小梁切除联合视网膜冷凝治疗新生血管青光眼41例疗效分析

A Clinical Comparative Study of the Combined Surgical Treatment of Neovascular Glaucoma

目的:通过疗效比较,分析阐述新生血管性青光眼的治疗难点。方法:随机对照研究。将41例(41眼)新生血管性青光眼随机分为2组:A组(20眼)行手术区域虹膜、房角新生血管光凝及小梁切除联合前视网膜冷凝术;B组(21眼)行睫状体冷凝术联合前视网膜冷凝术。观察1周内眼压及眼内情况,随访1年眼压及并发症情况。结果:术后1周A组眼压明显低于B组,差异有统计学意义(t=7.12,P<0.01);A组疼痛消失明显,差异有统计学意义(χ2=7.15,P<0.01)。术后1年A组眼压90%(18/20)正常,B组49%(10/21)正常,差异有统计学意义(t=2.37,P<0.05)。两组病例中虹膜新生血管均有减退,A组优于B组,差异有统计学意义(χ2=5.53,P<0.05)。结论:手术区域虹膜、房角新生血管光凝及小梁切除联合前视网膜冷凝术疗效更优越。

Objective： There were two difficult aspects in treatment of neovascular glaucoma. They are containment neovascularization by solving retinal hypoxia and reducing aqueous humor flow or finding another filtration channel due to obstruction of anterior chamber angle neovascularization. Two different strategies were employed to compare the two groups to see which group was more advantaged. Methods： By a randomized control trial study, 41 patients （41 eyes） with neovascular glaucoma were randomly divided into two groups. Group A （20 eyes） was treated with iris and chamber angle neovascularization phtocoagulation and trabeculectomy combined with anterior retinal cryotherapy （ARC）, while Group B （20 eyes） received cyclocryosurgery combined with anterior retinal cryotherapy （ARC）. We observed the intraocular pressure （IOP） and conditions in the eye for a week and investigated the follow-up status of intraocular pressure and complication for a year. Results： There was a remarkable difference （t= 7.12, P〈0.01 ） in intraocular pressure. In Group A, it was significantly lower than that in Group B one week after the operation. Ophthalmalgia of group A was significantly relieved, showing significant difference （χ2=7.15, P 〈 0.01 ）. In the year after operation, intraocular pressure of Group A was controlled in the normal range, the effective rate accounting for 90% （18/20）, while in Group B, the rate being 49%（ 10/21 ）. The difference was statistically significant （t=2.73, P〈0.05 ）. Iris neovascularization（INV） of two groups decreased, but Group A was better than Group B. Thus they had statistical differences （χ2=5.53, P〈0.05）. Conclusion： Iris and chamber angle neovascularization phtocoagulation and trabeculectomy combined with anterior retinal cryotherapy （ARC） has more advantages.