原发性开角型青光眼治疗后24h眼压波动的临床观察

目的 比较降眼压药物治疗或小梁切除术治疗后原发性开角型青光眼患者的24h眼压波动差异.方法 取自2006年4月至2008年9月住院或门诊确诊为原发性开角型青光眼(POAG)47例(70只眼),随机分成手术组24例(34只眼)采用复合式小梁切除术;药物组23例(36只眼).设健康志愿者为正常对照组.所有病例治疗前、后均行24h眼压测量,使用Goldmann压平眼压计,对各组的平均眼压、眼压峰值、眼压波动进行比较分析.结果 药物组眼压控制成功率76.5%(26/34)与手术组眼压控制成功率90.6%(29/32)比较差异无统计学意义(X2=2.378,P=0.123);治疗前两组患者的平均眼压、眼压峰值、眼压波动比较差异均无统计学意义(t=0.659,P=0.512;t=0.274,P=0.785;t=1.373,P=0.174);治疗后药物组与手术组患者的平均眼压、眼压峰值比较差异均有统计学意义(t=2.11,P=0.038;t=-2.397,P=0.019).两组的眼压波动比较有显著统计学意义(t=2.792,P=0.007);在眼压控制成功的药物组和手术组与正常对照组两两比较,两组的平均眼压、眼压波动差异均有统计学意义(P＜0.05);两组的眼压峰值差异有显著统计学意义(P＜0.01);且手术组眼压波动、眼压峰值均低于正常对照组(P＜0.01).结论 小梁切除术治疗开角型青光眼能获得较低的24h眼压波动.在控制平均眼压、眼压峰值及眼压波动方面要优于药物治疗.且波动幅度与眼压峰值均小于正常对照组.

Research on 24-hour IOP Fluctuation of Primary Open Angle Glaucoma

Objective To investigate the difference of 24-hour IOP fluctuation of primary open angle glaucoma patient treated with anti-glaucoma medicine or trabeculectomy.Methods Forty-seven cases(70 eyes),whichthe final diagnosis was primary open angle glaucoma(POAG)between April 2006 and September 2008,were randomly divided into surgical group:24 cases(34eyes)use combination trabeculectomy and medical group:23 cases(36 eyes)use anti-glaucoma medicine.Set the healthy volunteers as normal control.24-hour tonometry of all cases was carried out with Goldmann applanation tonometer before and after the treatment.Comparison and analysis of the average IOP,the peak of IOP and the IOP fluctuation were undertaken between these three groups.Results The success rate of IOP control was 76.5%(26/34)in medical group,and that was 90.6%(29/32)in surgical group.There was no statistically significant in the success rate of IOP control between the medical group and the surgical group(X2=2.378,P=0.123).There was no statistically significant in the average IOP,the peak of IOP and the IOP fluctuation between the medical group andthe surgical group before treatment(t=0.659,P=0.512;t=0.274,P=0.785;t=1.373,P=0.174),and the average IOP and the peak of IOP after treatment in surgical group were statistically significant compared with the medical group(t=2.11,P=0.038;t=2.397,P=0.019).The IOP fluctuation had statistically significant between these two groups(t=2.792,P=0.007),the trabeculectomy treatment can get lower average IOP,and the 24-hour IOP fluctuation was more stable.Among the success cases in IOP control.the average IOP and the IOP fluctuation were statistically significant in medical group and surgical group(P＜0.05).The peak of IOP had statistically significant between these two groups(P＜0.01).And the IOP fluctuation,the peak of IOP in surgical group were all lower than the normal control(P＜0.01).Conclusions Treat POAG with trabeculectomy can get lower 24-hour IOP fluctuation.Compared with the medicine treatment.trabeculectomy was superior in control of the average IOP,the peak of IOP and the IOP fluctuation.And also the amplitude of IOP fluctuation,the peak of IOP is all lower than the normal control.