联合手术治疗增殖性糖尿病视网膜病变的继发性闭角型新生血管性青光眼的临床效果观察

Clinical efficacy of combined surgery for angle-closure neovascular glaucoma secondary to proliferative diabetic retinopathy

目的观察玻璃体切割手术(pars plana vitrectomy,PPV)、眼内窥镜下睫状体激光光凝(endoscopic cyclophotocoagulation,ECP)联合全视网膜光凝(panretinal photocoagulation,PRP)治疗增殖性糖尿病视网膜病变(proliferative diabetic retinopathy,PDR)的继发性闭角型新生血管性青光眼(neovascular glaucoma,NVG)的临床效果。方法选取临床诊断为PDR的继发性闭角型NVG患者21例(21眼)。完善相关检查后行玻璃体腔抗血管内皮生长因子治疗,待虹膜新生血管萎缩后,行PPV+PRP+ECP联合手术治疗,如果患者合并白内障,可以同时行白内障超声乳化摘除+人工晶体植入术。术后随访至少12个月,观察记录患者治疗后1周、1个月、3个月、6个月、12个月最佳矫正视力(best corrected vision acuity,BCVA)、眼压、抗青光眼药物使用情况,统计眼前节变化情况、手术成功率和并发症发生情况。结果术后12个月时患眼logMARBCVA低于术前(P<0.01)。视力提高9例(占43%),维持术前视力12例(占57%),无视力下降病例。其中有8例随访达18个月,末次随访时视力较术后12个月时维持6例(占75%),视力下降2例(占25%)。术后1周、1个月、3个月、6个月、12个月平均眼压均低于术前,术后1个月、3个月、6个月、12个月平均眼压低于术后1周,差异有统计学意义(P<0.05)。术后1个月、3个月、6个月、12个月抗青光眼药物使用数量少于术前,差异有统计学意义(P<0.05)。随访12个月时完全成功10眼,条件成功7眼,失败4眼,总成功率81%。发生前房炎性渗出3眼,局部治疗后全部吸收。结论PPV+PRP+ECP联合手术治疗PDR的继发性闭角型NVG是安全有效的。

Objective To observe the clinical efficacy of pars plana vitrectomy(PPV)combined with endoscopic cyclophotocoagulation(ECP)and panretinal photocoagulation(PRP)for angle-closure neovascular glaucoma(NVG)secondary to proliferative diabetic retinopathy(PDR).Methods Twenty-one patients(21 eyes)diagnosed with angle-closure NVG secondary to PDR were enrolled in this study.Intravitreal injection of anti-vascular endothelial growth factor(anti-VEGF)was performed after completing the relevant examinations,which led to regression of neovascularizations(NVs)on the iris and in the angle,and all the eyes underwent PPV combined with ECP and PRP,and also combined with phacoemulsification(PHACO),intraocular lens(IOL)implantation,if the patients were complicated with cataract.The duration of follow-up was more than 12 months.The best corrected visual acuity(BCVA),intraocular pressure(IOP),the mean number of IOP-lowering drugs,changes in the anterior segment,surgical success rate,and the occurrence of complications were comparatively observed and recorded at 1 week,1 month,3 months,6 months,and 12 months after surgery.Results Compared with that before surgery,the log MARBCVA of the affected eyes at 12 months after surgery was improved in 9 eyes(43%),stabled in 12 eyes(57%),and decreased in no eyes.Eight patients were followed up for 18 months,6 of them(75%)maintained their visual acuity,while 2 of them(25%)decreased at the last follow-up compared with that at 12 months.The mean IOP at 1 week,1 month,3 months,6 months,and 12 months after surgery was lower than that before surgery,and the mean IOP at 1 month,3 months,6 months,and 12 months was lower than that at 1 week after surgery,suggesting significant differences(P<0.05).The number of IOP-lowering drugs used at 1 month,3 months,6 months,and 12 months after surgery was less than that before surgery,and the difference was statistically significant(P<0.05).At 12-month follow-up,10 eyes were a complete success,7 eyes were a conditional success,while 4 eyes were a failure at 12 months after surgery,and the overall success rate was 81%.Inflammatory exudation of the anterior chamber occurred in 3 eyes,but it was fully absorbed after local treatment.Conclusion PPV combined with ECP and PRP in the treatment of angle-closure NVG secondary to PDR is safe and effective.