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目的探讨青光眼引流阀与综合性小梁切除术治疗新生血管性青光眼的疗效。方法对39例(39眼)NVG患者随机分3组进行治疗。A组行Ahmed青光眼阀植入加视网膜光凝术,B组行Ahmed青光眼阀植入加丝裂霉素加视网膜光凝术,C组行小梁切除加丝裂霉素加虹膜烧灼加睫状体冷冻加视网膜光凝术。术后随访10～24个月,观察术前与术后的眼压、视力、虹膜表面新生血管及术中术后并发症。结果术前眼压平均(62.58±1.34)mm Hg,术后各组眼压均明显较术前下降(P<0.01),A、B组术后长期眼压无显著差异(P>0.05);术后视力20例提高,14例无变化,5例下降,无视力丧失;虹膜表面新生血管B、C组全部消退;A、B组患者术中、术后早期均有前房积血,C组4例前房出血,无前房消失、角膜内皮失代偿等并发症。结论Ahmed青光眼阀植入术和综合性小梁切除术是治疗新生血管性青光眼有效的两种手术方法,后者具有简单易行、并发症少、更经济的优势。
Objective To investigate the efficacy of glaucoma drainage valve and comprehensive trabeculectomy in the treatment of neovascular glaucoma. Methods Thirty-nine patients (39 eyes) with NVG were randomly divided into 3 groups. Group A Ahmed glaucoma valve implantation plus retinal photocoagulation, B group Ahmed glaucoma valve implantation with mitomycin plus retinal photocoagulation, C group trabeculectomy plus mitomycin plus iris cautery and ciliary Body freezing plus retinal photocoagulation. The patients were followed up for 10-24 months. The preoperative and postoperative intraocular pressure, visual acuity, neovascularization on the surface of iris and postoperative complications were observed. Results The intraocular pressure (IOP) was 62.58 ± 1.34 mm Hg before operation, and the intraocular pressure in each group was significantly lower than that before operation (P <0.01). There was no significant difference in IOP between A and B groups after operation (P> 0.05). Postoperative visual acuity increased in 20 cases, 14 cases without change, 5 cases decreased, no loss of vision; iris surface neovascularization B, C group all subsided; A, B group patients with intraoperative and early postoperative anterior chamber hemorrhage, C Group 4 cases of anterior chamber hemorrhage, no anterior chamber disappeared, corneal endothelial decompensation and other complications. Conclusion Ahmed glaucoma valve implantation and comprehensive trabeculectomy are two effective surgical methods for the treatment of neovascular glaucoma. The latter has the advantages of simple and easy operation, less complications and more economical advantages.