糖尿病性新生血管性青光眼综合治疗的效果观察  

Observation on the efficacy of comprehensive treatment for diabetic neovascular glaucoma

作　　者：李艳丽[1] 李珂[1] 刘艳艳[1] Li Yanli;Li Ke;Liu Yanyan(Department of Ophthalmology,Anyang Regional Hospital of Puyang,Henan 455000,China)

机构地区：[1]濮阳市安阳地区医院眼科,河南455000

出　　处：《中华眼外伤职业眼病杂志》2021年第11期867-870,共4页Chinese Journal of Ocular Trauma and Occupational Eye Disease

摘　　要：目的观察糖尿病性新生血管性青光眼的综合治疗效果。方法回顾性病例研究。收集濮阳市安阳地区医院2015年6月至2019年12月糖尿病性新生血管性青光眼40例(40眼)的临床资料。所有患者先行玻璃体内注射雷珠单抗,待虹膜新生血管消退后行Ahmed青光眼引流阀植入联合23 G玻璃体切除术。术后随访12个月,观察眼压及并发症等。结果术后1周、1、6及12个月的眼压依次为(18.1±7.6)mmHg、(13.8±4.1)mmHg、(12.4±3.8)mmHg、(15.8±4.3)mmHg,均低于术前的(43.4±5.3)mmHg;(1 mmHg=0.133 kPa)(F=8.31,P<0.05)。手术完全成功率为80.0%(32/40),条件成功率90.0%(36/40)。32眼手术后眼压在正常范围,4眼需要加用降眼压药物控制。有2眼浅前房,以散瞳、高渗剂及糖皮质激素治疗后好转;引流管阻塞1眼,经引流管冲洗后恢复;前房积血1眼,用药后吸收;玻璃体积血2眼,经玻璃体灌洗及激光光凝后恢复。结论玻璃体内注射雷珠单抗后植入Ahmed青光眼引流阀联合玻璃体切除术是治疗糖尿病性新生血管性青光眼的较有效的方法。Objective To observe the efficacy of the comprehensive treatment for diabetic neovascular glaucoma.Methods This was a retrospective case study.The clinical data of 40 eyes of 40 patients with diabetic neovascular glaucoma from Jun.2015 to Dec.2019 in the Anyang Regional Hospital of Puyang were retrospectively analyzed.All patients received intravitreal injection of ranibizumab firstly,then received Ahmed glaucoma valve implantation combined with 23G vitrectomy after iris neovascularization faded.The intraocular pressure and complications were observed after surgery.The follow-up time was 12 months after surgery.Results The intraocular pressure was(18.1±7.6)mmHg,(13.8±4.1)mmHg and(12.4±3.8)mmHg,(15.8±4.3)mmHg at 1 week,1,6 and 12 months in sequence postoperatively,which were all lower than the(43.4±5.3)mmHg preoperatively(F=8.31,P<0.05).The complete success rate was 80.0%(32/40),and qualified success rate was 90.0%(36/40).The intraocular pressure of 32 eyes was in the normal range after surgery,and 4 eyes needed to be controlled with antihypertensive drug.There were 2 cases with shallow anterior chamber which improved with mydriasis,hyperosmotic agents and glucocorticoid treatment.There was 1 eye with drainage tube obstruction,which restored after flushing the drainage pipe.There was 1 eye with hyphema,which restored after drug therapy.There were 2 cases with vitreous hemorrhage,which restored with vitreous lavage and laser photocoagulation.Conclusion Implantation of Ahmed glaucoma drainage valve after intravitreal injection of ranibizumab combined with vitrectomy is a more effective treatment for diabetic neovascular glaucoma.

关 键 词：青光眼 新生血管性 糖尿病性 阀 引流 青光眼 Ahmed 雷珠单抗 注射 玻璃体内 玻璃体切除术 

分 类 号：R587.2[医药卫生—内分泌] R779.6[医药卫生—内科学]