新生血管性青光眼分期综合治疗的效果  

Efficacy of combining treatment based on clinical stage in neovascular glaucoma

作　　者：刘国军[1] 仇宜解[2] 于湛[1] 庞凤[1] 邸霞[1] 金栋[1] 李菊[1] 

机构地区：[1]青岛大学医学院附属海慈医院眼科,266033 [2]四川成都医学院附属康桥眼科医院

出　　处：《眼科》2012年第4期268-272,共5页Ophthalmology in China

摘　　要：目的探讨新生血管性青光眼按不同分期综合治疗的效果。设计回顾性病例系列。研究对象63例(69眼)新生血管性青光眼患者分为虹膜红变组(15例16眼)、开角型青光眼组(20例22眼)和闭角型青光眼组(28例31眼)。方法虹膜红变组行全视网膜光凝术治疗,其中3眼行白内障手术,1眼玻璃体内注射bevacizumab。开角型青光眼组在全视网膜光凝术基础上应用抗青光眼药物,其中8眼行小梁切除术,4眼行白内障手术,2眼白内障联合玻璃体切除,5眼玻璃体内注射bevacizumab。闭角型青光眼组在全视网膜光凝术、抗青光眼药物、小梁切除术或睫状体光凝术基础上,联合玻璃体内注射bevacizumab,其中21眼玻璃体切除联合白内障手术,12眼填充硅油。平均随访(18.6±15.3)个月。主要指标视力、眼压、虹膜红变、前房角及并发症。结果虹膜红变组、开角型青光眼组和闭角型青光眼组治疗后视力不变或提高分别为15眼(93.8%)、17眼(77.3%)和16眼(51.6%)(χ2=9.76,P﹤0.01)。治疗前眼压分别为(14.6±3.8)mmHg、(31.6±9.1)mmHg和(44.8±12.2)mmHg,治疗后眼压为(14.1±3.86)mmHg、(17.9±3.7)mmHg和(18.9±10.8)mmHg(F=185.8,P﹤0.001)。治疗后虹膜红变在虹膜红变组16/16眼消退,开角型青光眼组20/22眼消退及闭角型青光眼组28/31眼消退。治疗后前房角在虹膜红变组16眼仍为宽角,开角型青光眼组18/22眼前房角中的纤维血管膜萎缩,房角开放范围较治疗前扩大,闭角型青光眼组31眼房角中的纤维血管膜不同程度萎缩,但房角开放范围无扩大。三组患者治疗后并发症的发生率分别为6.3%、22.7%和48.4%(χ2=9.75,P﹤0.01)。结论新生血管性青光眼按临床分期差异化综合治疗对虹膜红变期及开角型青光眼期效果较好。Objective To study the efficacy of combining treatment based on clinical stage for neovascular glaucoma （NVG）. Design Retrospective case series. Participants Sixty-nine eyes of 63 cases with NVG were divided into 3 groups： the iris neovasculariza- tion （INV） group （16 eyes of 15 cases）, the NVG with open angle （O-NVG） group （22 eyes of 20 cases） and the NVG with angle closure （C-NVG） group （31 eyes of 28 cases）. Methods In the INV group, panretinal photocoagulation （PRP） were done in all cases, of which 3 eyes underwent cataract surgery and 1 eye received intravitreal bevacizumab. In the O-NVG group, anti-glaucoma drug was used based on PRP. 8 eyes of 22 eyes underwent trabeculectomy, 4 eyes received cataract surgery, 2 eyes combining vitreetomy and 5 eyes re- quired intravitreal bevacizumab. In the C-NVG group, bevacizumab was injected into the vitreous based on PRP, trabeculectomy or cy- clophotocoagulation; in which 21 eyes underwent combining vitrectomy and cataract surgery, 12 eyes received silicone oil tamponade. All cases were followed up for 18.6±15.3 months. Main Outcome Measures Intraocular pressure （IOP）, visual acuity, iris neovascular- ization, anterior chamber angle and complications. Results The number of the eyes with invariability or improvement of visual acuity af- ter treatment in INN, O-NVG and C-NVG group was 15（93.8%）, 17（77.3%） and 16（51.6%） respectively（x2=9.76, P〈0.01）. The IOP be- fore treatment in the three groups was （14.6±3.8） mmHg, （31.6±9.1） mmHg and（44.8±12.2）mmHg , respectively. The IOP after treat- ment was （14.1±3.6）mmHg, （17.9±3.9） mmHg and （18.9±10.8） mmHg respectively（F=185.8, P〈0.001）. Iris neovascularization after treat- ment disappeared in all eyes of the INV group, in 20/22 eyes of the O-NVG group and in 28/31 of the C-NVG group. The anterior chamber angle after treatment was still wide in the INV group. The range of open angle after treatment was larger than before treatment in 1

关 键 词：新生血管性青光眼/治疗 虹膜红变 

分 类 号：R779.6[医药卫生—眼科]