家族性渗出性玻璃体视网膜病变继发性青光眼的临床特点及治疗

Clinical features and treatment of glaucoma secondary to familial exudative vitreoretinopathy

目的观察家族性渗出性玻璃体视网膜病变(FEVR)继发性青光眼的病因、临床特征及治疗方案。方法回顾性临床研究。2016年1月1日至2022年1月1日于首都医科大学附属北京同仁医院眼科检查确诊的FEVR继发性青光眼患者15例17只眼纳入研究。患者均行系统性眼科评估。根据患者年龄、视力、眼压、眼前节、玻璃体及视网膜情况,选择经角膜缘入路晶状体切除联合玻璃体切割、房角分离、睫状体激光光凝、玻璃体腔注射抗血管内皮生长因子(VEGF)药物治疗。手术后随访时间3~37个月。观察患眼临床特征以及手术后眼压、前房深度变化以及并发症发生情况。结果15例患者17只眼中,男性11例13只眼,女性4例4只眼;年龄(6.14±7.37)岁。FEVR分期为2B、3B、4A、4B、5A、5B期分别为1、1、5、6、3、1只眼。患眼眼压(42.74±9.06)mm Hg(1 mm Hg=0.133 kPa)。所有患眼均存在浅前房及房角关闭、虹膜前和(或)后粘连、晶状体混浊、视网膜脱离。存在虹膜新生血管4只眼;玻璃体积血2只眼。行经角膜缘入路晶状体切除联合玻璃体切割及房角分离手术16只眼,其中联合抗VEGF药物治疗8只眼;行睫状体激光光凝联合抗VEGF药物治疗1只眼。末次随访时,眼压恢复正常范围16只眼;前房深度恢复正常16只眼。无明显并发症发生。结论FEVR继发性青光眼最主要病因为前房及房角结构和功能异常,见于FEVR分期中2B期及以上;经角膜缘入路晶状体切除联合玻璃体切割手术能有效控制眼压、恢复前房结构,无严重并发症。

Objective To investigate the etiology,clinical features and treatment of familial exudative vitreoretinopathy(FEVR)secondary glaucoma.Methods A retrospective clinical study.From January 1,2016 to January 1,2022,15 patients(17 eyes)were diagnosed with FEVR secondary glaucoma in Beijing Tongren Hospital,Capital Medical University were included in the study.All patients underwent systematic ophthalmological evaluation.According to the patient's age,visual acuity,intraocular pressure,anterior segment,vitreous body and retina condition,the choice of translimbal lensectomy combined with vitrectomy,goniectomy,cyclophotocoagulation,intravitreal injection of anti-vascular endothelial growth factor(VEGF)treatment were chosen.The follow-up time was 3 to 37 months.The clinical characteristics of the affected eye,and the changes of intraocular pressure,anterior chamber depth and complications after surgery were observed.Results Among the 15 patients,there were 11 males with 13 eyes,and 4 females with 4 eyes.Age was 6.14±7.37 years old.FEVR stages 2B,3B,4A,4B,5A,and 5B were 1,1,5,6,3,and 1 eye,respectively.The intraocular pressure of the affected eye was 42.74±9.06 mm Hg(1 mm Hg=0.133 kPa).All eyes had shallow anterior chamber and angle closure,anterior or posterior iris adhesions,lens opacity,retinal detachment,iris neovascularization in 4 eyes,and vitreous hemorrhage in 2 eyes.Sixteen eyes were treated with translimbal lensectomy combined with vitrectomy and goniotomy,of which 8 eyes were treated with anti-VEGF treatment;1 eye was treated with cyclophotocoagulation combined with anti-VEGF treatment.After operation,the intraocular pressure of 16 eyes returned to normal range,and the depth of anterior chamber of 16 eyes returned to normal,and no obvious complications occurred.Conclusions The main etiology of secondary glaucoma in FEVR is the structural and functional abnormalities of the anterior chamber and angle,which are found in the 2B and above stages of FEVR.The lensectomy and vitrectomy via limbal approach can effectively control the intraocular pressure and restore the anterior chamber,with no serious complications.