Ahmed青光眼阀植入联合视网膜光凝或冷凝治疗新生血管性青光眼

Ahmed glaucoma valve implantation combined with retinal photocoagulation or cryocoagulation for the treatment of neovascular glaucoma

目的:探讨Ahmed青光眼阀植入联合视网膜光凝或冷凝术对新生血管性青光眼治疗的临床效果。方法:选取4a来住院的新生血管性青光眼56例58眼,其中视网膜中央静脉阻塞25例25眼,糖尿病性视网膜病变21例23眼,视网膜血管炎5例5眼,颈动脉狭窄4例4眼,视网膜分支静脉阻塞1例1眼,平均年龄50.6岁,均行Ahmed青光眼阀植入联合视网膜光凝或冷凝治疗,其中47眼于手术前后行全视网膜光凝,11眼于手术中联合周边视网膜冷凝术,平均随访18.0±6.2mo,观察手术前后视力和眼压的变化以及术后并发症的情况,结果进行统计学分析。结果:视力:术后43眼有不同程度地提高,15眼无变化,无视力下降者。眼压:随访6mo时眼压由术前49.56±8.25mmHg降至17.86±5.25mmHg,总成功率为85%;随访12mo时,眼压由术前50.25±7.18mmHg降至18.80±6.81mmHg,总成功率为78%;24mo以上随访19眼,眼压由术前51.05±8.10mmHg降至20.12±7.01mmHg,总成功率为74%,手术前后眼压比较差异有非常显著性。并发症主要有前房出血、前房延缓形成、引流管内口堵塞、引流盘纤维包裹,经术后处理均得到了恢复。结论:Ahmed青光眼阀植入联合视网膜光凝或冷凝是治疗新生血管性青光眼安全有效的方法之一。

AIM：To investigate the therapeutic effect of Ahmed glaucoma valve implantation combined with retinal photocoagulation or cryocoagulation for the treatment of neovascular glaucoma.·METHODS：Fifty-six cases（58 eyes） with neovascular glaucoma were involved in this study.In them,25 cases（25 eyes） sufferred from central retinal vein occlusion（CRVO）;21 cases（23 eyes） with diabetic retinopathy;5 cases（5 eyes） with retinal vasculitis;4 cases（4 eyes） with carotid artery stenosis;one eye with branch retinal vein occlusion.All cases underwent Ahmed glaucoma valve implantation combined with retinal photocoagulation or cryocoagulation;47 eyes underwent panretinal photoco-agulation before and after surgery;11 eyes underwent peripheral retinal cryocoagulation during surgery.The mean follow-up time was 18.0±6.2 months.The changes of visual acuity and IOP and complications were observed before and after operation.The results were statistically analyzed.·RESULTS：Visual acuity：The visual acuity of 43 eyes were improved at different degrees after surgery,and 15 eyes had no change.The visual acuities were not worsened in any eyes.IOP：The mean IOP decreased from 49.56±8.25mmHg to 17.86±5.25mmHg 6 months after surgery,and the success rate was 85%;the mean IOP decreased from 50.25±7.18mmHg to 18.80±6.81mmHg 12 months after surgery,and the success rate was 78%;There were 19 eyes which were followed up over 24 months.The mean IOP decreased from 51.05±8.10mmHg to 20.12±7.01mmHg,and the success rate was 74%.There were significant differences in IOP reduction before and after surgery.Its complications included hemorrhage in anterior chamber,delaying the formation of anterior chamber,drainage tube endostoma occlusion,drainage plate coated by fiber.All recovered after treatment.·CONCLUSION：Ahmed glaucoma valve implantation combined with retinal photocoagulation or cryocoagulation seems to be a safe and effective method for the treatment of neovascular glaucoma.