摘要
目的 探究Nd∶YAG激光周边虹膜切开对原发性闭角型青光眼(PACG)急性发作期的治疗效果及安全性.方法 前瞻性选取2020年1月至2022年1月在首都医科大学附属北京世纪坛医院接受治疗的PACG急性发作期患者102例作为研究对象,按照随机数字表法将其分为研究组和对照组,每组各51例.对照组予以传统药物进行诊治,研究组接受Nd∶YAG激光周边虹膜切开治疗.记录并比较两组患者的术前,术后1、3、6、12个月眼压变化,术前,术后1、3、6、12个月疼痛视觉模拟评分法(VAS)评分、角膜内皮细胞[平均面积(AVE)、最大面积(MAX)、最小面积(MIN)、细胞密度(CD)、面积变异系数(CV)、面积标准偏差(SD)]变化,治疗后视野、房角情况以及并发症发生情况.结果 研究组患者术后 1、3、6、12 个月的眼压分别为(17.55±2.09)、(17.56±2.04)、(17.89±2.16)、(18.33±2.98)mmHg,均低于对照组[(19.87±1.98)、(20.55±1.78)、(17.89±2.16)、(18.33±2.98)mmHg],差异均有统计学意义(P＜0.05).研究组患者术后 1、3、6、12 个月的 VAS评分分别为(4.03±0.64)、(3.22±0.15)、(2.31±0.14)、(1.99± 0.13)分,均低于对照组[(4.66±0.74)、(3.55±0.12)、(2.98±0.11)、(2.32±0.15)分],差异均有统计学意义(P＜0.05).术后1个月,研究组患者的CD、CV、AVE、SD均高于对照组,MAX、MIN、六角形细胞百分数均低于对照组,差异均有统计学意义(P＜0.05).研究组患者治疗后视野缺损进展、开放角度减小发生率分别为3.92％、7.84％,均低于对照组(17.65％、23.53％),房角增大、开放角度＞5 °发生率分别为90.20％、62.75％,均高于对照组(45.10％、13.73％),差异均有统计学意义(P＜0.05).随访期内,两组患者发生高眼压、眼角膜水肿、眼前房渗出、眼前房出血情况及总并发症发生率比较,差异均无统计学意义(P＞0.05).结论 对于PACG急性发作期的患者,Nd:YAG激光周边虹膜切开治疗较传统药物治疗在眼压控制、疼痛缓解以及视野缺损进展和房角变化等方面具有更显著的效果,且安全性较好,是一种有效且安全的PACG急性发作期治疗手段.
Abstract
Objective To explore the treatment efficacy and safety of neodymium:yttrium-aluminum-garnet(Nd∶YAG)laser periph-eral iridotomy in the acute onset of primary angle closure glaucoma(PACG).Methods A total of 102 PACG patients treated in Beijing Shijitan Hospital,Capital Medical University from January 2020 to January 2022 were prospectively divided into the study group and the control group ac-cording to the random number table method,51 patients in each group.The control group received traditional drug therapy,the study group re-ceived Nd∶YAG laser peripheral irridotomy.Intraocular pressure changes before surgery and at 1,3,6,and 12 months after surgery,pain[visual analogue scale(V AS)]scores before surgery and at 1,3,6,and 12 months after surgery,corneal endothelial cell[average area(AVE),maxi-mum area(MAX),minimum area(MIN),cell density(CD),coefficient variation(CV),standard deviation(SD)]changes at 1 month after sur-gery,posttherapeutic visual field,atrial angle status,and the occurrence of complications were recorded and compared in two groups patients.Results The intraocular pressure of the study group patients at 1,3,6,and 12 months after surgery were(17.55±2.09),(17.56±2.04),(17.89±2.16),and(18.33±2.98)mmHg,respectively,which were lower than those of the control group[(19.87±1.98),(20.55± 1.78),(17.89±2.16),and(18.33±2.98)mmHg],and the differences were statistically significant(P＜0.05).The VAS scores of the study group patients at 1,3,6,and 12 months after surgery were(4.03±0.64),(3.22±0.15),(2.31±0.14),and(1.99±0.13)points,respectively,which were lower than those of the control group[(4.66±0.74),(3.55±0.12),(2.98±0.11),and(2.32±0.15)points],and the differences were statistically significant(P＜0.05).The CD,CV,AVE,and SD of the study group patients at 1 month after surgery were higher than those of the control group,and the percentages of MAX,MIN,and hexagonal cells were lower than those of the control group,and the differences were statistically significant(P＜0.05).The incidence rates of visual field defect progression and open angle reduction in the study group patients after treatment were 3.92％and 7.84％,respectively,which were lower than those in the control group(17.65％and 23.53％),the incidence rates of increased atrial angle and open angle＞5 °were 90.20％and 62.75％,respectively,which were higher than those in the control group(45.10％and 13.73％),and the differences were statistically significant(P＜0.05).During the follow-up period,there was no significant difference in ocular hypertension,corneal edema,atrial exudation,and hemorrhage,and the incidence of total complica-tions(P＞0.05).Conclusion For patients with acute attack of PACG,Nd∶YAG laser peripheral iridotomy is more effective in intraocular pressure control,pain relief,visual field defect progression and atrial angle change,and is better safe,which is an effective and safe treatment for acute attack of PACG.
基金项目
北京市科技计划(Z211100002921049)
维普
万方数据