PDR玻璃体切割术后继发新生血管性青光眼的再次手术分析

Analysis of secondary surgery for neovascular glaucoma after vitrectomy in PDR

目的:探讨增殖性糖尿病视网膜病变(proliferative diabetic retinopathy,PDR)玻璃体切割术后继发新生血管性青光眼(neovascular glaucoma,NVG)的影响因素及再次手术疗效。方法:回顾性分析2009-10/2012-12因PDR玻璃体切割术后继发NVG行再次玻璃体手术联合激光光凝治疗的7例7眼患者临床资料。结果:患者7例首次术前眼压11.21±4.22mmHg。术中激光622～1124点,患者均联合白内障摘除术,5例植入人工晶状体。术后2mo内眼压10.11±3.62mmHg。随访中7例术眼炎症加重,2例玻璃体积血未完全吸收,5例复发玻璃体积血,5例血糖控制欠佳、2例血压控制欠佳。7例均发生NVG。再次手术前眼压41.13±7.76mmHg,术后眼压5例正常,1例睫状体光凝术后正常,1例失访,眼压未控制。结论:首次术中联合行晶状体手术、激光斑不足、术后出血不吸收及再次出血、眼内炎症及全身因素均可能是PDR术后NVG形成危险因素。再次玻璃体手术联合充分视网膜光凝可有效控制PDR术后NVG的眼压。

AIM： To investigate risk factors and efficacy of reoperation for neovascular glaucoma（ NVG） secondary to vitrectomy in proliferative diabetic retinopathy（ PDR）.METHODS： Seven cases（ 7 eyes） from October,2009 to December,2012 were analyzed retrospectively. All the patients had NVG after the primary vitrectomy for PDR and were performed secondary vitrectomy combined with laser photocoagulation.RESULTS： The mean intraocular pressure（ IOP） was（ 11.21±4.22） mmHg before primary surgery. The number of laser spots ranged from 622 to 1124 during the first vitrectomy. Cataract extraction was performed in all 7cases and intraocular lens was implanted in 5 cases. The mean IOP was（ 10.11±3.62） mmHg during 2mo after the primary surgery. During follow- up,all the patients had significantly progressive intraocular inflammation.Vitreous hemorrhage was not absorbed completely in 2cases and recurrent vitreous hemorrhage occurred in the other 5 cases. Five cases had poor glycemic control and the other 2 cases had bad blood pressure control. NVG occurred in all 7cases. The mean IOP was（ 41. 13± 7. 76）mmHg before the secondary surgery. After the secondary surgery,the IOP were under control in 5 cases. For theother 2 cases,the IOP was controlled in one case by transscleral cyclophotocoagulation,another one was lost in follow-up with uncontrolled IOP.CONCLUSION： Primary vitrectomy combined with lens extraction, insufficient laser speckle, unabsorbed and recurrent vitreous hemorrhage,intraocular inflammation and systemic condition may be the risk factors associated with the occurrent of NVG after vitrectomy in PDR.Secondary vitrectomy combined with sufficient retinal photocoagulation is efficiency for NVG after vitrectomy for the PDR.