改良小梁切除术治疗新生血管性青光眼的临床观察

目的 观察改良小梁切除术治疗新生血管性青光眼的临床疗效.方法 搜集2011年1月至2011年8月行改良小梁切除术的新生血管性青光眼患者22例(22只眼),术中应用丝裂霉素C和2针可调节缝线,巩膜瓣上无固定缝线,根据术后眼压和滤过泡情况决定拆除可调节缝线的时间.观察术后眼压等指标变化.随访6个月.结果 术前眼压35～65 mm Hg,平均(46.45±7.40) mm Hg,术后末次随访眼压9～31 mm Hg,平均(16.14±6.56) mm Hg,二者之间差异有统计学意义(P＜0.01).术后6个月时,眼压均较术前降低,其中Goldman眼压计测量眼压正常者17例,达77.3％,其余5例眼压也均较术前明显下降.结论 改良小梁切除术治疗新生血管性青光眼疗效满意,效果确切.     

新生血管性青光眼的手术治疗

目的分析新生血管性青光眼的手术疗效。方法对20例（23眼）新生血管性青光眼，术前充分控制全身病（高血压、高血糖等），最大限度降低眼压，在粘弹剂辅助下行小梁切除术，术后辅以5-氟尿嘧啶及按摩治疗。结果术中所有患者前房均有少量出血，但均在3d内自行吸收。术后大部分患者前房维持良好。术后20眼视力维持术前，3眼略有提高；眼压降至21mmHg（1kPa=7．5mmHg）以下者20眼；虹膜新生血管变细或消失19眼。结论对新生血管性青光眼在小梁切除术中辅以粘弹剂，术后配合5-氟尿嘧啶及按摩治疗，效果肯定，并发症少。     

玻璃体腔注射雷珠单抗联合小梁切除术治疗新生血管性青光眼疗效观察

目的观察玻璃体腔注射雷珠单抗（Lucentis）联合复合式小梁切除术治疗新生血管性青光眼的疗效。方法对17例（17只眼）新生血管性青光眼行玻璃体腔注射Lucentis 0.50 mg/0.05 ml,8~14 d后行复合式小梁切除术。观察玻璃体腔注射Lucentis后虹膜及房角新生血管消退的时间、眼压的变化以及复合式小梁切除术后视力和眼压的变化。术后随访8~12个月。结果玻璃体腔注射Lucentis后,13只眼虹膜新生血管1周内完全消退,4只眼2二周内完全消退。注药前平均眼压（39.56±10.12）mm Hg,注药后1周平均眼压（38.62±8.35）mm Hg与注药前比较眼压变化无统计学意义（t=0.951,P〉0.05）。小梁切除术后1周眼压（10.43±6.12）mm Hg,最后一次随访眼压（13.61±4.31）mm Hg,与术前比较差异均有统计学意义（t=21.362、19.817,P均﹤0.01）。末次随访时12只眼视力提高,5只眼视力未变。结论玻璃体腔注射雷珠单抗联合复合式小梁切除术能有效地控制眼压,保护视功能。     

睫状体冷冻联合小梁切除治疗晚期新生血管性青光眼

目的：分析睫状体冷冻联合小梁切除治疗晚期新生血管性青光眼疗效。方法：晚期新生血管性青光眼37例37眼,行睫状体冷冻联合小梁切除术,术后随访12mo,观察术后眼压、前房反应及疼痛程度和并发症等。结果：术前平均眼压52.34mmHg,术后1,3d;1wk;1,3,12mo平均眼压分别为17.30±9.35,17.98±7.69,17.38±5.31,17.22±3.82,16.45±4.82,16.76±4.52mmHg,与手术前平均眼压比较,差异均有统计学意义（P〈0.05）。术后前房反应较轻,疼痛缓解明显,无严重并发症。结论：睫状体冷冻联合小梁切除术能有效治疗晚期新生血管性青光眼。     

原发性闭角型青光眼持续高眼压状态下的手术治疗

目的 研究闭角型青光眼持续高眼压状态下小梁切除术的临床效果.方法 对52例(57眼)眼压控制不良的闭角型青光眼进行了联合前房穿刺的小梁切除术.术后1周、1个月、6个月、1年时,观察患者的视力和眼压情况.结果 所有病例术中无脉络膜爆发性出血、恶性青光眼等并发症发生.术后1年,视力低于0.1者17眼,0.1～0.3者20眼,大于0.3者20眼.眼压控制在10～21 mm Hg(1 mm Hg=0.133 kPa)者50眼,需要加用局部降眼压药才能控制眼压者7眼,手术成功率87.7%.结论 持续高眼压状态下的闭角型青光眼进行联合前房穿刺的小梁切除术是安全有效的.     

复合式小梁切除术联合睫状体冷凝治疗晚期新生血管性青光眼

目的探讨复合式小梁切除术联合睫状体冷凝治疗晚期新生血管性青光眼的疗效。方法晚期新生血管性青光眼16例（16眼）．一次性施行180°睫状体冷凝联合复合式小梁切除术．观察术后眼压、新生血管消退情况及手术并发症。结果术后随访6—48个月,视力均无明显改善,平均眼压自（57．48±10．00）mmHg降至（12．46±4．36）mmHg,控制在21mmHg以下者13眼（占80．12％）,手术眼压控制较好。结论一次性施行复合式小梁切除术联合睫状体冷凝对晚期新生血管性青光眼有较好的长期疗效。     

视网膜睫状体冷凝联合小梁切除术治疗新生血管性青光眼

目的评价广泛视网膜睫状体冷凝联合丝裂霉素C及小梁切除术治疗新生血管性青光眼的临床效果。方法采用广泛视网膜睫状体冷凝联合丝裂霉素C及小梁切除术治疗新生血管性青光眼20例（20眼），观察术后眼压、视力及并发症等。结果术后随访6个月～1a，18眼眼压得以控制；各眼视力无明显变化；功能滤过泡占80％：出现一过性高眼压、前房积血等并发症，经对症处理，均在1周内恢复。结论广泛视网膜睫状体冷凝联合丝裂霉素C及小梁切除术治疗新生血管性青光眼可以有效控制眼压。     

虹膜光凝联合复合式小梁切除治疗新生血管性青光眼

目的评价倍频532激光虹膜表面新生血管光凝术联合复合式小梁切除术治疗新生血管性青光眼的效果。方法对31例（32只眼）新生血管性青光眼先用倍频532 nm激光封闭虹膜表面新生血管,1～d天后再行复合式小梁切除术。结果术后随访半年,27例（28只眼）眼压控制在21 mm Hg以下,有效率达85.71%。结论倍频532激光虹膜光凝联合复合式小梁切除术是治疗新生血管性青光眼较为满意的方法。     

改良小梁切除术联合睫状体视网膜冷凝治疗新生血管性青光眼

目的 观察改良小梁切除术联合睫状体视网膜冷凝治疗新生血管性青光眼的临床疗效.方法 2008年1月至2011年6月我院共收治新生血管性青光眼患者46例(46眼),均采用改良小梁切除术联合睫状体视网膜冷凝治疗,术后随访6 ～12个月,观察患者术后一般疗效、视力、眼压及并发症等情况.结果 46眼中手术完全成功38眼,条件成功6眼,失败2眼,手术成功率为95.7％.与术前比较,术后1周、1个月、6个月视力均有不同程度提高,差异均有统计学意义(均为P＜0.05).术前眼压(38.9±3.2)mmHg(1 kPa =7.5 mmHg),术后1周、1个月、6个月眼压分别为(18.2±1.2) mmHg、(17.8±1.6) mmHg、(17.2±1.5)mmHg,与术前比较,差异均有显著统计学意义(均为P＜0.01).术后1周形成功能性滤过泡39眼(84.8％),非功能性滤过泡7眼(15.2％);术后6个月形成功能性滤过泡42眼(91.3％),非功能性滤过泡4眼(8.7％).术后并发症主要包括前房积血、浅前房、前部葡萄膜炎、玻璃体出血等.结论 改良小梁切除术联合睫状体视网膜冷凝治疗新生血管性青光眼能显著控制眼压,改善视力.     

抗青光眼术后浅前房相关因素分析及处理

目的探讨抗青光眼术后浅前房与术前眼压及手术方式的关系；分析与术后结膜伤121渗漏、滤过过强及脉络膜脱离的关系。方法回顾性总结各类型青光眼的抗青光眼手术236例（278眼）术后发生浅前房的情况。结果发生浅前房49眼（17．63％）。术前眼压≤21mmHg者183眼中发生浅前房17眼（9．29％），术前眼压22—35mmHg者57眼发生浅前房15眼（26．32％），术前眼压≥35mmHg者38眼巾发生浅前房17眼（44．74％）。小梁切除术185眼中术后发生浅前房26眼（14．54％），巩膜咬切术93眼中浅前房23眼（24．73％）。术后结膜渗漏9眼（18．37％），滤过过强20眼（36．73％），脉络膜脱离5眼（10．20％），另有原因不明者15眼。结论抗青光眼术后浅前房与多种因素有关。（1）术前眼压控制正常者，发生率低；（2）小梁切除较巩膜咬切术发生率低；（3）以滤过过强性者为最多。     

小梁切除术治疗绝对期青光眼临床观察

目的 观察小梁切除术治疗绝对期青光眼中的效果.方法 对34例(35眼)绝对期青光眼施行小梁切除术,随访6个月～3年,观察眼压、主观症状及视力变化情况.结果 行小梁切除术后,高眼压明显缓解,术前眼压平均值(42.00± 13.43)mm Hg(1 mm Hg=0.133 kPa),术后1周出院时眼压平均值为(14.00±5.69) mm Hg,术后6个月为(19.00 ±7.26) mm Hg.术后眼压控制较好,与术前比较差异有统计学意义(P＜0.01).2眼视力恢复为光感和手动,另33眼视力仍无光感.患者眼胀、眼痛等主观不适症状减轻,眼球得以保留,且无严重并发症.结论 小梁切除术是治疗绝对期青光眼更简便、安全、有效的手术选择.(中国眼耳鼻喉科杂志,2012,12:44-46)     

改良小梁切除术联合生物羊膜植入治疗闭角型青光眼的临床观察

目的探讨Tenon’s筋膜切除联合生物羊膜植入的小梁切除术治疗闭角型青光眼临床疗效。方法对26例(30只眼)闭角型青光眼患者行Tenon’s筋膜切除联合生物羊膜植入的小梁切除术,术后随访1年,观察降眼压效果及其手术并发症。结果术后1周眼压(11.80±2.23)mmHg,较术前眼压(38.53±7.17)mmHg明显降低(P<0.01)。术后随访1年,眼压(17.80±4.11)mmHg,保持功能性滤泡27只眼(90%)。结论 Tenon’s筋膜切除联合生物羊膜植入的小梁切除术可作为治疗闭角型青光眼的一种有效方法,手术成功率高,长期眼压控制好,可有效地减少瘢痕组织形成。     

原发性急性闭角型青光眼持续性高眼压睫状体光凝后残余青光眼行超声乳化术的临床疗效

目的：探讨原发性急性闭角型青光眼持续性高眼压行睫状体光凝后因眼压仍高行超声乳化术的临床疗效。方法选择原发性急性闭角型青光眼持续性高眼压患者12例（12只眼）行经巩膜二极管激光睫状体光凝（ TDCP），因光凝后眼压仍高且合并白内障，行白内障超声乳化吸除联合后房型人工晶状体植入术。测量光凝前、光凝后1周、超声乳化术前、术后1周、3个月时的眼压和视力。记录患者症状和术中、术后并发症。结果睫状体光凝前、光凝后1周、超声乳化术前、术后1周、3个月时的眼压分别为（50．83±9．86） mm Hg、（15．70±6．23） mm Hg、（27．63±4．59）mm Hg、（13．89±4．82）mm Hg、（16．98±3．51）mm Hg；视力分别是0．1030±0．1277、0．1380±0.1266、0．0989±0．0835、0．2589±0．2033、0．2630±0．2036。光凝后1周、超声乳化术前与光凝前相比眼压下降，差异有统计学意义（ P ＜0．001）。超声乳化术后1周、3个月时与超声乳化术前相比眼压下降，差异有统计学意义（ P＜0．001）。超声乳化术后1周、3个月时眼压比较，差异无统计学意义（ P ＝0．229）。光凝前后、超声乳化术前的视力相比，差异无统计学意义。超声乳化术后1周、3个月与超声乳化术前相比视力提高，差异有统计学意义（P值分别为0．015和0．013）。光凝后当天诉眼痛者2例，予止痛药口服后缓解，之后所有患者均未再诉患眼剧烈疼痛或严重的眼部不适。光凝后1例前房出血，2 d后吸收。2例光凝后持续性前房闪辉超过1个月。结论原发性急性闭角型青光眼持续性高眼压可首选TDCP治疗；如果术后存在残余青光眼且合并白内障，可行超声乳化术进一步降低眼压；TDCP对后续的超声乳化术无不良影响。     

视网膜及虹膜光凝联合小梁切除术治疗新生血管性青光眼

目的 观察视网膜及虹膜光凝联合小梁切除术治疗新生血管性青光眼的效果.方法 对32例(34只眼)新生血管性青光眼先行全视网膜光凝,再行虹膜光凝,用氪-绿激光封闭虹膜表面及房角新生血管,3～5d后行复合式小梁切除术,观察手术前后的最佳矫正视力、眼压、使用抗青光眼药物的数量,虹膜新生血管消退情况及术中术后并发症等.结果 治疗后视力提高14只眼,无变化14只眼,下降6只眼;在用抗青光眼药物的情况下,治疗前眼压平均(42.9±8.9)mmHg,术后1周、1月及3月平均眼压为(13.6±3.4)mmHg,(15.4±3.0)mmHg,及(18.2 4±3.1)mmHg(t值分别为t=17.695.t=18.669,t=14.781,均P<0.05)治疗前后对比有统计学意义.抗青光眼用药量从治疗前3.1±0.8降至治疗后0.2±0.6(t=15.760.P=0.000<0.05)治疗前后对比有统计学意义.术后并发症:术后早期前房出血5只眼(14.7%),经药物治疗均在2周内消失;1只眼术后2月发生睫状环阻滞性青光眼,药物治疗后缓解.结论 采用视网膜及虹膜光凝联合小梁切除术,治疗新生血管性青光眼能有效降低新生血管性青光眼患者眼压及减少术中、术后并发症,为新生血管性青光眼治疗提供了一种经济有效的综合治疗方法.     

房角虹膜前粘分离术治疗闭角型青光眼的临床观察

目的探讨房角虹膜前粘连分离术治疗闭角型青光眼的临床效果。方法 9例（9只眼）闭角型青光眼行房角虹膜前粘连分离术,观察术后眼压、房角及并发症的情况。随访时间6周至4个月。结果 9例（9只眼）术前平均眼压（39.44±12.86）mm Hg,至最后1次随访,术后平均眼压（13.33±1.80）mm Hg,与术前相比明显降低,差异有统计学意义（P〈0.01）。超声生物显微镜（UBM）检查示：术后房角大部分或全开放。并发症：3例发生前房出血渗出,逐渐吸收,无浅前房、脉络膜脱离等并发症。结论对于闭角型青光眼,房角虹膜前粘连分离术疗效确切,具有较好的临床应用价值。     

Trabeculectomy with mitomycin C combined with direct cauterization of peripheral iris in the management of neovascular glaucoma

PURPOSE: To determine the outcomes of trabeculectomy with mitomycin C (MMC) combined with direct cauterization of peripheral iris before iridectomy in the management of neovascular glaucoma (NVG), and to demonstrate the effect of this surgical technique on decreasing the incidence of intraoperative bleeding and early postoperative hyphema. METHODS: This prospective study was based on 72 eyes of 72 patients with NVG who underwent primary trabeculectomy with MMC combined with direct cauterization of peripheral iris before iridectomy. The patients were evaluated for intraoperative and early postoperative complications such as hyphema, and operative success rates. Operative success was defined as an intraocular pressure (IOP) < or =22 mm Hg (+/-medical therapy) in the absence of phthisis. The mean IOP and the mean number of antiglaucomatous medications at baseline and at the posttrabeculectomy sixth month were compared by paired Student t test. RESULTS: The mean preoperative IOP was 39.3+/-5.6 mm Hg (range, 29 to 60 mm Hg) whereas it was 20.02+/-4.3 mm Hg (range, 14 to 38 mm Hg) at the postoperative sixth month. The mean preoperative number of antiglaucoma medications was 3.2+/-0.4 (range, 2 to 4) but it reduced to 1.8+/-0.6 (range, 1 to 4) at the postoperative sixth month. These differences were statistically significant (P<0.00001). The IOP was < or =22 mm Hg (+/-medical therapy) in 69 eyes (95.8%) at the postoperative first week, in 62 eyes (86.1%) at the postoperative first month, in 60 eyes (83.3%) at the postoperative third month and in 48 eyes (66%) at the postoperative sixth month. Hyphema occurred in 15 eyes (20.8%) within the first week of the surgery. In 12 eyes it was transient; however, in 3 eyes irrigation of anterior chamber was required. CONCLUSIONS: Trabeculectomy with MMC combined with direct cauterization of peripheral iris decreases the incidence of both intraoperative bleeding, and early postoperative hyphema, and provides reduction of IOP and the number of antiglaucomatous medications in cases with NVG in a 6-month follow-up period.     

Intracameral anti-VEGF injection for advanced neovascular glaucoma after vitrectomy with silicone oil tamponade

AIM: To evaluate the effect of intracameral injection of conbercept for the treatment of advanced neovascular glaucoma(NVG) after vitrectomy with silicone oil tamponade.METHODS: Conbercept 0.5 mg/0.05 m L was injected into the anterior chamber of 5 eyes, which had developed advanced NVG after vitrectomy with silicone oil tamponade. Then, trabeculectomy with mitomycin C and pan-retinal photocoagulation(PRP) or extra-PRP were conducted within 2 d. The follow-up time was 6 mo. Best-corrected visual acuity(BCVA), intraocular pressure(IOP), neovascularization of iris(NVI) were recorded before and after treatment.RESULTS: Within 2 d after injection, IOP control, and NVI regression were optimal for trabeculectomy. Hyphema occurred in one eye in the process of injection. But none of them present hyphema after trabeculectomy. At the end of follow-up time, all eyes had improved BCVA, well-controlled IOP, and completely regressed NVI. CONCLUSION: Intracameral injection of conbercept is safe and effective in the treatment of patients with advanced NVG after vitrectomy with silicone oil tamponade. Within 2 d after injection is the optimal time window for trabeculectomy, which can maximally reduce the risk of perioperative hyphema.     

Comparison of healing patterns of different side-cut angulations after FS-LASIK

AIM: To investigate and evaluate healing patterns around flaps made with different side-cut angulations after femtosecond laser in situ keratomileusis(FS-LASIK).METHODS: Thirty-four patients(68 eyes) received a 90° side-cut(n=34) or a 120° side-cut flaps(n=34) made with a femtosecond laser. One day, 1 wk, 1 and 3 mo postoperatively, side-cut scar was evaluated under slit-lamp photography according to a new grading system(Grade 0=transparent scar, 1=faint healing opacity, and 2=evident healing opacity). In vivo corneal confocal microscopy and anterior segment optical coherence tomography(AS-OCT) were used to observe wound-healing patterns around flap margin in the two groups. Sirius Scheimpflug Analyzer was also used to analyze higher order aberrations 3 mo after surgery.RESULTS: There were no significant differences in flap wound-healing patterns at each follow up between the two groups(P>0.05). Three months after surgery, the flap edge scar classified as Grade 0 had excellent apposition and rapid nerve regeneration. At 3 mm and 5 mm pupil diameters, there were significant differences in trefoil aberrations between the two groups(P<0.05), but no statistically significant differences were found in total higher order aberrations(HOAs), spherical aberrations or coma in any of the pupil size conditions(P>0.05).CONCLUSION: Flap edge scars classified as Grade 0 have excellent apposition and rapid nerve regeneration, and 120° side-cut angle flaps induce less trefoil aberrations after FS-LASIK.     

依据24h眼压峰值的青光眼个性化药物治疗观察

目的 通过对开角型青光眼患者进行24h眼压监测后采用不同的降眼压用药时间,来探索青光眼的个性化治疗.方法 入选18例正常眼压性青光眼和14例原发性开角型青光眼,治疗前均给予视野检查,进行24 h眼压监测(每2h1次),并根据眼压波动曲线,给予前列腺素类降眼压药,1次/d,用药时间为峰值眼压提前12 h;1个月后复查24 h眼压,随访(23.7±12.4)个月,记录随访终末期的视野.结果 治疗前平均眼压(16.8±3.5)mm Hg(1 mm Hg=0.133 kPa),峰值眼压(20.8±4.6)mm Hg,谷值眼压(13.7±3.1)mm Hg,眼压波动值(7.1 ±2.4)mm Hg;治疗后平均眼压(13.2±2.6) mm Hg,峰值眼压(16.4±3.4) mm Hg,谷值眼压(10.7±2.3)mm Hg,眼压波动值(5.7±2.1)mm Hg.治疗前后平均眼压、峰值眼压、谷值眼压、眼压波动值的差异均具有统计学意义(P ＜0.000 1).治疗前视敏度(19.0±5.2)dB,视敏度缺损值(8.2±4.9)dB;治疗后视敏度(19.7±5.5)dB,视敏度缺损值(7.2±5.1)dB.结论 通过依据24h眼压峰值来确定青光眼的用药及其用药时点的选择,以及青光眼随访过程中治疗药物的调整,是一种值得推广的青光眼个性化治疗模式.(中国眼耳鼻喉科杂志,2012,12:36-39)