摘要
目的 观察视网膜及虹膜光凝联合小梁切除术治疗新生血管性青光眼的效果.方法 对32例（34只眼）新生血管性青光眼先行全视网膜光凝,再行虹膜光凝,用氪-绿激光封闭虹膜表面及房角新生血管,3～5d后行复合式小梁切除术,观察手术前后的最佳矫正视力、眼压、使用抗青光眼药物的数量,虹膜新生血管消退情况及术中术后并发症等.结果 治疗后视力提高14只眼,无变化14只眼,下降6只眼;在用抗青光眼药物的情况下,治疗前眼压平均（42.9±8.9）mmHg,术后1周、1月及3月平均眼压为（13.6±3.4）mmHg,（15.4±3.0）mmHg,及（18.2 4±3.1）mmHg（t值分别为t=17.695.t=18.669,t=14.781,均P〈0.05）治疗前后对比有统计学意义.抗青光眼用药量从治疗前3.1±0.8降至治疗后0.2±0.6（t=15.760.P=0.000〈0.05）治疗前后对比有统计学意义.术后并发症：术后早期前房出血5只眼（14.7%）,经药物治疗均在2周内消失;1只眼术后2月发生睫状环阻滞性青光眼,药物治疗后缓解.结论 采用视网膜及虹膜光凝联合小梁切除术,治疗新生血管性青光眼能有效降低新生血管性青光眼患者眼压及减少术中、术后并发症,为新生血管性青光眼治疗提供了一种经济有效的综合治疗方法.
Objective To determine the outcomes of trabeculectomy combined with panretinal photo-coagulation and direct cauterization of peripheral iris before iridectomy in the management of neovascular glaucoma （NVG）, and to demonstrate the effect of this surgical technique. Methods This study was based on 34 eyes of 32 patients with NVG who underwent primary trabeculectomy with MMC combined with panretinal photocoagulation and direct cauterization of peripheral iris before iridectomy. The patients were evaluated for intraoperative and early postoperative complications such as hyphema and phthisis. The mean IOP and the mean number of antiglaucomatous medications at baseline and at the posttrabeculectomy one week, one month and three months were compared by paired Student t test.Results The visual acuity was improved in 14 eyes, declined in 6 eyes and no changed in 14 eyes. The mean preoperative IOP was 42.9± 8.9 mmHg whereas it was 13.6± 3.4 mmHg, 15.4± 3.0 mm Hg and.l8.2± 3.1 mmHg at the postoperative one week, one month and three months （P〈0.05 ）.The mean preoperative number of antiglaucoma medications was 3.1± 0.8 but it reduced to 0.2± 0.6 at the three months postoperatively.These differences were statistically significant （P〈 0.05）.Hyphema occurred in 5 eyes （14.7%） within the 2 weeks of the surgery, but it was transient; ciliary block glaucoma occurred in 1 eye 2 months postoperative.Conclusions Trabeculectomy combined with panretinal photocoagulation and direct cauterization of peripheral iris decreases the incidence of both intraoperative bleeding, and early postoperative hyphema, and provides reduction of IOP and the number of antiglaucomatous medications in cases with NVG in a 3- month follow-up period.
出处
《中国实用眼科杂志》
CSCD
北大核心
2010年第5期466-469,共4页
Chinese Journal of Practical Ophthalmology
