大节段小梁切除术治疗新生血管性青光眼

Treatment of neovascular glaucoma with large segment trabeculectomy

目的 评价大节段小梁切除术治疗新生血管性青光眼的临床效果。方法 对 2 3例 (2 3眼 )新生血管性青光眼采用大节段小梁切除术 ,术后给予视网膜光凝或虹膜根部新生血管直接光凝。术后随访 6～ 2 4月 ,平均 18月。结果 出院时眼压 :5～ 2 1mmHg者 2 1眼 (91 3 % ) ,小于 5mmHg者 2眼 (8 7% )。全部形成功能型滤过泡 ,2眼视力下降 ,6眼视力提高。随访眼压 :5～ 2 1mmHg者 19眼 (82 6% ) ,其中 5眼须局部滴用降低眼压药物。小于 5mmHg者 1眼 (4 .3 % ) ,3眼眼压升高 (13 .0 % )。术后早期并发症主要有前房积血 (3 9.1% )和浅前房 (4 7.8% ) ,后期主要有滤过区巩膜葡萄肿 (3 0 .4% )。结论 新生血管性青光眼需要手术、激光、药物等综合治疗 ,大节段小梁切除术是疗效较好手术方法。

Objective To evaluate the clinical effects of large segment trabeculectomy for neovascular glaucoma. Methods 23 cases(23 eyes) with neovascular glaucoma underwent the large segment trabeculectomy. Then they were treated with laser photocoagulation on the retina.Indometacin and Atriphos were taken orally after the operation. Following up was 6-24 months, means 18 months. Results After operation, the lOP of 21 eyes(91.3%) were controlled at 5-21 mmHg, the IOP of 2 eyes(8.7%) were less than 5 mmHg. The filtering bleb of all cases were good. The vision of 2 eyes descended, and the vision of 6 eyes ascended. In the period of follow-up, the IOP of 19 cases (82.6%) were 5-21mmHg, and one(4.3%) was less than 5mmHg, the IOP of 3 cases (13. 0%) were rised. Early postoperative complications were hyphema(39. 1%) and shallow anterior chamber(47.8%).Scleral staphyloma(30.4%) was the complication in the end stage. Conclusions The large segment trabeculectomy is effective for neovascular glaucoma.