玻璃体切割联合视网膜睫状体光凝术与内窥镜睫状体光凝术治疗新生血管性青光眼疗效对比  

Comparison of the clinical efficacy of vitrectomy combined with retinal laser and cyclophotocoagulationand endoscopic cyclophotocoagulation in neovascular glaucoma

作　　者：王楠叶[1] 游志鹏[1] 李国栋[1] 宋映[1] WANG Nanye;YOU Zhipeng;LI Guodong;SONG Ying(Department of Ophthalmology,the Second Affiliated Hospital of Nanchang University,Nanchang 330000,Jiangxi Province,China)

机构地区：[1]南昌大学第二附属医院眼科,江西省南昌市330000

出　　处：《眼科新进展》2020年第10期977-980,共4页Recent Advances in Ophthalmology

摘　　要：目的对比抗VEGF治疗联合微创玻璃体切割、视网膜睫状体光凝术与内窥镜睫状体光凝术(ECP)治疗新生血管性青光眼(neovascular glaucoma,NVG)的疗效。方法回顾性分析NVG患者49例49眼,分为玻璃体切割联合视网膜睫状体光凝术组(A组)25例25眼和ECP组(B组)24例24眼。观察两组患者术后眼压、视力、虹膜新生血管、术中及术后并发症。结果两组术后眼压下降,与术前相比差异均有统计学意义(均为P=0.00)。术后2 d、7 d及1个月两组眼压差异均有统计学意义(P=0.00、0.04、0.00),术后3个月、6个月两组眼压相比差异均无统计学意义(P=0.68、0.59)。末次随访两组视力差异无统计学意义(P=0.64),较其术前差异均有统计学意义(P=0.04、0.03)。两组患者术后6个月虹膜新生血管消退情况差异有统计学意义(P=0.00)。A组患者术后并发症主要有前房反应性渗出、前房积血,B组患者术中并发症为前房出血,早期并发症有短期内高眼压、角膜水肿、前房反应性渗出、前房积血。结论玻璃体切割联合视网膜睫状体光凝术与ECP均能降低NVG患者眼压。玻璃体切割联合视网膜睫状体光凝术后早期降低眼压更有效,并发症少。Objective To compare the clinical effects of anti VEGF therapy combined with 23 G vitrectomy,pan-retinal photocoagulation,cyclophotocoagulation and endoscopic cyclophotocoagulation(ECP)in the treatment of neovascular glaucoma(NVG).Methods A total of 49 patients(49 eyes)of NVG were analyzed retrospectively,which were divided into 25 patients 25 eyes in the vitrectomy combined with retinal laser and cyclophotocoagulation group(group A)and 24 patients 24 eyes in the ECP group(group B).The postoperative intraocular pressure(IOP),best corrected visual acuity(BCVA),iris neovascularization,intraoperative and postoperative complications were observed in the two groups.Results The IOP in the two groups were decreased significantly compared with that before operation(P=0.00,0.00).There were statistically significant differences in IOP between the two groups at 2 days,7 days and 1 month after operation(P=0.00,0.04 and 0.00),and no significant difference in IOP at 3 months and 6 months after operation(P=0.68,0.59).There was no significant difference in BCVA between the two groups in the last follow-up(P=0.64),and there were statistically significant differences in BCVA before and after operation in each group(P=0.04,0.03).There was statistically significant between the two groups in the regression of iris neovascularization(P=0.00).Postoperative complications including anterior chamber reactive exudation and hemorrhage occurred in group A.In group B,intraoperative complications were anterior chamber hemorrhage,high IOP at early postoperative stage,corneal edema,anterior chamber reactive exudation,and anterior chamber hemorrhage.Conclusion The vitrectomy combined with retinal laser and cyclophotocoagulation and ECP can reduce IOP in NVG patients.The vitrectomy combined with retinal laser and cyclophotocoagulation is more effective to reduce IOP in the early postoperative stage with less complications.

关 键 词：抗VEGF 微创玻璃体切割术 内窥镜睫状体光凝术 新生血管性青光眼 

分 类 号：R775[医药卫生—眼科]