睫状体光凝联合超全视网膜光凝术治疗新生血管性青光眼

Transscleral cyclophotocoagulation and extra-panretinal photocoagulation in treatment of neovascular glaucoma

目的观察经巩膜睫状体光凝联合超全视网膜光凝术(extra-panretinal photocoagulation,E-PRP)治疗新生血管性青光眼的临床效果。方法选择29例29眼药物不能控制的新生血管性青光眼患者进行经巩膜睫状体光凝联合E-PRP治疗,所有患者术后随访12个月,观察患者术后眼压、视力及并发症。结果治疗前及治疗后1d、1周、1个月、3个月、6个月及1a的平均眼压分别为(44.38±10.62)mmHg(1kPa=7.5mmHg)、(34.43±9.68)mmHg、(25.31±7.27)mmHg、(22.94±9.74)mmHg、(20.90±11.07)mmHg、(18.30±12.00)mmHg及(18.91±5.27)mmHg,除术后1d与术前差异无统计学意义外,术后其他时间与术前相比差异均有显著统计学意义(均为P<0.01)。治疗后视力下降者4眼,提高者7眼,不变者18眼。并发症主要有眼疼痛14例,葡萄膜炎23例,前房积血2例。结论睫状体光凝联合E-PRP能改善视网膜缺血状态,有效降低眼压,并发症少,为目前治疗新生血管性青光眼安全、有效的治疗方法。

Objective To observe the clinical results of transscleral cyclophotocoagulation（TSCPC）and extra-panretinal photocoagulation（E-PRP）in patients with neovascular glaucoma.Methods Twenty-nine eyes of 29 patients with uncontrolled neovascular glaucoma by medication were treated with TSCPC and E-PRP.All patients were followed up for 12 months.Postoperative intraocular pressure（IOP）,visual acuity,and complications were observed.Results The average IOP were（44.38±10.62）mmHg（1 kPa=7.5 mmHg）,（34.43±9.68）mmHg,（25.31±7.27）mmHg, （22.94±9.74） nunHg, （20.90± 11.07） mmHg, （ 18.30 ±12.00） mmHg, and（ 18.91± 5.27） mmHg, respectively, at preoperation,postoperative 1 day, 1 week, 1 month, 3 months, 6 months and 1 year. No significant difference was found in average IOP between preoperation and at postoperatie 1 day, but significant difference was found between each of the other preoperative times and preoperation（ all P 〈0.01 ）. Visual acuity decreased in 4 eyes, improved in 7 eyes and maintained in 18 eyes. Complications were ophthalmalgia in 14 cases, uveitis in 23 cases and hyphema in 2 cases. Conclusion TSCPC and E-PRP can improve the state of retinal ischemia, reduce IOP effectively and be with few complications. It is a safe, effective treatment for neovascular glaucoma.