睫状体冷凝联合小梁切除术治疗新生血管性青光眼25例疗效观察

Effectiveness Observations of Cyclocryotherapy Combined with Trabeculectomy to Neovascular Glaucoma in 25 Cases

摘要: 目的：探索睫状体冷凝术联合小梁切除术治疗新生血管性青光眼的疗效。方法：选择2012.1~2014.12于昆明医科大学第一附属医院眼科住院治疗的新生血管性青光眼患者，共25例(25眼)，先进行全视网膜激光光凝，所有患者均给予经睫状体平坦部玻璃体腔注射Lucentis 0.1 ml (1.0 mg)。注药3天后，行睫状体冷凝术联合小梁切除术，观察手术前至术后1 w、1 m、3 m、6 m，分别记录两组的病人自觉症状、眼压、视力、并发症情况。结果：术后所有患者的眼部胀痛消失，术后1 w、1 m、3 m、6 m平均眼压较术前明显降低，分别降低22.64 mmHg，23.6 mmHg，24.2 mmHg，26.16 mmHg。差异有统计学意义(P < 0.001)。1例术后低眼压，1例浅前房，8例前房积血，3例眼球萎缩，2例行眼内容物剜出。结论：睫状体冷凝术联合小梁切除术对于治疗新生血管性青光眼有显著效果。

Abstract: Objective: To observe the results of cyclocryotherapy combined with trabeculectomy to neovascular glaucoma. Methods: 25 eyes in 25 cases with neovascular glaucoma in the First Affiliated Hospital of Kunming Medical University from Jan. 2012 to Dec. 2014 were analyzed retrospectively. Pan-retina photocoagulations were executed firstly. All patients were treated with intravitreal injection of Lucentis 0.1 ml (1.0 mg) pars plana at first. 3 days latter, 25 eyes were treated by cyclocryostherapy combined with trabeculectomy. Pre- and post-operative (1 week, 1 month, 3 months, 6 months) swelling pain of eye, intraocular pressures (I0P), visual acuity and complications were observed. Results: All the swelling pain of the eye disappeared. The average IOP reduced greatly. The IOP decreased 22.64 mmHg, 23.6 mmHg, 24.2 mmHg, 26.16 mmHg in 1 week, 1 month, 3 months and 6 months in post-operation, respectively. The difference was statistically significant (P < 0.001). After operations, intraocular hypotension in 1 case, shallow anterior chamber in 1 case, anterior chamber hemorrhage in 8 cases, and eyeball atrophy in 3 cases were observed, respectively. 2 eyes were enucleated lastly. Conclusions: Cyclocryotherapy combined with trabeculectomy should be a good method for controlling neovascular glaucoma.