眼压控制后青光眼患者球后血流动力学改变及揿针疗效观察

Changes of retrobulbar hemodynamics in patients with glaucoma after intraocular pressure control and curative effect of press-needle

目的观察眼压控制后青光眼患者球后血流动力学改变及揿针对其球后血流动力学的影响。方法采用前瞻性、多中心、随机对照临床研究,从各中心选取192例眼压控制后青光眼患者,随机分为揿针组及安慰针组,分别予以揿针、安慰针治疗。比较两组患者治疗前、治疗后2月及4月的眼压、BCVA、眼动脉(OA)、视网膜中央动脉(CRA)以及睫状后短动脉(SPCA)的收缩期峰值流速(PSV)、舒张期峰值流速(EDV)、阻力指数(RI)。结果治疗前两组间眼压、BCVA、OA、CRA、SPCA相关血流动力学指标无差异(P>0.05),治疗后2月及4月,揿针组BCVA与治疗前比较无差异(P>0.05),然而,安慰针组BCVA却明显降低(P<0.05);治疗后2月及4月,揿针组及安慰针组IOP较治疗前无统计学差异(P>0.05);与治疗前比较,治疗后2月及4月揿针组OA、CRA、SPCA的PSV与EDV有所提高(P<0.05),RI均有所下降(P<0.05);然而,治疗后2月,安慰针组RI较治疗前无改善,且治疗4月后仍进一步升高(P<0.05),治疗后2月及4月,安慰针组PSV与EDV有所下降(P<0.05)。结论眼压控制后青光眼患者存在球后血流动力学障碍,揿针改善眼压控制后青光眼患者视力,可能是通过改善球后血流动力学改变引起的。

Objective To observe the changes of retrobulbar hemodynamics in glaucoma patients after intraocular pressure(IOP)control and the effect of press-needle on retrobulbar hemodynamics.Methods A prospective,multicentre,randomised controlled clinical study was conducted on 192 glaucoma patients after IOP control,recruited from each centre,all the patients were randomly divided into the press-needle group and placebo-needle group.The press-needle group was treated with press-needle acupuncture,while the placebo-needle group with placebo-needle acupuncture.Intraocular pressure(IOP),best-corrected visual acuity(BCVA),peak systolic flow velocity(PSV),peak diastolic flow velocity(EDV),and resistance index(RI)of the ophthalmic artery(OA),central retinal artery(CRA),and short posterior ciliary artery(SPCA)were compared between the two groups before,2 months after,and 4 months after treatment.Results There were no statistically significant differences in IOP,BCVA,OA,CRA,and SPCA-related haemodynamic indices between the two groups before treatment(P>0.05).At 2 and 4 months after treatment,the BCVA of the press-needle group was not significantly different from that before treatment(P>0.05),However,BCVA in the placebo group was significantly lower than that before treatment(P<0.05).At 2 and 4 months after treatment,There was no significant difference in IOP between the press-needle group and the placebo-needle group(P>0.05).Compared with the tine of before treatment,PSV and EDV of OA,CRA and SPCA in the press-needle group were increased at 2 and 4 months after treatment(P<0.05),RI decreased at 2 and 4 months after treatment(P<0.05);However,2 months after treatment,RI in the placebo-needle group did not improve compared with that before treatment,and further increased after 4 months of treatment(P<0.05);At 2 and 4 months after treatment,PSV and EDV in the placebo-needle group decreased(P<0.05).Conclusion Glaucoma patients with IOP control have impaired retrobulbar haemodynamics,and the improvement of visual acuity in glaucoma patients with IOP control by press-needle may be caused by the improvement of retrobulbar haemodynamic changes.