伴玻璃体积血的新生血管性青光眼四联手术的效果

The efficacy of quadruplicated operation for the treatment of neovascular glaucoma hemorrhage

目的评价四联手术玻璃体内注射雷珠单抗、Ahmed青光眼引流阀植入、玻璃体切除及视网膜光凝术治疗伴有玻璃体积血的新生血管性青光眼的临床效果。方法30例（30只眼）术后随访12～32个月，平均（20．30±5．40）个月，观察眼压、新生血管、视力及手术并发症情况。结果术前平均眼压为（48．23±8．17）mmHg（1mmHg=0．133kPa），术后1周、3、6、12和24个月平均眼压依次为：（11．33±3．28）、（16．62±3．12）、（16．87±3．08）、（17．10±2．94）和（17．86±2．91）mmHg。与术前相比，术后各时间点眼压均较术前下降，差异具有统计学意义（F=158．004，P=0．000）。术后6、12和24个月手术成功率依次为86．7％、83．3％和67．7％。术后末次随访的最佳矫正视力与术前相比差异无统计学意义（t=0．432，P=0．669）。术后未发现严重并发症。结论四联手术治疗伴玻璃体积血的新生血管性青光眼是安全有效的。

Objective To evaluate the efficacy of quadruplicated surgery--Ahmed glaucoma valve implantation, vitreetomy, panretinal photocoagulation and intravitreal injection of ranibizumab, for the treatment of neovascular glaucoma （NVG） with vitreous hemorrhage. Methods Thirty eyes of 30 patients with NVG were observed and followed up for 12-32 months, average （20. 30 ± 5.40 ） months. The intraocular pressure （IOP）, surgical success rate, visual acuity and complications were observed. Results The mean baseline IOP before surgery was （48.23 ± 8.17 ）mmHg （lmmHg = 0.133kPa）. The mean IOP in 1 week, 3, 6, 12 and 24 months after quadruplicated operation were （ 11.33 ± 3.28） mmHg, （ 16.62 ± 3.12） mmHg, （ 16.87 ± 3.08） mmHg, （ 17.10 ± 2. 94） mmHg and （ 17.86 ± 2.91 ） mmHg respectively. The difference of the mean baseline IOP was statistically significant between preoperatively and each follow- up point after surgery （F = 158. 004, P = 0.000）. The surgical success rates at 6, 12 and 24 months were 86.7%, 83.3% and 67.7%, respectively. The difference in the best corrected visual acuity （BCVA） was not significant between the final visit and the baseline before surgery （ t = 0. 432, P = 0.669）. No serious postoperative complication was observed. Conclusion The quadruplicated operation is efficient for the treatment of NVG with vitreous hemorrhage.