内窥镜睫状体光凝术治疗难治性青光眼后短期视力改变及安全性研究

目的观察内窥镜睫状体光凝术治疗难治性青光眼后短期视力改变及安全性。方法采用随机平行对照方法纳入2015年10月至2017年10月,难治性青光眼患者96例96只眼,按照抽签随机方法分为两组,对照组采用青光眼阀植入术治疗;观察组实施内窥镜睫状体光凝术治疗,每组患者48例48只眼。对比两组患者术前(用药后)及术后2 d、7 d、14 d,术后1、3和6个月眼压变化情况,分析术前(用药后)及术后6个月视力改变情况,并观察两组并发症发生情况。结果两组患者术前眼压比较,差异无统计学意义(P>0.05);观察组术后2d眼压(19.6±4.1) mmHg明显高于对照组(14.4±3.9)mmHg,术后7 d眼压(19.1±3.8) mmHg显著高于对照组(14.9±3.9) mmHg,术后14 d眼压(18.5±3.7) mmHg明显高于对照组(15.2±3.5) mmHg,上述差异具有统计学意义(P<0.05);术后1、2、3个月,观察组眼压较对照组比较差异均无统计学意义(P>0.05)。观察组术后矫正视力(眼数)<0.05者有23只眼,处于0.05～0.08有5只眼,≥0.1者有20只眼;对照组术后矫正视力(眼数)<0.05者有21只眼,处于0.05～0.08有4只眼,≥0.1者有23只眼;两组术后矫正视力频数分布情况比较,差异均无统计学意义(P>0.05);与术前比较,两组患者术后视力均明显改善,差异均有统计学意义(P<0.05)。观察组术后早期高眼压、阀体移位与暴露发生率分别为14.6%、0.0%;对照组分别为33.3%、8.33%,差异具有统计学意义(P<0.05);观察组引流管排斥、脉络膜脱离、切口渗漏、迟发性前房出血、人工晶体移位、角膜内皮失代偿、迟发型脉络膜上腔出血、感染性眼内炎发生率分别为0.0%、0.0%、2.08%、16.7%、2.08%、2.08%、0.0%、0.0%;对照组分别为2.08%、2.08%、0%、2.92%、0.0%、4.17%、4.17%、2.08%,差异均无统计学意义(P>0.05)。结论青光眼阀植入术与内窥镜睫状体光凝术均能有效降低难治性青光眼患者眼压,改善短期视力,但后者并发症少,安全性更高。

Study on Ssafety and Short-term Change of Visual Acuity after Intractable Ciliary Body Photocoagulation for Refractory Glaucoma

Objective To observe the safety and short-term change of visual acuity after endoscopic ciliary body photocoagulation for refractory glaucoma.Methods Totally 96 patients of refractory glaucoma treated from Oct.2015 to Oct.2017 were selected and randomly divided into two groups,each having 48 patients.The patients in the control group were treated with glaucoma valve implantation and those in the observation group endoscopy ciliary body photocoagulation.The changes of intraocular pressure(IOP)(after medication)of the two groups before the operation and 2 d,7 d,14 d,lm,3 m and 6 m after the operation were compared.The difference of visual acuity before and 6 months after the operation were analyzed,and the complications of the two groups were observed.Results There was no significant difference in intraocular pressure between the two groups before the operation(P>0.05).The intraocular pressure(IOP)of the observation group was significantly higher than that of the controf group on Day 2(19.6±4.1)mmHg vs.(14.4±3.9)mmHg],Day 7(19.1±3.8)mmHg vs.(14.9±3.9)mmHg]and Day 14(18.5±3.7)mmHg vs.(15.2±3.5)mmHg]after the operation,and the differences were statistically significant(P<0.05).Nevertheless,there was no significant difference(P>0.05)in intraocular pressure between the observation group and the control group 1,2 and 3 months after the operation.In the observation group,23 eyes had a corrected visual acuity less than 0.05,5 eyes between 0.05 and 0.08,20 eyes above0.1.In the control group,21 eyes had a corrected visual acuity less than 0.05,4 eyes between 0.05 and 0.08,23 eyes above 0.1.There was no significant difference in the frequency distribution of corrected visual acuity between the two groups(P>0.05).The visual acuity of both groups improved significantly after the operation,and the difference was statistically significant(P<0.05).The incidence of high intraocular pressure,body displacement and exposure was 14.6%and 0.0%respectively in the observation group and33.33%and 8.33%in the control group(P<0.05).The incidence of drainage tube rejection,choroidal detachment,incision leakage,delayed anterior chamber hemorrhage,intraocular lens displacement,corneal endothelium decompensation,delayed hair choroidal hemorrhage and infectious endophthalmitis were 0.0%,0.0%,2.08%,16.7%,2.08%,2.08%,0.0%and 0.0%respectively in the observation group and 2.08%,2.08%,0.0%,2.92%,0.0%,4.17%,4.17%,2.08%respectively in the control group,the difference was not statistically significant(P>0.05).Conclusions Both glaucoma valve implantation and endoscopic cyclophotocoagulation can effectively reduce intraocular pressure and improve short-term vision of refractory glaucoma patients,but the latter is safer and has fewer complications.