虹膜氪激光联合小梁切除术治疗新生血管性青光眼临床观察  

Laser treatment of iris neovascularization combined with trabeculectomy for neovascular glau-coma

作　　者：苏兆安[1] 尹金福[1] 吴仁毅[1] 

机构地区：[1]浙江大学医学院附属第二医院眼科中心,杭州310009

出　　处：《中国实用眼科杂志》2006年第3期288-290,共3页Chinese Journal of Practical Ophthalmology

摘　　要：目的评价氪激光虹膜新生血管光凝联合小梁切除术治疗新生血管性青光眼的效果。方法对22例(男15例、女7例)药物难于控制的新生血管性青光眼患者,首先应用氪-绿激光器对虹膜新生血管进行直接覆盖光凝,观察虹膜新生血管闭塞、萎缩后,施行巩膜瓣下小梁切除与虹膜周边切除,术中应用丝裂霉素C(MMC0.4mg/ml)。术后处理同常规小梁切除术。术后观察项目:眼压、结膜滤过泡、眼前段反应等,随访时间6～12个月。结果22例术后第1周眼压(11.42±2.61)mmHg较术前(43.42±6.46)mmHg明显降低(t=15.06,p=0.000):随访时眼压控制良好(18.17±2.04mmHg),其中仅2例接受局部应用β-受体阻滞剂。20例结膜滤过泡弥散隆起,2例较为扁平。术中有1例前房少量出血,不影响手术操作。术后前房无继发性出血发生。结论采用氪-绿激光直接覆盖光凝虹膜新生血管及小梁切除术的“二步”法,即首先利用氪-绿激光器对虹膜新生血管进行激光光凝,待虹膜新生血管闭塞、萎缩后,继之施行巩膜瓣下小梁切除联合MMC治疗新生血管性青光眼,经随访能有效降低眼压,控制病情进展。减少与避免常规滤过性手术中、术后因虹膜新生血管出血而导致的前房出血并发症,提高了新生血管性青光眼手术治疗的成功率。Objectives To evaluate the effectiveness of laser coagulation of iris neovascularization combined with combined trabeculectomy for neovascular glaucoma. Methods In 22 cases （15 male, 7 female） of neovascular glaucoma, Krypton-green laser therapy to iris neovascularization was first conducted followed by routine trabeculectomy. Mitomycin C was applied in all cases. The change of the intraocular pressure （IOP）, filtering bleb as well as the reaction in the anterior segment of the eye was carefully observed after the surgery. The follow-up period was 6-12 months. Results The IOP was （11.42 ± 2.61） mmHg 1 week after the surgery which was significantly （t = 15.06, P = 0.0000） lower than it was before the surgery （43.42 ± 6.46 mmHg ）. At the time of the last visit, the IOP was （18.17 ± 2.04） mmHg. In 2 cases local administration of β-blocker was required to control the IOP. Functional blebs were observed in 20 cases, while in 2 cases the blebs were flat. Mild hyphema occurred only in 1 case during trebeclectomy. In all cases secondary hyphema after the surgery could not be observed. Conclusion Laser coagulation of iris neovascularization combined with trabeculectomy reduces effectively the IOP as well as the risk of hyphema in neovascular glaucoma.

关 键 词：激光 虹膜 小梁切除术 新生血管性青光眼 

分 类 号：R775[医药卫生—眼科] R775.2[医药卫生—临床医学]