眼内窥镜下联合手术治疗晚期新生血管性青光眼的疗效

Clinical effect of endoscope-assisted combined operation for late neovascular glaucoma

目的：观察小梁切除术结合眼内窥镜技术下前部玻璃体切割术联合视网膜激光光凝术治疗晚期新生血管性青光眼的疗效。方法：对2012-07/2013-07期间在我院住院的15例15眼伴光感以上视力的新生血管性青光眼患者使用小梁切除术结合眼内窥镜技术下前部玻璃体切割术联合视网膜激光光凝术治疗的临床资料进行回顾性分析。结果：所有患者出院后随访6mo。15例15眼术后1wk眼压12.53±3.73mm Hg（1mm Hg=0.133k Pa）,较术前眼压58.81±5.91mm Hg明显降低,差异有统计学意义（P〈0.05）,术后1mo患者平均眼压18.26±4.31mm Hg,术后3mo患者平均眼压17.06±3.65mm Hg,术后6mo患者平均眼压16.13±3.66mm Hg,患者术后随访各时段的眼压与术前比较,差异具有统计学意义（P〈0.05）。术后视力提高2例2眼（13%）,无变化者11例11眼（73%）,视力下降者2例2眼（13%）。随访中有4例4眼眼压增高,使用1~2种降眼压眼药水及局部按摩眼球使得患者眼压〈21mm Hg。术后眼部疼痛症状明显缓解。15例15眼虹膜及房角新生血管均有不同程度回退。术后随访眼部B超检查未见眼球萎缩、脉络膜及视网膜脱离。结论：小梁切除术结合眼内窥镜技术下前部玻璃体切割术联合视网膜激光光凝术治疗晚期新生血管性青光眼,能有效降低眼压,挽救患者残存视力,解除疼痛,为一种较安全而有效的治疗方法。

AIM：To observe the clinical efficacy of trabeculectomy and endoscope-assisted vitrectomy combined with retinal photocoagulation in management of late neovascular glaucoma. METHODS： Fifteen cases（ 15 eyes） with late neovascular glaucoma with above light perception vision in our hospital between Jul. 2012 to Jul. 2013 were treated with trabeculectomy and endoscope- assisted vitrectomy combined with retinal photocoagulation. The clinical data were retrospectively analyzed.RESULTS： All the patients were followed up for 6mo. A total of 15 cases（ 15 eyes） of mean postoperative intraocular pressure（ IOP）（ 12. 53±3. 73 mmHg）（ 1mmHg= 0. 133 k Pa） at 1 week compared with preoperative IOP（ 58. 81±5. 9mmHg） was decreased obviously（ P〈0. 05）.One month（ 18. 26 ± 4. 31 mmHg）, 3mo（ 17. 06 ±3. 65 mmHg） and 6mo（ 16. 13 ± 3. 66 mmHg） mean postoperative IOP respectively compared with preoperative IOP（ 58. 81 ± 5. 91 mmHg） were significantly difference（ P〈0. 05）. The postoperative visual acuity improved in 2 eyes（ 13%）,had no change in 11 eyes（ 73%） and decreased in 2 eyes（ 13%）. During follow-up period, 4 eyes IOP were higher than 21 mmHg and decreased to the normal range after the drug treatment.The pain of patients was alleviated. The iris neovascularization of all patients eliminated. No eyeball atrophy,retinal or choroidal detachment occurred during follow-up period. CONCLUSION： Trabeculectomy and endoscope-assisted vitrectomy combined with retinal photocoagulation is a safe and effective therapy to reduce IOP,saving the residual vision and relieve suffering of patients with NVG.