开角型青光眼患者小梁切除术后黄斑中心凹下脉络膜厚度变化及其与视功能关系  

Change of subfoveal choroidal thickness after trabeculectomy in patients with open-angle glaucoma and its relationship with visual function

作　　者：周文娟 谭经果 李俊 曾艳 刘艳琼 周莅斌 ZHOU Wenjuan;TAN Jingguo;LI Jun;ZENG Yan;LIU Yanqiong ZHOU Libin(Department of Ophthalmology,Affiliated Hospital of Panzhihua University,Panzhihua 617000,China)

机构地区：[1]攀枝花学院附属医院眼科,四川攀枝花617000

出　　处：《陕西医学杂志》2024年第5期627-631,共5页Shaanxi Medical Journal

基　　金：四川省卫生健康委员会科技项目(2022JDXM013)。

摘　　要：目的:探讨开角型青光眼患者小梁切除术后黄斑中心凹下脉络膜厚度变化及其与视功能的关系。方法:选取开角型青光眼患者54例,根据患者术后1个月视功能情况分为视功能未减退组(28例)和视功能减退组(26例)。比较患者术前、术后1周及术后1个月黄斑中心凹下脉络膜厚度和最佳矫正视力(BCVA)。采用多因素Logistic回归分析患者术后视功能减退的影响因素。绘制受试者工作特征(ROC)曲线分析手术前后脉络膜厚度差值对患者术后视功能减退的预测价值。构建多元Logistic回归模型,并对模型效能进行验证。采用自举重采样对模型进行内部验证。结果:与术前比较,开角型青光眼患者术后1周和术后1个月黄斑中心凹下脉络膜厚度增加,术后1周BCVA降低(均P<0.05)。年龄>60岁、手术前后眼压差值、前房出血、手术前后脉络膜厚度差值、术后前房明显炎症反应是患者术后视功能减退的独立影响因素(均P<0.05)。手术前后脉络膜厚度差值预测患者术后视功能减退的曲线下面积为0.791(P<0.05)。内部验证前和验证后的参数非常接近,表明预测模型稳定。结论:开角型青光眼患者小梁切除术后黄斑中心凹下脉络膜厚度增加,是患者术后视功能减退的独立影响因素,对术后视功能减退具有一定预测价值。Objective:To investigate the changes of subfoveal choroidal thickness after trabeculectomy and its relationship with visual function in patients with open-angle glaucoma.Methods:Fifty-four patients with open-angle glaucoma were selected and divided into the non-impaired visual function group(28 cases)and the impaired visual function group(26 cases)according to their visual function 1 month after operation.The subfoveal choroidal thickness and the best corrected visual acuity(BCVA)were compared before surgery,1 week and 1 month after surgery.Multivariate Logistic regression was used to analyze the influencing factors of postoperative visual impairment.Receiver operating characteristic(ROC)curve was drawn to analyze the predictive value of choroidal thickness difference before and after surgery in patients with postoperative visual impairment.Multivariate Logistic regression model was constructed,and the effectiveness of the model was verified.Self-lifting sampling was used to validate the model internally.Results:Compared with preoperative results,choroidal thickness increased and BCVA decreased in patients with open-angle glaucoma at 1 week and 1 month after surgery(all P<0.05).Age>60 years old,intraocular pressure difference before and after surgery,anterior chamber hemorrhage,choroid thickness difference before and after surgery,and obvious anterior chamber inflammation were independent influencing factors for postoperative visual impairment(all P<0.05).The difference of choroid thickness before and after surgery predicted the area under the curve of postoperative visual impairment was 0.791(P<0.05).The parameters before and after internal validation were very close,indicating that the prediction model was stable.Conclusion:The increase of subfoveal choroidal thickness after trabeculectomy in patients with open-angle glaucoma is an independent factor of postoperative visual impairment,and has certain predictive value for postoperative visual impairment.

关 键 词：开角型青光眼 小梁切除术 黄斑中心凹下脉络膜厚度 视功能 影响因素 预测价值 

分 类 号：R775[医药卫生—眼科]