复合式小梁切除术联合视网膜光凝治疗新生血管性青光眼的临床研究

Clinical study on compound trabeculectomy combined with retinal photocoagulation in treatment of neovascular glaucoma

目的研究复合式小梁切除术联合视网膜光凝治疗新生血管性青光眼(NVG)的临床效果。方法回顾性分析西安市第一医院眼科2013年8月至2018年8月期间收治的60例(62眼)NVG患者的相关资料,根据治疗方式分为复合式小梁切除术组(34眼)和睫状体冷凝术组(28眼)。比较两组患者的手术成功率,虹膜、房角新生血管消退视力及眼压变化情况,并记录术后不良反应发生率。结果复合式小梁切除术组患者的手术成功率为91.18%,明显高于睫状体冷凝术组的71.43%,差异有统计学意义(P<0.05);术后2周,复合式小梁切除术组患者的虹膜及房角新生血管完全消退率为100.00%,明显高于睫状体冷凝术组的85.71%,消退时间为(6.48±2.14)d,明显短于睫状体冷凝术组的(10.39±3.51)d,差异均有统计学意义(P<0.05);复合式小梁切除术组患者术后视力改善率为17.86%,明显高于睫状体冷凝术组的0,差异有统计学意义(P<0.05);复合式小梁切除术组患者术后7 d、1个月、3个月、6个月时的眼压[(16.78±2.64)mmHg、(14.37±2.11)mmHg、(16.19±2.42)mmHg、(18.45±2.41)mmHg]明显低于睫状体冷凝术组[(26.32±2.79)mm Hg、(24.33±2.51)mmHg、(24.97±3.03)mmHg、(27.92±2.96)mmHg],差异均有统计学意义(P<0.05);复合式小梁切除术组患者不良反应发生率为11.76%,明显低于睫状体冷凝术组的32.14%,差异有统计学意义(P<0.05)。结论复合式小梁切除术联合视网膜光凝治疗NVG安全有效,且临床治疗效果优于睫状体光凝术联合视网膜光凝术。

Objective To study clinical curative effect of compound trabeculectomy combined with retinal photocoagulation on neovascular glaucoma(NVG). Methods A retrospective analysis was performed on the related data of60 NVG patients(62 eyes) who were admitted to Department of Ophthalmology, Xi’an First Hospital from August 2013 to August 2018. According to different treatment methods, they were divided into compound trabeculectomy group(34 eyes) and cyclocryotherapy group(28 eyes). The surgical success rate, neovascularization regression of iris and chamber angle, changes in visual acuity, and intraocular pressure were compared between the two groups. The incidence of postoperative adverse reactions was recorded. Results The surgical success rate in compound trabeculectomy group was significantly higher than that in cyclocryotherapy group: 91.18% vs 71.43%, P<0.05. At 2 weeks after surgery, neovascularization complete regression rate of iris and chamber angle in compound trabeculectomy group was significantly higher than that in cyclocryotherapy group(100.00% vs 85.71%, P<0.05). The regression time in compound trabeculectomy group was significantly shorter than that in cyclocryotherapy group:(6.48±2.14) d vs(10.39±3.51) d, P<0.05. The improvement rate of postoperative visual acuity in compound trabeculectomy group was significantly higher than that in cyclocryotherapy group(17.86% vs 0, P<0.05). At 7 d, 1 month, 3 months, and 6 months after surgery, intraocular pressure in compound trabeculectomy group were(16.78±2.64) mmHg,(14.37±2.11) mmHg,(16.19±2.42) mmHg,(18.45±2.41) mmHg, respectively, significantly lower than(26.32 ± 2.79) mmHg,(24.33 ± 2.51) mmHg,(24.97 ± 3.03) mmHg,(27.92±2.96) mm Hg in cyclocryotherapy group(P<0.05). The incidence of adverse reactions in compound trabeculectomy group was significantly lower than that in cyclocryotherapy group(11.76% vs 32.14%, P<0.05). Conclusion Compound trabeculectomy combined with retinal photocoagulation is safe and effective in the treatment of NVG. And the clinic.