原发性开角型青光眼临床观察分析

Clinical Observation on and Analysis of Primary Open Angle Glaucoma

目的通过对228例经临床确诊,及111例5年以上长期随访病例,观察分析原发性开角型青光眼的诊断与治疗,进一步明确原发性开角青光眼的诊断依据与治疗效果。方法回顾性分析2004年8月—2012年1月经我科门诊确诊的228例原发性开角型青光眼。根据患者的眼压情况,眼底照相所见,及视野改变,参考HRT、OCT等检查结果,将之分为高眼压型及低眼压型两组进行观察分析,并对其中111例随访5年以上病例的治疗方法和效果,进行分析讨论。结果 228例中,高眼压型者126例,占55.3%,低眼压型者102例,占44.7%;药物治疗随访5年以上者111例,其中高眼压组72例,平均眼压下降33.55%,低眼压组39例,平均眼压下降13.93%。所有病例眼压均可控制在各自的目标眼压水平范围,眼底及视野损害无进一步发展。病情得到稳定控制;另有15例药物未能控制眼压者行滤过性手术,其中11例成功,4例失败最终失明。结论 (1)原发性开角型青光眼早期诊断相当困难,尤其低眼压型者,主要根据眼底照相,观察视网膜神经纤维层缺损、视杯凹陷、盘沿面积等的改变。(2)视野检查出现青光眼性损害,是POAG诊断的金标准。HRT、OCT仅作为参考。(3)目标眼压设定:早期患者为18 mmHg以下,或比基线眼压下降30%以上;晚期患者眼压应降至12 mmHg以下,介于早期与晚期之间的进展期患者,眼压应控制在15 mmHg左右。

Objective Through the clinical diagnosis of 228 cases and more than 5 years long term follow up of 111 cases to observe and analysis the diagnosis and treatment of primary open glaucoma（POAG）. In order to advance clear cut on the basis of diagnosis and the effect of therapy. Methods Retrospective analysis of 228 cases of POAG from August 2004 to January 2012 in outpatient of eye. According to the diurnal intra ocular pressure, fundus apparent, field changes and the results of HRT, OCT examination etc. To divided into high pressure type and low pressure type two groups for observe and analysis. In regard to the 111 cases which had been follow up for more than five years to analysis and discuss the therapeutic methods and effects. Results In 228 cases that the high pressure type are 126 cases was about 55.3% in the total, the low pressure type are 102 cases its about 44.7% from the total. In 111 cases of medical treatment which have follow up for 5 years that there were 72 cases of high pressure the average IOP is drop 33.55% from the basal line. And there were 39 cases of low IOP that the average IOP is drop to 13.93% from the basal line. The IOP of all cases were controlled to the target pressure scale respectively and no further loss of fundus and field defect. There were 15 cases which do not controlled by medicine had made infiltrating operation. In which group 11 cases success and 4 cases were failure and got blind at last. Conclusion（1） It is so difficult to the diagnosis of early POAG especially in the low IOP type. Mainly according to the fundus photograph to observe the retinal nerve fiber layer defect the cup disc ratio and the area of rim of disc.（2） The field appear of glaucomatous defect is the golden standard for diagnosis, HRT, OCT are for reference only.（3） To set up objective IOP In early stage is below 18 mmHg or lower the pressure 30% from the baseline IOP. In late stage the IOP is set at 12 mmHg or lower. The IOP is control at about 15 mmHg in patient between the early stage to late stage.