三种睫状体破坏性手术降眼压的临床效果比较

Comparison of clinical efficacy among three kinds of ciliary body destructive surgery on intraocular pressure reduction

目的比较不同睫状体破坏性手术治疗难治性青光眼的临床效果。方法收集2018年1月至2020年4月安徽医科大学第二附属医院的近绝对期和绝对期难治性青光眼105例(106只眼),对病历资料进行回顾性分析。按治疗方式将患者分为3组,其中实施超声睫状体成形术(UCP)54例(55只眼)为UCP组,经巩膜睫状体光凝术31例(31只眼)为光凝组,睫状体冷冻术20例(20只眼)为冷冻组。术后随访3个月,三组进行效果比较。结果 UCP组术后1 d、1周、1及3个月平均眼压分别为:(28.69±10.08)mmHg、(22.45±7.33)mmHg、(20.34±5.03)mmHg及(19.31±4.67)mmHg(1 mmHg=0.133 kPa);光凝组为:(27.63±9.05)mmHg、(23.76±8.92)mmHg、(20.81±5.02)及(19.97±4.90)mmHg;冷冻组为:(22.60±7.30)mmHg、(21.30±8.03)mmHg、(22.20±7.05)及(22.85±6.39)mmHg;3组术后每个随访时间点眼压均较术前明显下降(P<0.05),而3组间各时间点的眼压值比较差异无统计学意义(P>0.05)。3组术后各随访时间点的疼痛等级评分均较术前降低(P<0.05);3组间术后疼痛等级评分差异具有统计学意义(P<0.05)。术后出现并发症者UCP组26只眼(47.27%),光凝组22只眼(70.97%),冷冻组17只眼(85.00%)。术后3个月UCP组视力提高者4只眼,光凝组及冷冻组无视力提高者。结论三种方法均可以达到降低眼压、减轻眼部疼痛的效果;在术后的早期,UCP对眼痛的缓解效果最明显,且并发症最少。

Objective To compare the clinical efficacy of different ciliary body destructive surgeries in the treatment of refractory glaucoma.Methods The clinical data of 106 eyes of 105 cases with refractory glaucoma in the Second Affiliated Hospital of Anhui Medical University from Jan.2018 to Apr.2020 were collected and analyzed retrospectively.They were divided into three groups based on treatment methods.Fifty-five eyes of 54 cases were treated with ultrasound ciliary plasty(UCP)in UCP group,31 eyes of 31 cases were treated with transscleral ciliary body photocoagulation in photocoagulation group,and 20 eyes of 20 cases were treated with ciliary body cryotherapy in cryotherapy group.The follow-up time was 3 months.The efficacy among three groups were compared.Results The mean intraocular pressure at 1 day,1 week,1 month and 3 months after operation in UCP group were(28.69±10.08)mmHg,(22.45±7.33)mmHg,(20.34±5.03)mmHg and(19.31±4.67)mmHg(1 mmHg=0.133 kPa);in photocoagulation group that were(27.63±9.05)mmHg,(23.76±8.92)mmHg,(20.81±5.02)mmHg and(19.97±4.90)mmHg;in cryotherapy group that were(22.60±7.30)mmHg,(21.30±8.03)mmHg,(22.20±7.05)mmHg and(22.85±6.39)mmHg.The intraocular pressure at each follow-up time in the three groups was significantly lower than that before operation(P<0.05),while there was no statistical difference in IOP among the three groups at each time point(P>0.05).The postoperative pain grade score of each follow-up time in the three groups was lower than that before operation(P<0.05),and there was significant difference in postoperative pain grade among the three groups(P<0.05).Postoperative complication occurred in 26 eyes(47.27%)in UCP group,22 eyes(70.97%)in photocoagulation group,and 17 eyes(85.00%)in cryotherapy group.Three months after operation,the visual acuity of 4 eyes increased in the UCP group,while no improvement in the photocoagulation group and cryotherapy group.Conclusion All the three methods can achieve the efficacy of lowering intraocular pressure and reduce ocular pain.In the early stage after operation,ultrasound UCP has the most obvious relieving efficacy on eye pain and the least incidence of complications.