23G玻璃体切割术联合全视网膜光凝和二期Ahmed引流阀植入治疗新生血管性青光眼疗效探讨  

The outcome of 23 Gauge vitrectomy combined with pan retina photocoagulation followed by Ahmed glaucoma valve implantation in neovascular glaucoma

作　　者：吴敏[1] 薛黎萍[1] 和丹[1] 胡竹林[1] 肖丽波[1] 

机构地区：[1]云南省第二人民医院眼科 昆明医科大学第四附属医院眼科,650021

出　　处：《中国实用眼科杂志》2015年第11期1284-1287,共4页Chinese Journal of Practical Ophthalmology

基　　金：基金项目：云南省教育厅科学研究基金项目（2011C079）;云南省卫生科技计划项目（2012WS0109）;云南省高层次卫生技术人才培养专项经费资助

摘　　要：目的探讨23G微创玻璃体切割术联合全视网膜光凝及二期Ahmed引流阀植入术治疗新生血管性青光眼的效果和安全性。方法对2010年1月至2013年1月在昆明医科大学附属四院眼科收治的有玻璃体积血的Ⅲ期NVG21例（21只眼），接受23G微创玻璃体切割手术联合全视网膜光凝，术后10～15天接受二期Ahmed引流阀植入术。术后随访（8．1±1．1）个月，随访内容包括最佳矫正视力、眼压、裂隙灯显微镜、间接眼底镜检查、B超和并发症发生情况。结果手术成功率为80．9％（17／21），部分成功19．0％（4／21）；末次随访患者BCVA较术前显著提高；玻璃体切割术后眼压明显下降，虹膜新生血管大部分消退，AGV植入术后1个月新生血管完全消退，平均眼压显著降低差异有统计学意义（t=25．141，P〈0．01），之后眼压保持稳定。除术后前房积血和葡萄膜反应外，未观察到严重的并发症发生。结论对于有玻璃体积血的Ⅲ期NVG患者，选择23G微创玻璃体切割手术联合PRP和二期AGV植入治疗，是安全有效的．可以在较短的时间内获得良好的原发病和眼压摔制。Objective To explore the effectiveness and safety of 23 Gauge vltrectomy combined with pan retina photocoagulation followed by Ahmed galucoma valve （AGV） implantation in neovas- cular glaucoma. Methods Twenty-one cases of stage Ⅲ neovascular glaucoma with vitreous hemor- rhage were treated by 23 Gauge vitrectomy combined with pan retina photocoagulation from January 2010 to January 2013. AGV implantation was performed 10-15 days after vitrectomy. All cases were followed up for （8.1±1.1） months. The BCVA, IOP, slit lamp microscope, indirect ophthalmoscope, ul- trasound B scan and complications were monitored. Results The surgical success rate was 80.9% and partially success was achieved in 19.0% of cases. BCVA at last visit was significantly improved compared with pre-operative BCVA. IOP after vitrectomy decreased significantly, and the new ves- sels on iris were faded gradually. After AGV implantation, IOP in all cases was under good control. IOP at 1 month after AGV implantation was significantly lower than IOP at 1 week （t=25.141, P〈 0.0001） and new vessels vanished completely. After that, IOP was kept stably. Except hyphema and uveitic responses, no severe post-operative complication was observed. Conclusions For stage Ⅲ neovascular glaucoma with vitreous hemorrhage, 23 Gauge vitrcctomy combined with pan retina pho- tocoagulation followed by Ahmed glaucoma valve implantation is safe and effective, and good con- trol of primary diseases and IOP can be achieved in relatively short time.

关 键 词：新生血管性青光眼 23G微创玻璃体切割 Ahmed引流阀 

分 类 号：R775.06[医药卫生—眼科]