Ahmed青光眼阀植入联合玻璃体切割术治疗伴玻璃体积血的新生血管性青光眼

Combined vitrectomy and glaucoma drainage implant placement for neovascular glaucoma cornbined with vitreous hemorrhage

目的探讨Ahmed青光眼阀植入联合玻璃体切割术治疗伴有玻璃体积血的新生血管陛青光眼的效果。方法回顾性分析22例（28只眼）患者因新生血管性青光眼伴有玻璃体积血接受玻璃体切割、Ahmed青光眼阀植入及全视网膜光凝。手术前视力光感～0．2，眼压平均44mmHg（38～63mmHg）（1mmHg=0．133kPa）。平均随访10个月（6～15个月）。结果手术后视力光感～0．3；眼压平均17mmHg（10-33mmHg），显著低于手术前眼压（P〈0．05）。术后6，12，15个月的累积成功率分别为（85．1±3．2）％、（80．0±2．2）％、（65．0±4．1）％。手术后并发症主要包括一过性低眼压（4只眼），引流管堵塞（2只眼），玻璃体内再出血（2只眼），脉络膜上腔出血（1只眼），视网膜脱离（1只眼）。结论玻璃体切割联合Ahmed青光眼阀植入及全视网膜光凝术可能是治疗某些伴有玻璃体积血的新生血管性青光眼的有效方法。

Objective To explore the effects of vitrectomy combined with placement of Ahmed glaucoma drainage implant on neovascular glaucoma combined with vitreous hemorrhage. Methods The medical records of 22 patients （28 eyes） with neovascular glaucoma combined with vitreous hemorrhage were reviewed,all patients who underwent vitrectomy combined with placement of Ahmed glaucoma drainage implant and panretinal photocogulation. The preoperative visual acuity ranged from light perception to 0.2 and mean intraocular pressure 44 mm Hg （38-63mmHg） （lmmHg=0.133kPa）. The mean follow-up 10 months （6- 15months）. Results The postoperative visual acuity ranged from light perception to 0.3 and mean postoperafive intraocular pressure 17ram Hg（10-33mm Hg）whith was significantly lower than preoperative one（P〈0.05）. The cumulative probabilities of success at 6,12,15 months were （85.1 ± 3.2）%, （80.0 ± 2.2） %, （65.0 ± 4.1）% respectively..The main postoperative complications include transient hypotony（4 eyes）, tube blockage （2 eyes）, vitreous hemorrhage （2 eyes）, postoperative suprachoroid-cavity hemorrhage （1 eye）, retinal detathment（1 eye）. Conclusions vitrectomy combined with placement of Ahmed glaucoma drainage implant and panretinal photocogulationmay be effective procedures for some cases of neovascular glaucoma combined with vitreous hemorrhage.