泛视网膜光凝联合减压阀治疗新生血管性青光眼

Panretinal photocoagulation combined with Ahmed glaucoma valve implantation for neovascular glaucoma

目的观察泛视网膜光凝联合Ahmed减压阀植入术治疗新生血管性青光眼的临床效果。方法对28例（30眼）新生血管性青光眼先行泛视网膜光凝，5—7d后行Ahmed减压阀植入术。观察手术前后的最佳矫正视力、眼压、虹膜新生血管消退情况及术后并发症。结果治疗后最佳矫正视力提高13眼，无变化12眼，下降5眼；治疗前平均眼压（43．2±5．4）mmHg（1mmHg=0．133kPa），术后1周、1个月及3个月平均眼压为（12．9±4．9）mmHg、（14．8±4．5）mmHg、（16．3±3．9）mmHg（t=16．584、t=17．576、t=14．328，P〈0．05），治疗前后对比差异有统计学意义。术后并发症：前房形成迟缓7眼，前房积血4眼，引流管堵塞2眼，脉络膜脱离2眼。30眼虹膜新生血管全部或部分消退，临床症状缓解。结论采用泛视网膜光凝联合Ahmed减压阀植入术治疗新生血管性青光眼既能降低眼压，又能减少术后并发症及挽救视力，是新生血管性青光眼的一种安全有效的治疗方法。

Objective To evaluate the clinical effect of panretinal photocoagulation combined with Ahmed glaucoma valve implantation for neovascular glaucoma （NVG）. Methods This study was based on 30 eyes of 28 patients with NVG who underwent panretinal photocoagulation combined with Ahmed glaucoma valve implantation. The best corrected visual acuity, the new vessels of iris, intraocular pressure （lOP） and complication were observed preoperatively and postoperatively. Results The best corrected visual acuities were improved in 13 eyes, decline in 5 eyes and no change in 12 eyes. The average lOP was （43.2 ±5.4） mm Hg preoperatively, （ 12.9 ± 4.9） mm Hg at 1 week, （ 14.8 ± 4.5） mm Hg at 1 month, （ 16.3 ± 3.9） mm Hg at 3 months postoperatively （ t = 16. 584, t = 17. 576, t = 14. 328, P 〈 0.05 ）. These differences were statistically significant （ P 〈 0.05 ）. The new vessels of iris in 30 eyes had disappeared completely or partly. The predominant complications were hyphema （4 eyes）, shallow anterior chamber （7 eyes）, drain- age tube blocking （2 eyes）, choroidal detachment （2 eyes）. Conclusion The panretinal photoeoagulation combined with Ahmed glaucoma valve implantation is an ideal operation for NVG, because it can lower lOP, decrease complication and preserve visual function.