外伤继发性青光眼视网膜神经纤维层厚度变化的研究  

Research on Thickness Variation of Retinal Nerve Fiber Layer of Traumatic Secondary Glaucoma

作　　者：刘琳琳[1] 蒋贻平[1] 胡成全[1] 吴虹[1] 

机构地区：[1]赣南医学院第一附属医院眼科,江西赣州341000

出　　处：《赣南医学院学报》2017年第4期519-522,526,共5页JOURNAL OF GANNAN MEDICAL UNIVERSITY

基　　金：赣州市科技局课题(GZ2014ZSF017)

摘　　要：目的:观察眼球钝挫伤继发性青光眼患者不同时期视乳头旁视网膜神经纤维层(retinal nerve fiber layer,RNFL)厚度变化,并分析其特点。方法:参与检测的人群共108例(216眼),外伤继发性青光眼组53例(53眼),对侧健眼组53例(53眼),健康对照组55例(110眼),对外伤继发性青光眼患眼行复合小梁切除术,术后眼压控制在11~20 mm Hg,在术后第2天,第10天,第1月采用光学相干断层扫描(OCT)检测视乳头旁12个钟点方位的RNFL厚度,采用t检验法分析外伤继发性青光眼组患者RNFL厚度变化的规律。结果:所有参与检查人群RNFL均以上方(11点至1点方位)及下方(5点至7点方位)较厚,鼻侧及颞侧较薄,分布呈"双驼峰"型。术后第2天青光眼组(11点至1点方位)及(5点至7点方位)RNFL厚度明显增加较其余两组差异具有统计学意义(P﹤0.05)。术后第10天青光眼组1~12点方位RNFL厚度无明显变化,较其余两组差异无统计学意义(P﹥0.05)。术后第1月青光眼组1点至12点方位RNFL厚度明显减少,较其余两组差异具有统计学意义(P﹤0.05)。结论:眼球钝挫伤继发性青光眼患者在术后第2天RNFL增厚,术后第10天RNFL厚度与正常组接近,在术后1月RNFL厚度明显变薄,萎缩。对于继发性青光眼患者药物无法控制眼压时候,需积极采取手术治疗控制眼压,避免晚期出现视神经萎缩。Objective: To observe the thickness variation of peripapillary retinal nerve fiber layer( RNFL) of secondary glaucoma caused by blunt ocular trauma at different periods and to analyze its characteristics. Method: 108 cases( 216eyes) were involved in the test,including 53 cases( 53 eyes) in traumatic secondary glaucoma group,53 cases( 53eyes) in fellow eyes group and 55 cases( 110 eyes) of healthy controls. Complex trabeculectomy is carried out for traumatic secondary glaucoma and the postoperative intraocular pressure is controlled within 11 ~ 20 mm Hg. Optical coherence tomography( OCT) is adopted to examine the thickness of RNFL in 12 o'clock direction beside the optic nerve in the 2nd day,10 th day and the 1st month after the surgery. T-test was adopted to analyze the rules of the thickness variation of RNFL in traumatic secondary glaucoma group. Results: The RNFL of all examinees was thicker in the upward side( 11 to 1 o'clock direction) and the downward side( 5 to 7 o'clock direction),and thinner in the nasal and the temporal sides,which presented a'double hump'curve. On the 2nd day of operation,the thickness of RNFL( 11 to 1o'clock direction) and( 5 to 7 o'clock direction) increased obviously for secondary glaucoma group,which had statistical significance( P ﹤ 0. 05) compared with the other two groups. On the 10 th day of operation,there was no obvious increase in the thickness of RNFL in 1 ~ 12 o'clock direction,which had no statistical significance( P ﹥ 0. 05) compared with the other two groups. In the postoperative month,the thickness of RNFL in 1 ~ 12 o'clock direction decreased obviously,which had statistical significance( P ﹤ 0. 05) compared with the other two groups. Conclusion: The thickness of RNFL of traumatic secondary glaucoma patients increases on the 2nd day,approaches the normal group on the 10 th day and grows thinner and atrophies in the 1st month after the surgery. If the intraocular pressure of secondary glaucoma patients cannot be controlled by medication,surgery should be adopted

关 键 词：继发性青光眼 视网膜神经纤维层厚度 

分 类 号：R775.3[医药卫生—眼科]