同的能量、持续时间。两组患者术后并发症包括前房积血、前房纤维素样渗出、术后早期低眼压、渗出性脉络膜脱离。直视下光凝组可见玻璃体积血，经巩膜光凝组可见球结膜灼伤水肿。以上并发症均短期内恢复，未见眼球萎缩等严重并发症。结论 两种手术方式治疗继发青光眼各有优势，均可安全有效降低眼压，玻璃体切除直视下光凝联合手术有助于患者提高视力。（眼科，2016, 25： 330－334）Objective To compare the clinical efficacy of vitrectomy combined with cyclophotocoagulation and trans-scleral cyclophotocoagulation to treat secondary glaucoma. Design Retrospective cases series. Participants 68 cases （68 eyes） of secondary glaucoma in Beijing Tongren Hospital from July 2011 to December 2014. Methods All cases were divided into two groups. 37 cases in one group were treated by vitrectomy combined with cyclophotocoagulation and 31 cases in the other group were treated by trans-scleral cyclophotocoagulation（TSCP）. The postoperative follow-up periods were 1 to 50 months.The operative parameters of laser, changes of intraocular pressure（IOP）, postoperative best corrective visual acuity （BCVA）and postoperative complications were observed and compared between the two groups. Main Outcome Measures Parameters of laser, postoperative BCVA, IOP and complications. Results Preoperative IOP of two groups was 28-55 mmHg（37.4±7.5 mmHg） and 30-53 mmHg（39.8±6.0 mmHg） respectively and there was no significant difference （P〉0.05） between the two groups. The number of patients who got BCVA improvements within the two groups was 20 （54.1%） and 8 （25.8%） respectively. The difference was significant （χ^2=23.92, P〈0.001）. The amplitudes of IOP decrease on the first postoperative day in the TSCP group was 10-29 mmHg （19.4±5.3 mmHg） , significantly less than that of the vitrectomy combined with cyclophotocoagulation group 12-33 mmHg（23.9±5.9 mmHg）, and the last follow-up IOP of was significantly lower in the vitrectomy combined with cyclophotocoagulation group 12-30 mmHg（17.6±3.8 mmHg） than the TCSP group 16-32 mmHg（20.4±4.1 mmHg） respectively. While the energy and duration time of laser was different. Postoperative complications included hyphema, transient low IOP, fibrous exudates in anterior chamber, and exudative choroidal detachment in both groups. Moreover there was vitreous hemorrhage in vitrectomy combined with cyclophotocoagulation group and bulb

关 键 词：青光眼继发性 睫状体光凝 

分 类 号：R779.63[医药卫生—眼科]