不同术式治疗新生血管性青光眼的疗效比较

目的：比较不同手术方法治疗新生血管性青光眼（neovascular glaucoma，NVG）的疗效。方法：对接受不同术式治疗的57例57只眼NVG的临床资料进行回顾性分析，其中行单纯睫状体冷凝术20例（A组），改良小梁切除术15例（B组），引流阀植入术联合全视网膜光凝术22例（c组）。比较各组患者手术前后主观眼痛症状、眼压及视力变化情况，并随访3～6个月。结果：A组患者出院时的平均眼压为（28．13＋4．83）mmHg，B组为（19．24±5．48）mmHg，C组为（21．22±4．76）mmHg。随访期间，术后A组9例眼压正常，手术成功率45％；B组11例眼压正常，手术成功率73．3％；C组13例眼压正常，手术成功率57．1％。B组手术成功率最高，A组最低。结论：三种手术方法均可不同程度降低新生血管性青光眼的眼压。单纯睫状体冷凝术后眼压控制效果欠佳，有视力眼不宜采用此种手术方式；改良小梁切除术是治疗新生血管性青光眼安全、有效、经济的手术方式；引流阀植入术联合全视网膜光凝术费用较高。

Clinical Effects of Different Operation Ways on Neovascular Glaucoma

Objective： To evaluate the clinical effects of different surgical management on neovascular glaucoma （NVG）. Methods： 57 eyes in 57 cases with neovascular glaucoma received different surgical managements were analyzed retrospectively. All cases were divided into three groups： 20 eyes in the group A were treated by cyclocryotherapy, 15 eyes in the group B were treated by improved trabeculectomy, 22 eyes in the group were treated with glaucoma valve combined with retinal photocoagulation. Pre and post-operative intraocular pressures （10Ps） were observed and compared among the three groups. The changes in visual acuity were evaluated. Results： On discharge from the hospital, the intraocular pressure （lOP） in group A, B, C were respectively （28.13±4.83） mmHg, （19.24±5.48） mmHg and （21.22±4.76） mmHg, the surgery successful rate were respectively 45%, 73.3% and 57.1%, which was highest in group B and lowest in group A. Conclusion： Various operation ways may lower the intraocular pressure in neovascular glaucoma at different degrees. Retinal photocoagulation was not effective enough, improved trabeculectomy was an effective, safe and economical method for the treatment of neovascular glaucoma, while glaucoma valve combined with retinal photocoagulation was relatively more expensive.