原发性闭角型青光眼住院患者初始手术术式变化分析  

Changes of initial surgical methods for inpatients with primary angle-closure glaucoma

作　　者：张倩倩 刘姗姗 范晓军 陈思源 刘海霞 孙晓祥 尹福梅 王继兵 ZHANG Qianqian;LIU Shanshan;FAN Xiaojun;CHEN Siyuan;LIU Haixia;SUN Xiaoxiang;YIN Fumei;WANG Jibing(Department of Ophthalmology,Weifang Medical University,Weifang 261053,China;Department of Glaucoma,Weifang Eye Hospital)

机构地区：[1]潍坊医学院眼科学教研室,山东潍坊261053 [2]潍坊眼科医院青光眼科

出　　处：《潍坊医学院学报》2021年第3期161-164,共4页Acta Academiae Medicinae Weifang

摘　　要：目的对2009年2月~2019年12月收治的原发性闭角型青光眼住院患者初始手术术式进行回顾性研究,分析演变趋势,为优化个性化手术治疗提供参考依据。方法分析住院行初始手术治疗的原发性闭角型青光眼患者的临床资料。青光眼手术术式分为以滤过泡依赖为降眼压术式的外引流手术、促进房水通过小梁网-Schlemm’s管途径引流的内引流术和减少房水生成的睫状体功能减弱术。外引流手术包括复合小梁切除术(Trab)、Ahmed引流阀和ExPress引流钉植入手术。内引流手术为白内障超声乳化联合房角粘连分离术和虹膜激光周边切除术。睫状体功能减弱术包括经巩膜睫状体光凝术和内窥镜下睫状体光凝术。结果原发性闭角型青光眼:2009年Trab占72.73%(32眼/44眼),2019年占1.26%(3眼/239眼);而白内障超声乳化术联合前房角粘连分离术自2009年的4眼上升到2019年的224眼(93.72%),其中飞秒激光白内障超声乳化术联合房角粘连分离术者89眼(37.24%),联合高端晶体植入者66眼,手术术式自外引流Trab向内引流白内障超声乳化术联合前房角粘连分离术转变,期间原发性闭角型青光眼外引流手术呈下降趋势,差异有统计学意义(Z=13.819,P<0.05)。结论原发性闭角型青光眼住院患者初始手术术式由Trab向白内障超声乳化术联合前房角粘连分离术转变。Objective A retrospective study of the initial surgical procedures for primary angle-closure glaucoma(PACG) inpatients in the past 10 years, analysis of the evolution trend, and provides a reference for optimizing personalized surgical treatment.Methods A retrospective analysis of the clinical data of PACG patients for initial surgical treatment from February 2009 to December 2019.The initial surgical methods for glaucoma were divided into external drainage surgery that depend on filtering bleb to decrease intraocular pressure, internal drainage surgery that promotes drainage of aqueous humor through the trabecular meshwork-schlemm’s canal route, ciliary body weakening surgery that reduces aqueous humor production.The surgical methods of external drainage include compound trabeculectomy(Trab),glaucoma drainage device(GDD) include Ahmed glaucoma valve and ExPress, combined surgery for glaucoma and cataract.Internal drainage surgical methods includes Phacoemulsification combined with goniosynechialysis(Phaco-GSL) and Laser peripheral iridotomy(LPI).Ciliary body function wickening surgery includes transscleral cyclophotocoagulation(TSCP) and endoscopic cyclophotocoagulation(ECP).Results Among PACG:72.73%(32 eyes/44 eyes) of compound trabeculectomy in 2009;1.26%(3 eyes/239 eyes) in 2019;Phaco-GSL had increased from 4 eyes in 2009 to 224 eyes in 2019,accounting for 93.72%.Among them, femtosecond laser assisted cataract surgery(FLACS) combined with goniosynechialysis were performed in 89 eyes, accounting for 37.24%,combined with premium IOL implantation in 66 eyes, the surgical methods were changed from external drainage surgery(compound trab) to internal drainage surgery(Phaco-GSL).From February 2009 to December 2019,the external drainage of PACG showed a significant decrease trend, and the difference was statistically significant(Z=13.819,P<0.05).Conclusion In the past 10 years, the initial surgical options for PACG have gradually changed from compound trab.to Phaco-GSL.

关 键 词：闭角型青光眼 原发性 白内障超声乳化人工晶体植入联合房角粘连分离术 初始手术术式 

分 类 号：R775.2[医药卫生—眼科]