眼內(nèi)窺鏡下聯(lián)合手術(shù)治療晚期新生血管性青光眼的療效

鐘沐睿，江 林，李明德，劉聰慧，劉少山

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·臨床報告·

眼內(nèi)窺鏡下聯(lián)合手術(shù)治療晚期新生血管性青光眼的療效

鐘沐睿，江 林，李明德，劉聰慧，劉少山

?METHODS: Fifteen cases (15 eyes) with late neovascular glaucoma with above light perception vision in our hospital between Jul.2012 to Jul.2013 were treated with trabeculectomy and endoscope-assisted vitrectomy combined with retinal photocoagulation. The clinical data were retrospectively analyzed.

?RESULTS: All the patients were followed up for 6mo. A total of 15 cases (15 eyes) of mean postoperative intraocular pressure (IOP) (12.53±3.73mmHg) (1mmHg=0.133kPa) at 1 week compared with preoperative IOP (58.81±5.9mmHg) was decreased obviously (P<0.05). One month (18.26±4.31mmHg), 3mo (17.06±3.65mmHg) and 6mo (16.13±3.66mmHg) mean postoperative IOP respectively compared with preoperative IOP (58.81±5.91mmHg) were significantly difference (P<0.05). The postoperative visual acuity improved in 2 eyes (13%), had no change in 11 eyes (73%) and decreased in 2 eyes (13%). During follow-up period, 4 eyes IOP were higher than 21mmHg and decreased to the normal range after the drug treatment. The pain of patients was alleviated. The iris neovascularization of all patients eliminated. No eyeball atrophy, retinal or choroidal detachment occurred during follow-up period.

?CONCLUSION: Trabeculectomy and endoscope-assisted vitrectomy combined with retinal photocoagulation is a safe and effective therapy to reduce IOP, saving the residual vision and relieve suffering of patients with NVG.

目的：觀察小梁切除術(shù)結(jié)合眼內(nèi)窺鏡技術(shù)下前部玻璃體切割術(shù)聯(lián)合視網(wǎng)膜激光光凝術(shù)治療晚期新生血管性青光眼的療效。

方法：對2012-07/2013-07期間在我院住院的15例15眼伴光感以上視力的新生血管性青光眼患者使用小梁切除術(shù)結(jié)合眼內(nèi)窺鏡技術(shù)下前部玻璃體切割術(shù)聯(lián)合視網(wǎng)膜激光光凝術(shù)治療的臨床資料進行回顧性分析。

結(jié)果：所有患者出院后隨訪6mo。15例15眼術(shù)后1wk眼壓12.53±3.73mmHg (1mmHg=0.133kPa)， 較術(shù)前眼壓58.81±5.91mmHg明顯降低，差異有統(tǒng)計學(xué)意義(P<0.05)，術(shù)后1mo患者平均眼壓18.26±4.31mmHg，術(shù)后3mo患者平均眼壓17.06±3.65mmHg，術(shù)后6mo患者平均眼壓16.13±3.66mmHg，患者術(shù)后隨訪各時段的眼壓與術(shù)前比較，差異具有統(tǒng)計學(xué)意義(P<0.05)。術(shù)后視力提高2例2眼(13%)，無變化者11例11眼(73%)，視力下降者2例2眼(13%)。隨訪中有4例4眼眼壓增高，使用1～2種降眼壓眼藥水及局部按摩眼球使得患者眼壓<21mmHg。術(shù)后眼部疼痛癥狀明顯緩解。15例15眼虹膜及房角新生血管均有不同程度回退。術(shù)后隨訪眼部B超檢查未見眼球萎縮、脈絡(luò)膜及視網(wǎng)膜脫離。

結(jié)論：小梁切除術(shù)結(jié)合眼內(nèi)窺鏡技術(shù)下前部玻璃體切割術(shù)聯(lián)合視網(wǎng)膜激光光凝術(shù)治療晚期新生血管性青光眼，能有效降低眼壓，挽救患者殘存視力，解除疼痛，為一種較安全而有效的治療方法。

新生血管青光眼；內(nèi)窺鏡；小梁切除術(shù)；前段玻璃體切除手術(shù)；視網(wǎng)膜激光光凝

引用：鐘沐睿，江林，李明德，等.眼內(nèi)窺鏡下聯(lián)合手術(shù)治療晚期新生血管性青光眼的療效.國際眼科雜志2016;16(12):2323-2325

0引言

新生血管性青光眼(neovascular glaucoma，NVG)是一組繼發(fā)于各種眼部疾病及全身血管疾病的青光眼，以虹膜及房角新生血管為其主要臨床表現(xiàn)[1]。NVG常常由于頑固性高眼壓引起患者眼脹、頭痛、惡心、嘔吐，嚴(yán)重影響患者生活質(zhì)量。晚期NVG患者由于各種原因，比如屈光介質(zhì)混濁、瞳孔固定等喪失了常規(guī)進行視網(wǎng)膜激光光凝的機會，其治療一直是眼科臨床醫(yī)生面臨的一個棘手問題。……