小梁切除术后青光眼视野改变的研究

Study of the Changes of Glaucoma Visual Field after Trabeculectomy

目的研究小梁切除术(trabecu lectomy)后眼压下降超过50%的青光眼视野的改变.方法选择小梁切除术后眼压下降超过50%的原发性青光眼80例(110眼),其中原发性开角型青光眼32例(50眼),原发性慢性闭角型青光眼48例(60眼).利用改良的HPA国际视野分期法根据术前视野将青光眼分为早、中、晚期后,根据视野指数比较术后1 a两型不同时期青光眼的治疗效果;并进一步"点对点"比较两型三期青光眼术后与术前视野光敏度变化的频数,分析术后视野的易变区域.结果(1)术后1 a两型早、中期青光眼视野各指标好转,均有显著性差异(P<0.05),两型晚期青光眼视野稳定,各指标变化无显著性差异(P>0.05);(2)术后视野光敏度变化的频数在两型青光眼之间无显著性差异(P>0.05);(3)术后视野光敏度有变化(P<0.05)的频数及频率分布区域在早、中、晚期青光眼之间不同.结论小梁切除术后的眼压控制对青光眼预后起着积极的作用,而尽早手术更有利于青光眼视功能的恢复;术后各期青光眼视野改变区域的不同,与视网膜神经纤维层的解剖生理密切相关.

Objective To investigate the changes of visual field pressure decreasing by over 50 percent after trabeculectomy. Methods in the glaucoma cases with the intraocular To select 80 cases with primary glaucoma （110 eyes） of which the intraocular pressure decreased by over 50 percent after trabeculectomy. There were 32 cases （50 eyes） with primary open-angle glaucoma （POAG） and 48 cases （60 eyes） with chronic angleclosure glaucoma （CACG） among them. After classifying the glaucoma cases into early stage, moderate stage and severe stage by visual fields before operation with the Modified Hodapp-Parrish -Anderson Visual Fields Grading System, therapeutic effects of different stage glaucoma were observed in one year after operation according to visual field factors ; and the pre - operative and post - operative changes of light sensitivity of the two - style and three - stage glaucoma cases were compared and the post - operative mutable areas of visual field were analyzed according to the method of ＂dot to dot＂. Results （ 1 ） All indicators of visual fields of both early and moderate stage glaucoma in three examinations in one year after operation are found to improve compared with those before operation with obvious turn to for the better （P 〈 0. 05 ）. Compared with those before operation, there is not significant difference in all indicators inclusive of visual fields of two styles of severe stage glaucoma in three examinations after - operatively （ P 〉 0.05 ） ; （2） There is not significant difterence between two of the change of visual field light sensitivity after operation （P 〉 0. 05 ） ; （3） Compared with styles ot glaucoma that before operation, the increased and decreased spot frequency （P 〈 0. 05） of visual field light sensitivity after operation and distribution area of the spot frequency are different among early stage, moderate stage and severe stage glaucoma. Conclusion To control intraocular pressure after trabeculectomy plays an active role in the prognosis of glaucoma and to cure patients as early as possible can contribute to the recovery of the visual function of glaucoma.. The different mutable area of visual field of all stages of glaucoma after operation correlated closely with the anatomy and physiology of retinal nerve fiber layer.