原发性开角型青光眼小梁切除术前后视盘出血发生率临床观察.docVIP

原发性开角型青光眼小梁切除术前后视盘出血发生率临床观察 　［摘要］ 目的 研究原发性开角型青光眼(POAG)小梁切除术引起的眼压降低对视盘出血率的影响。方法 行小梁切除术的POAG患者50例50眼，术后1～3个月内到我院眼科进行青光眼检查，对小梁切除术前后视盘出血进行分析。结果 小梁切除术能显著降低POAG患者的眼压：从术前(19.6±4.4)mmHg降低到术后(11.1±4.2)mmHg(P＜0.01），手术后检测到的视盘出血率为(5.5±2.2)%，显著低于手术前的(33.4±7.8)%(P＜0.01）。结论 小梁切除术可使眼压降低，还可显著减少POAG患者视盘出血率。　　　　　　　　　　　 　［关键词］ 小梁切除术；视盘出血；开角型青光眼 Clinical observation of incidence of disc hemorrhages in primary openangle glaucoma before and after trabeculectomy ［Abstract］ Objective To investigate the effects of reduction of intraocular pressure (IOP) by trabeculectomy on the frequency of disc hemorrhages in eyes with primary openangle glaucoma(POAG).Methods 50 eyes of 50 patients with POAG were studied，who underwent trabeculectomy and were followed regularly at 1 to 3month intervals at the Department of Ophthalmology of our Hospital.The detection of disc hemorrhages before and after trabeculectomy was analysed.Results Trabeculectomy significantly reduced IOP (in POAG:19.6±4.4 down to 11.1±4.2mmHg).The final cumulative probability of detecting a disc hemorrhage after surgery in POAG was 5.5±2.2% and was significantly lower than that (33.4±7.8%) before surgery (Plt;0.0001).Conclusion IOP reduction via trabeculectomy significantly decreases the frequency of disc hemorrhages in POAG patients. ［Key words］ trabeculectomy；disc hemorrhage；openangle glaucoma 视盘出血于1889年开始报道，随着研究的深入，发现视盘出血与青光眼引起的视网膜神经纤维层缺损之间有着紧密联系［1］，并且视野改变也与其有关［2］。已有报道视盘出血是青光眼视神经病变的预兆因素［3］，且通过治疗，不仅能使眼压降低，还可以降低青光眼视野恶化的风险［4］。本文拟观察原发性开角型青光眼(primary openangle glaucoma，POAG)小梁切除手术前后的视盘出血发生率，以及术后视盘出血率的变化是否与手术引起的眼压降低有关。 1 资料与方法 1.1 一般资料 选择我院1997～2000年期间行小梁切除术的POAG患者100例122眼，病例纳入的标准为:(1)至少6个月的术前随访期；(2)至少12个月的术后随访期；（3）使用Humphrey视野仪获得术前和术后可靠的视野检查结果(lt;20%不正常缺失和lt;33%的假阳性或假阴性结果)；（4）手术期间异常青光眼单侧视野检查结果平均偏差≥-20db；（5）其裸眼视力或矫正视力在0.8以上（最好的矫正视力超过或等于20/40）［5］。 1.2 POAG的诊断标准 POAG的诊断根据以下标准：（1）术前用Goldmann压平眼压计测量眼压，包括在没有任何青光眼治疗时双眼的24h眼压峰值至少有1眼≥22mmHg；（2）双眼用前房角镜证明正常开角；（3）至少有1眼证明有符合青光眼视盘改变的典型视野缺损存在；（4）神经放射检查，鼻检查和其他医疗检查显示没有其他原因引起的视神经损害