玻璃体腔注射曲安奈德后行复合式小梁切除术治疗新生血管性青光眼

Intravitreal triamcinolone acetonide combined with compound trabeculectomy in treatment of neovascular glaucoma

目的探讨玻璃体腔注射曲安奈德后行复合式小梁切除术对新生血管性青光眼的治疗效果。方法新生血管性青光眼51例（51眼）。随机分为两组，试验组26例，对照组25例。试验组先在局麻下玻璃体腔注射曲安奈德4mg，待虹膜新生血管消退后再行复合式小梁切除术。对照组行常规复合式小梁切除术。术后随访6—24个月，观察玻璃体腔注射曲安奈德后虹膜及前房角新生血管消退时间，注药后眼压、晶状体改变，以及复合式小梁切除术后眼压、前房、视力、滤过泡、前房积血、前房渗出情况。结果玻璃体腔注药后26眼4—10d虹膜新生血管完全消退。复合式小梁切除术后两组眼压、前房、滤过泡差异有统计学意义（P〈0．05）；两组术后视力差异无统计学意义（P〉0．05）。结论玻璃体内注射曲安奈德后再行复合式小梁切除术能有效治疗新生血管性青光眼，可以使虹膜新生血管快速消退或萎缩，降低术后前房积血的发生率、提高手术成功率。

Objective To investigate the therapeutic effect of intravitreal triamcinolone acetonide combined with compound trabculectomy for treatment of neovascular glaucoma. Methods 51 patients （51 eyes） with neovaseular glaucoma in our hospital were treated. The patients were randomly divided into two groups ： experimentmal group 26 eyes, and control group 25 eyes. Patients in experimentmal group was injec- ted with triamcinolone 4 mg in vitreous cavity before the compound trabeeuleetomy operation under the local anesthesia. After new blood vessels of iris regressed, we carried out the combined trabeculectomy operation. The patients of control Group only received the compound trabeculectomy. All patients received follow up from 6 months to 24 months. We observed the phase of new blood vessels in iris and anterior chamber after intravitreal triamcinolone acetonide, intraocular pressure, crystal changes after injection, intraocular pres- sure, shallow anterior chamber, anterior chamber bleeding, the anterior chamber inflammation, filtrating bleb and vision after compound trabeculectomy operation. Results In 26 patients in group A, whose new blood vessels in iris completely regressed in 4 ~ 10 days. The intraocular pressure, anterior chamber and fil- trating blebs had statistical significance between the two groups（P 〈 0.05 ）. There was no statistically signif- icant in vision. （P 〉 0.05）. Conclusion Intravitreal injection of triamcinolone acetonide combined with trabeculectomy surgery can effectively treat neovascular glaucoma, and iris neovascularizations quickly fade or shrink. It can reduce the incidence of postoperative bleeding in the anterior chamber and improve the suc- cess rate of operation effectively.