改良小梁切除术联合睫状体视网膜冷凝治疗新生血管性青光眼

Clinical effects of improved trabeculectomy combined with ciliary body retinal condensation on neovascular glaucoma

目的观察改良小梁切除术联合睫状体视网膜冷凝治疗新生血管性青光眼的临床疗效。方法 2008年1月至2011年6月我院共收治新生血管性青光眼患者46例(46眼),均采用改良小梁切除术联合睫状体视网膜冷凝治疗,术后随访6～12个月,观察患者术后一般疗效、视力、眼压及并发症等情况。结果 46眼中手术完全成功38眼,条件成功6眼,失败2眼,手术成功率为95.7%。与术前比较,术后1周、1个月、6个月视力均有不同程度提高,差异均有统计学意义(均为P<0.05)。术前眼压(38.9±3.2)mmHg(1kPa=7.5mmHg),术后1周、1个月、6个月眼压分别为(18.2±1.2)mmHg、(17.8±1.6)mmHg、(17.2±1.5)mmHg,与术前比较,差异均有显著统计学意义(均为P<0.01)。术后1周形成功能性滤过泡39眼(84.8%),非功能性滤过泡7眼(15.2%);术后6个月形成功能性滤过泡42眼(91.3%),非功能性滤过泡4眼(8.7%)。术后并发症主要包括前房积血、浅前房、前部葡萄膜炎、玻璃体出血等。结论改良小梁切除术联合睫状体视网膜冷凝治疗新生血管性青光眼能显著控制眼压,改善视力。

Objective To observe the clinical effect of improved trabeculectomy combined with ciliary body retinal condensation on neovascular glaucoma. Methods A total of 46 patients（46 eyes） with neovascular glaucoma from January 2008 to June 2011 were selected in our hospital and were treated with improved trabeculectomy combined with ciliary body retinal condensation. Then they were followed up for 6 months to 12 months and the postoperative common clinical effect, visual acuity, intraocular pressure and comphcations were observed. Results There were 38 cases with complete success, 6 eyes with conditioned success, 2 cases with failure, so the successful rate was 95.7%. Compared with the postoperative visual acuity,visual acuities were significantly improved at different levels at 1 week, 1 month and 6 months （ all P 〈 0.05 ）.Compared with the preoperative intraocular pressure （38.9 ± 3.2 ） mmHg （ 1 kPa = 7.5 mmHg ）, the intraocular pressures at postoperative 1 week, 1 month and 6 months, which were （ 18.2 ± 1.2 ） mmHg, （ 17.8 ± 1.5 ） mmHg, （ 17.2 ± 1.5 ） lmnHg, respectively, were significantly different （ all P 〈 0.01 ）. At postoperative 1 month, functionality filtered bubble appeared in 39 eyes （84.8%） and non-functionality filtered bubble appeared in 7 eyes （ 15.2% ） ;At postoperative 6 months, functionality filtered bubble appeared in 42 eyes （ 91. 3% ） and non-functionality filtered bubble appeared in 4 eyes （ 9 1. 3% ）. The postoperative complications mainly included hyphema, shallow anterior chamber, anterior uveitis and vitreous hemorrhage. Conclusion The improved trabeculectomy combined with ciliary body retinal condensation in the treatment of neovascular glaucoma can effectively control the intraocular pressure and improve the visual acuity.