睫状体光凝与视网膜消融术治疗新生血管性青光眼

Treatment of neovascular glaucoma by cyclophotocoagulation and retinal ablation

目的观察半导体激光经巩膜睫状体光凝联合视网膜消融术(全视网膜光凝或前部视网膜冷凝)治疗新生血管性青光眼的临床效果。方法12例12眼药物不能控制的新生血管性青光眼接受治疗。8眼睫状体光凝和全视网膜光凝,4眼同时行睫状体光凝和前部视网膜冷凝。术后随访6～19月,对比分析6月时的眼压、视力及虹膜新生血管改变。结果睫状体光凝前眼压36～67mmHg(1mmHg=0.133kPa),平均45.52mmHg。末次治疗后6月,在不用抗青光眼药物的情况下,6眼(50%)眼压在9～17mmHg;局部滴用0.5%噻吗心胺滴眼液后4眼(33.33%)眼压低于21mmHg,2眼(16.67%)眼压高于21mmHg。视力下降者2眼,提高者2眼,不变者8眼。虹膜新生血管完全消失8眼,部分消失4眼。结论半导体激光经巩膜睫状体光凝联合视网膜消融术治疗新生血管性青光眼,既能及时降低眼压,又能减少视网膜缺血,拯救现有或潜在视力。

Objective To observe the clinical results of transscleral diode laser cyclophotocoagulation and retinal ablation(panretinal photocoagulation or anterior retinal cryotherapy)for neovascular glaucoma.Methods 12 cases(12 eyes)of uncontrolled neovascular glaucoma were treated.8 eyes were treated by transscleral diode laser cyclophotocoagulation and panretinal photocoagulation,4 eyes were treated by transscleral diode laser cyclophotocoagulation and anterior retinal cryotherapy.All patients were followed up for a minimum of 6 months(6～19 months).The intraocular pressure(IOP),visual acuity and neovascularization of the iris after 6 months of treatment were analyzed.Results Pre-cyclophotocoagulation IOP was 36mmHg～67mmHg(1mmHg=0.133kPa),averaged 45.52mmHg.6 months after treatment,6 eyes(50%)had IOP of 9～17mmHg without glaucoma medications,IOP were controlled lower than 21mmHg in 4 eyes(33.33%)and was higher than 21mmHg in 2 eyes with timolol eye drops.Iris neovascularization disappeared in 8 eyes and regressed partly in 4 eyes.Visual acuity decreased in 2 eyes,increased in 2 eyes and remained unchanged in 8 eyes.Conclusions The treatment of neovascular glaucoma by cyclophotocoagulation and retinal ablation can reduce IOP timely as well as reduce retinal ischemia,so effectively rescue the existing and potential visual acuity.