虹膜光凝联合小梁切除术治疗新生血管性青光眼

Curative effect of laser coagulation of iris neovascularization combined with complex trabeculectomy for neovascular glaucoma

目的评价虹膜激光光凝联合复合式小梁切除术治疗新生血管性青光眼临床疗效。方法46例（46眼）药物难以控制的新生血管性青光眼随机分为2组（各23眼）。A组行虹膜氪激光光凝联合复式小梁切除术，B组行睫状体冷凝术。术后观察眼压、眼前段反应及并发症等。结果经过6～12个月随访，A组治疗成功16眼，显效4眼，成功率69．57％，总有效率95．65％，术中、术后无严重前房积血；B组治疗成功7眼，显效5眼，成功率30．43％，总有效率69．56％，2眼需要再次手术，2眼眼球萎缩。结论虹膜氪激光联合复合式小梁切除术，避免了新生血管性青光眼滤过术中前房积血等问题，能有效降低眼压，控制病情进展，较睫状体冷凝术治疗成功率高，临床安全性好。

Objective To investigate the effectiveness of laser coagulation of iris neovascularization combined with complex trabeculectomy for neovascular glaucoma, Methods 46 patients （46 eyes） with neovascular glaucoma were randomly divided into 2 groups., patients of group A （n = 23） were performed the laser coagulation of iris neovascularization combined with complex trabeculectomy. Patients of group B （ n = 23） were performed ciliary body cryotherapy. The change of the intraocular pressure （IOP） ,the reaction in the anterior segment of eye and complications were observed after operation. Results In follow-up for 6 - 12 months, IOP of 16 eyes were successfully controlled and 11 eyes were efficiently controlled in group A. The success rate was 69.6% and total efficient rate was 95.7% . Serous hyphema during and after operation could not be found in all eyes in this group. In group B, lOP of 7 eyes were successfully controlled and 5 eyes were efficiently cuntrolled. The success rate was 30.4% and total efficient rate was 69.5%. 2 eyes would have to operate again and 2 eyeballs were atrophied finally. Conclusions Compared with ciliary body cryotherapy, laser coagulation of iris neovascularization combined with complex trabeculectomy reduces effectively the IOP as well as the risk of hyphema and improve the success rate of operation on neovascular glaucoma.