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.     

康柏西普联合多种方法综合治疗新生血管性青光眼

目的：观察康柏西普联合全视网膜光凝术和复合式小梁切除术综合治疗新生血管性青光眼的临床效果。

方法：对11例11眼新生血管性青光眼患者行康柏西普玻璃体腔注射,观察房角及虹膜新生血管消退后,行复合式小梁切除术,所有患者均在合适的时机行全视网膜光凝术。术后平均随防6mo,观察术后视力、眼压及并发症等情况。

结果：术后眼压与术前比较,术后1wk,1、3、6mo眼压均有下降,且差异有统计学意义(P<0.01)。术后6mo,2眼(18%)矫正视力提高,8眼(73%)视力无明显变化,1眼(9%)视力降低。术后并发症主要包括前房积血、浅前房、玻璃体积血等。

结论：康柏西普玻璃体腔注射联合全视网膜光凝术和复合式小梁切除术综合治疗新生血管性青光眼能有效控制眼压,保护视功能。     

硅油填充术后继发性青光眼的临床研究

目的:探讨硅油填充术后继发性青光眼(silicone oil glaucoma,SOG)的相关危险因素及处理方法。方法:回顾性分析本院眼科行玻璃体切除联合眼内硅油填充的患者114例118眼。术中保留晶状体78眼,摘除晶状体40眼;摘除晶状体眼中,植入人工晶状体27眼。硅油填充时间≤6mo者39眼,>6mo者79眼。随访时间16.2±4.9mo。术前排除原发性和继发性青光眼。硅油填充术后1mo后如果连续3次测量眼压高于21mmHg(1mmHg=0.133kPa),同时排除炎症和新生血管性青光眼引起的眼压升高者诊断为SOG。确诊后给予降眼压药物治疗,治疗约2wk眼压仍不能降至正常者行硅油取出术,如果眼压仍不能降至正常者行抗青光眼手术。统计分析采用SPSS 16.0软件中的单因素Logistic回归分析。结果:发生SOG的32眼,摘除晶状体16眼(50%),硅油填充时间>6mo 27眼(84.4%),硅油乳化20眼(62.5%)。17眼抗青光眼药物治疗后2wk内眼压恢复正常,15眼行硅油取出术,术后4眼眼压仍高,1眼行抗青光眼药物治疗,2眼行小梁切除术,1眼行睫状体光凝术。有无摘除晶状体(P=0.024),硅油填充时间是否超过6mo(P=0.014),有无发生硅油乳化(P=0.000)对是否出现继发性青光眼的影响差异有统计学意义。结论:联合晶状体摘除、硅油填充时间超过6mo和硅油乳化是SOG的危险因素,首选抗青光眼药物保守治疗,如果无效需及时取出硅油。     

硅油填充手术后继发性青光眼的临床观察

目的 探讨硅油填充手术后继发性青光眼(SOG)的危险因素和治疗方法.方法 玻璃体切割手术同时眼内硅油填充的93例患者95只眼纳入本研究.其中,手术中保留晶状体37只眼,摘除晶状体58只眼;摘除晶状体眼中,植入人工晶状体10只眼.硅油填充时间≤6个月者32只眼,＞6个月者63只眼.手术后1、2周,1个月时复查眼底和眼压,均随访至硅油取出.随访时间2～25个月,平均随访时间(9.5±5.1)个月.手术后1个月眼压高于21 mm Hg(1 mm Hg=0.133 kPa),同时排除有明显原发因素及新生血管性青光眼等其他继发因素所引起的眼压升高者诊断为SOG.SOG确诊后,立刻给予盐酸卡替洛尔、布林佐胺滴眼液、甘露醇静脉滴注降眼压治疗,治疗1周眼压仍不能降至正常者行硅油取出手术,仍不能降至正常者行小梁切除手术.结果 21只眼发生SOG,占总眼数的22.1%.21只眼的平均硅油填充时间为(10.8±5.1)个月.其中,16只眼为无晶状体眼,占无晶状体眼的33.3%;5只眼为有晶状体眼或人工晶状体眼,占有晶状体眼或人工晶状体眼的10.6%.18只眼的硅油填充时间＞6个月,占硅油填充时间＞6个月眼的28.6%;3只眼的硅油填充时间≤6个月,占硅油填充时间≤6个月眼的9.4%.17只眼查见硅油乳化,占81.0%.行硅油取出手术后17只眼1周内眼压恢复正常,占SOG眼的81.0%.结论 无晶状体眼、硅油填充时间长是SOG发病的危险因素,硅油乳化是主要的发病原因,及时取出硅油是有效的治疗方法.

Abstract：

Objective To investigate the risk factors and treatment of silicone oil glaucoma (SOG).Methods Ninety-five eyes of 93 patients who underwent pars plana vitrectomy and silicone oil tamponade were evaluated in this study. The lens was removed in 58 eyes in which intraocular lens (IOL) was implanted in 10 eyes, so 48 eyes were aphakic. Silicone oil tamponade time was ≤6 months in 32 eyes,and ＞6 months in 63 eyes. The follow-up time ranged from 2 to 25 months, with a mean of (9.5±5.1)months. The fundus and intraocular pressure (IOP) were evaluated at 1 week, 2 weeks and 1 month after surgery. The diagnosis of SOG was established if the one-month postoperative IOP ＞ 21 mm Hg (1 mm Hg=0.133 kPa), and primary and neovascular glaucoma were excluded. After the diagnosis of SOG, carteolol hydrochloride and brinzolamide solution were immediately applied to the eye, and intravenous mannitol infusion was performed. If the IOP still can not be controlled after 1 week of such treatment, silicone oil removal surgery will be performed. If removal of silicone oil can not control the IOP,trabeculectomy surgery will be performed. Results SOG occurred in 21 eyes (22.1%), including 5 phakic eyes (10.6% of 47 phakic eyes) and 16 aphakic eyes (33.3% of 48 aphakic eyes) , 3 eyes (9.4% of 32 eyes)with short tamponade time (≤6 months) and 18 eyes (28.6% of 63 eyes) with long tamponade time (＞6months). The average silicone oil tamponade time was (10.8±5.1) months. Emulsification of the silicone oil occurred in 17 eyes (81.0%). After silicone oil removed, IOP was controlled in 17 eyes (81.0%) within one week. Conclusions Aphakic eye and the duration of silicone oil tamponade are the risk factors of SOG.Emulsification of silicone oil is the main cause. Silicone oil removal is an effective way to treat SOG.     

康柏西普联合不同手术方式对新生血管性青光眼疗效观察

目的：探讨玻璃体腔注射康柏西普后对新生血管性青光眼(NVG)患者房水中VEGF、IL-6、IL-8的影响,并观察其联合不同手术方式对NVG患者的疗效。

方法：选择2019-01/2020-02在中国人民解放军新疆军区总医院全军眼科中心就诊的NVG患者102例,均玻璃体腔注射康柏西普,3～5d后行手术治疗,按照随机数字抽签法分为小梁切除术组(50例50眼)及EX-PRESS引流器植入术组(52例52眼),运用酶联免疫吸附法分析房水中VEGF、IL-6、IL-8的变化情况,观察虹膜新生血管消退情况,比较两组手术疗效及术后眼压变化、视力改善情况及并发症发生情况。

结果：玻璃体腔注射康柏西普3～5d后房水中VEGF、IL-6、IL-8表达水平较术前降低(均P<0.05); 术后随访各时间点两组眼压水平均显著低于术前(均P<0.05),两组患者眼压在术后3、6、12mo组间比较有差异(均P<0.05); 术后6、12mo时EX-PRESS组视力优于小梁切除术组(P<0.05); 术后12mo,两组使用抗青光眼药物种类及数量无明显差异(均P>0.05); 随访12mo,EX-PRESS组患者手术成功率(86.5%)优于小梁切除术组(70.0%),且EX-PRESS组术后并发症发生率显著低于小梁切除术组(P<0.05)。

结论：玻璃体腔注射康柏西普后可以降低NVG患者房水中VEGF、IL-6、IL-8等因子表达,同时小梁切除术与EX-PRESS引流器植入术均可降低NVG患者眼压,但后者手术并发症较少、改善视力方面更有优势。     

不同联合手术治疗伴有和不伴有玻璃体积血的新生血管性青光眼

目的：探讨玻璃体腔注射康柏西普联合青光眼引流器植入及视网膜激光光凝对伴有和不伴有玻璃体积血的新生血管性青光眼(NVG)的疗效。

方法：回顾性分析了2016/01～2017/12在西安市第一医院眼科被确诊的37例39眼伴有和不伴有玻璃体积血的NVG(虹膜房角黏连超过180°)患者的临床资料。根据是否有玻璃体积血分为两组。所有患者均接受0.5mg(0.05mL)玻璃体腔注射康柏西普。没有玻璃体积血的20例21眼(第1组)患者在玻璃体腔注射康柏西普后4d行EX-PRESS(P50)青光眼引流器植入,在青光眼引流器植入后2wk行全视网膜激光光凝。伴有玻璃体积血的17例18眼(第2组)患者在玻璃体腔注射康柏西普后4d行玻璃体切除联合EX-PRESS(P50)青光眼引流器植入及全视网膜激光光凝术,并且根据术中的实际情况选择填充空气或硅油。所有患者术后随访6mo。

结果：第1组患者术前与术后6mo最佳矫正视力(BCVA)无差异(P>0.05); 第2组患者术前与术后6mo BCVA有差异(P<0.05); 第1组患者术后1d,1wk、1、3和6mo眼压分别为20.5±4.3mmHg,19.6±3.8mmHg,20.1±3.7mmHg,19.9±4.2mmHg和19.3±2.9mmHg。第2组患者术后1d,1wk、1、3和6mo眼压分别为22.3±3.7mmHg,20.6±2.8mmHg,20.4±3.8mmHg,18.9±4.1mmHg和19.3±3.4mmHg。第1组和第2组患者术后平均眼压均低于术前眼压(P<0.05),在随访期间3眼出现虹膜新生血管复发,故再行1次玻璃体腔注射康柏西普,治疗1wk后虹膜新生血管消退。

结论：玻璃体腔注射康柏西普联合青光眼引流器植入及视网膜激光光凝能够有效降低伴有和不伴有玻璃体积血的NVG(虹膜房角黏连超过180°)患者的眼内压。     

糖尿病视网膜病变玻璃体切除术后新生血管性青光眼原因分析

目的:探讨增殖性糖尿病视网膜病变患者玻璃体切除术后发生新生血管性青光眼的原因。方法:对行玻璃体切除术后9例病例(11眼)发生新生血管性青光眼的原因进行回顾性分析。结果:11眼中行晶状体手术7眼,其中后囊破裂或不完整6眼,术前存在虹膜新生血管(NVI)2眼,术后视网膜脱离1眼,手术后至发生新生血管性青光眼(NVG)期间11眼均未行眼底荧光血管造影和视网膜光凝。结论:术中联合行晶状体手术、玻璃体腔填充物、光凝效果、术后发生视网膜脱离、术前存在NVI等对术后发生新生血管性青光眼均有影响。     

雷珠单抗辅助玻璃体切割和PRP联合小梁切除术治疗NVG的疗效

目的：观察雷珠单抗辅助玻璃体切割+全视网膜光凝(PRP)+小梁切除术治疗新生血管性青光眼(NVG)的临床疗效。

方法：回顾性分析2017-03/2018-10收治的NVG患者44例44眼,采用玻璃体腔内注射雷珠单抗+玻璃体切割+PRP+小梁切除手术治疗的患者22例22眼(A组),采用玻璃体腔内注射雷珠单抗+小梁切除+PRP治疗的患者22例22眼(B组)。术后随访6mo,观察患者视力、眼压、眼压控制率、新生血管及并发症等情况。

结果：治疗前两组患者眼压无差异(46.2±9.41mmHg vs 49.1±10.15mmHg,P>0.05),治疗后1wk,1、6mo A组患者眼压均低于B组(P<0.05)。治疗后6mo,A组视力、眼压控制率(95%)、新生血管消退情况(91%)均优于B组(P<0.05),但随访期间两组患者并发症发生率无差异(P>0.05)。

结论：雷珠单抗辅助玻璃体切割+PRP+小梁切除术治疗NVG安全有效,可稳定持久地控制眼压,改善部分患者视力。     

Ahmed valve implantation for neovascular glaucoma after 23-gauge vitrectomy in eyes with proliferative diabetic retinopathy

AIM:To report on the outcome of Ahmed glaucoma valve (AGV) implantation for the management of neovascular glaucoma (NVG) after 23-gauge vitrectomy for proliferative diabetic retinopathy (PDR).METHODS: Twelve medically uncontrolled NVG with earlier 23-gauge vitrectomy for PDR underwent AGV implantation. The control of intraocular pressure (IOP), preoperative and postoperative best-corrected visual acuity, the development of intraoperative and postoperative complications were evaluated during the follow-up.RESULTS: The mean follow-up was 15.4±4.3 months (9-23 months). Mean preoperative IOP was 49.4±5.1mmHg and mean postoperative IOP at the last visit was 17.5±1.6mmHg. The control of IOP was achieved at the final follow-up visits in all patients, however, 8 of 12 patients still needed anti-glaucoma medication (mean number of medications, 0.8±0.7). The visual acuity improved in nine eyes, and the visual acuity unchanged in three eyes at the final follow-up visits. The complications that occurred were minor hyphema in three eyes, choroid detachment in two eyes, and the minor hyphema and choroid detachments were reabsorbed without any surgical intervention.CONCLUSION: AGV implantation is a safe and effective procedure that enables successful IOP control and vision preservation in the NVG patients with the history of earlier 23-gauge vitrectomy for PDR.     

玻璃体切割术后早期角膜内皮细胞形态学改变

目的研究玻璃体切割术对晶体完整者角膜内皮细胞的早期影响。方法122例（131眼）行玻璃体切割术，其中无眼内充填46例（47眼），C3F8充填36例（38眼），硅油充填40例（46眼），分别在术前、术后1天、3天、5天和15天测量眼压、角膜内皮细胞密度、六角形细胞比例和变异系数。结果与术前相比，无眼内充填者眼压无明显改变，术后1天角膜六角形细胞百分数下降；C3F8充填术后1天眼压升高，角膜六角形细胞百分数术后1、3天下降；硅油充填术后1、3天眼压升高，角膜六角形细胞百分数术后1、3、5天下降；眼压升高与六角形细胞百分数下降显著相关。结论对于晶体完整者，玻璃体切割术后早期角膜内皮形态会受到一定的影响，可能主要由眼压及手术操作所致，在将眼压控制后，短期内即可恢复正常。     

术前应用康柏西普以不同手术方法治疗新生血管性青光眼

目的比较术前应用康柏西普两种手术方法治疗糖尿病继发新生血管性青光眼(NVG)的效果。方法前瞻性随机临床对照研究。以菏泽市中医医院眼科2018年2月至2019年8月诊治的糖尿病所致NVG 61例(62眼)为研究对象。患者按随机数字表法分为两组,两组患者手术前均进行康柏西普玻璃体内注射。试验组,31例(32眼),采取玻璃体切除联合青光眼引流阀植入及视网膜激光光凝术;对照组,30例(30眼),采取玻璃体切除联合小梁切除及视网膜激光光凝术;随访6个月,观察两组术后眼压、视力及并发症等。结果试验组眼压低于对照组(F=42.599,P<0.001),随访结束时,两组视力、并发症的发生率及疗效的比较差异均无统计学意义(P>0.05)。结论康柏西普玻璃体内注射后采用玻璃体切除联合青光眼引流阀值入术治疗糖尿病继发的NVG,降低眼压幅度更大且平稳。     

Cataract surgery in eyes after vitrectomy filled with long-term silicone oil tamponade

PURPOSE: Evaluation of the results of cataract extraction in eyes filled with silicone oil. MATERIAL AND METHODS: Twenty-nine eyes of 29 patients underwent cataract extraction without intraocular lens implantation, in eyes after vitrectomy filled with silicone oil. The average time of silicone oil tamponade was 3.5 years (range from 10 months to 6 years). The mean follow-up was 26.1 +/- 17.5 months. RESULTS: Useful visual acuity was achieved in 55% eyes. The main complication was the increased intraocular pressure, which appeared in 38% eyes. CONCLUSION: Cataract surgery in eyes with long-term silicone oil tamponade get benefit, because it enables restoring the useful visual acuity. More advanced retinal pathology and silicone oil tamponade increase the number of complications.     

综合治疗新生血管性青光眼的疗效观察

目的：评价玻璃体腔雷珠单抗注射联合全视网膜激光光凝（ panretinal photocoagulation ,PPR）及复合小梁切除术治疗新生血管性青光眼的临床疗效。方法：收集我院2015－01／11确诊为新生血管性青光眼患者14例14眼,依次行玻璃体腔雷珠单抗注射、PPR及复合小梁切除术治疗。观察术后眼压、视力、虹膜新生血管及术中术后并发症的情况。结果：经3～6mo观察及随访,末次随访平均眼压为18．00±6．70mmHg,较术前平均眼压（41．65±4．07mmHg）有显著降低（ t＝11．288,P＜0．05）。手术成功定义为未辅助用降眼压药物,眼压＜21 mmHg;有效定义为辅助用降眼压药物,眼压＜21mmHg。末次随访11眼眼压＜21mmHg,成功率为79％;2眼有效（14％）;1眼失败,眼压失控后行睫状体冷冻治疗。视力检查结果显示6眼稍有提高,7眼不变,1眼减退;13眼虹膜新生血管消失,1眼在随访的第3 mo消失的虹膜新生血管又复现,给予再次玻璃体腔雷珠单抗注射并补充眼底视网膜激光治疗后消失;术后前房积血1眼,1 wk后吸收,未出现术后浅前房及眼球萎缩患者。结论：玻璃体腔雷珠单抗注射及复合小梁切除术联合PPR治疗新生血管性青光眼安全、可靠,疗效确定。     

两种方法治疗新生血管性青光眼的临床观察

目的：观察玻璃体腔内注射康柏西普联合小梁切除术或联合Ahmed青光眼引流阀植入术治疗新生血管性青光眼(NVG)的临床疗效。

方法：回顾分析2016-02/2017-06我院收治的NVG患者40例40眼,根据治疗方法分为A组(康柏西普联合小梁切除术+全视网膜光凝)和B组(康柏西普联合Ahmed青光眼引流阀植入术+全视网膜光凝),每组20例20眼。治疗后随访6mo,观察患者视力、眼压、眼压控制率和新生血管消退情况等。

结果：治疗前,两组患者眼压比较无差异(P>0.05)。治疗后6mo,B组眼压低于A组(P<0.05),但两组视力、眼压控制率、新生血管消退情况无差异(均P>0.05)。

结论：玻璃体腔注射康柏西普联合Ahmed青光眼引流阀植入和康柏西普联合小梁切除术治疗NVG安全有效,前者术式降眼压幅度更大。     

尿毒症血液透析继发新生血管性青光眼的治疗

目的评价睫状体冷凝联合小梁切除术治疗尿毒症血液透析后继发新生血管性青光眼(neovascular glaucoma,NVG)的临床效果。方法对10例(13眼)尿毒症血液透析后继发NVG的患者的临床资料进行回顾性分析。所有患者均行睫状体冷凝及小梁切除术,观察术后前房反应、房角及虹膜新生血管、眼压、视力及并发症等。术后随访12～18个月。结果术后13眼视力均无明显变化。出现一过性高眼压5眼,前房积血4眼,前部葡萄膜炎4眼,经对症处理后均于1～2周恢复。3眼术前房角新生血管均完全消失;虹膜新生血管完全消失者7眼,减少者1眼,2眼保持不变或增多者于术后1个月后再次给予睫状体冷凝治疗后新生血管消失。11眼眼压均得以控制,2眼术后给予药物治疗后眼压得以控制。末次随访时,除1例患者因肾脏移植术后合并感染死亡外,其余9例患者均能继续维持血液透析,均未再出现眼压增高。结论血液透析时多重因素诱发视网膜微循环障碍是引起NVG发生的主要原因,睫状体冷凝联合小梁切除术能够有效治疗尿毒症血液透析后NVG。     

硅油填充术后早期高眼压的临床分析

目的：探讨玻璃体切割硅油填充术后早期高眼压的原因、临床表现及术后处理。 方法：对行玻璃体切割硅油填充术后的97例97眼患者的临床资料进行回顾性分析,高眼压的标准为术后眼压≥21mmHg（1mmHg=0.133kPa）。 结果：患者27例（27.84%）出现高眼压,以术后早期（术后1wk内）为多,所有患者经降眼压药物治疗及调整激素用量或停用激素处理后,眼压均控制在正常范围（10～21mmHg）。 结论：硅油填充术后早期高眼压是常见的并发症之一,术后眼内组织水肿、炎症反应、硅油填充过量等可能是引起术后早期高眼压的主要原因,但早期对症治疗均使眼压恢复正常,可早期预防视功能的损害。     

新生血管性青光眼分期综合治疗的效果

目的探讨新生血管性青光眼按不同分期综合治疗的效果。设计回顾性病例系列。研究对象63例（69眼）新生血管性青光眼患者分为虹膜红变组（15例16眼）、开角型青光眼组（20例22眼）和闭角型青光眼组（28例31眼）。方法虹膜红变组行全视网膜光凝术治疗,其中3眼行白内障手术,1眼玻璃体内注射bevacizumab。开角型青光眼组在全视网膜光凝术基础上应用抗青光眼药物,其中8眼行小梁切除术,4眼行白内障手术,2眼白内障联合玻璃体切除,5眼玻璃体内注射bevacizumab。闭角型青光眼组在全视网膜光凝术、抗青光眼药物、小梁切除术或睫状体光凝术基础上,联合玻璃体内注射bevacizumab,其中21眼玻璃体切除联合白内障手术,12眼填充硅油。平均随访（18.6±15.3）个月。主要指标视力、眼压、虹膜红变、前房角及并发症。结果虹膜红变组、开角型青光眼组和闭角型青光眼组治疗后视力不变或提高分别为15眼（93.8%）、17眼（77.3%）和16眼（51.6%）（χ2=9.76,P﹤0.01）。治疗前眼压分别为（14.6±3.8）mmHg、（31.6±9.1）mmHg和（44.8±12.2）mmHg,治疗后眼压为（14.1±3.86）mmHg、（17.9±3.7）mmHg和（18.9±10.8）mmHg（F=185.8,P﹤0.001）。治疗后虹膜红变在虹膜红变组16/16眼消退,开角型青光眼组20/22眼消退及闭角型青光眼组28/31眼消退。治疗后前房角在虹膜红变组16眼仍为宽角,开角型青光眼组18/22眼前房角中的纤维血管膜萎缩,房角开放范围较治疗前扩大,闭角型青光眼组31眼房角中的纤维血管膜不同程度萎缩,但房角开放范围无扩大。三组患者治疗后并发症的发生率分别为6.3%、22.7%和48.4%（χ2=9.75,P﹤0.01）。结论新生血管性青光眼按临床分期差异化综合治疗对虹膜红变期及开角型青光眼期效果较好。     

玻璃体腔注射康柏西普联合Ahmed青光眼 引流阀植入和视网膜光凝治疗 新生血管性青光眼

目的：探讨玻璃体腔注射康柏西普联合Ahmed青光眼引流阀植入和视网膜光凝对新生血管性青光眼 （NVG）的治疗效果。方法：回顾性研究。分析2017年6月至2018年6月于空军986医院眼科就诊的 NVG患者16例（17眼）,先行玻璃体腔注射康柏西普0.05 ml,再行Ahmed青光眼引流阀植入术,后择 机行视网膜激光光凝,观察治疗前后视力、新生血管、眼压等情况。数据采用连续测量方差分析比 较。术后各时间点眼压与术前比较采用独立样本t检验。结果：注药后3 d新生血管明显萎缩,1个月时, 17眼新生血管全部消退。治疗前眼压为（43.3±7.6）mmHg（1 mmHg=0.133 kPa）,联合治疗后3 d 眼压为（14.8±4.8）mmHg,7 d时眼压为（13.7±3.9）mmHg,1个月时为（14.5±4.6）mmHg,3个月时 为（13.6±5.4）mmHg,6个月时为（13.9±4.6）mmHg,不同时间点的眼压比较差异有统计学意义（F= 9.58,P=0.006）。治疗后各个时间点眼压与治疗前相比差异均有统计学意义（P<0.05）。联合治疗后 较治疗前,最佳矫正视力提高5眼。结论：玻璃体腔注射康柏西普联合Ahmed青光眼引流阀植入和 视网膜光凝治疗NVG安全有效。     

Pars plana vitrectomy and panretinal photocoagulation combined with trabeculectomy for successful treatment of neovascular glaucoma

Background Treatment of neovascular glaucoma (NVG) must be focused on the reduction of intraocular pressure (IOP) and prompt application of pan retinal photocoagulation (PRP). A combination of complete PRP during vitrectomy with trabeculectomy should theoretically be a better method to lower the IOP rapidly in eyes with NVG. The purpose of our study is to assess the efficacy of combining pars plana vitrectomy and PRP with trabeculectomy assisted by mitomycin C (MMC) on NVG eyes secondary to diabetic retinopathy.Methods Twenty-five eyes with NVG associated with diabetic retinopathy had pars plana vitrectomy, followed by PRP and trabeculectomy with MMC. The eyes were divided into two groups: nine eyes with vitreous hemorrhage, fibrovascular membrane and/or retinal detachment were placed in the Proliferation group; and 16 eyes without vitreous hemorrhage, fibrovascular membrane, or retinal detachment were placed in the PC (photocoagulation) group. These eyes had vitrectomy performed so that PRP could be safely performed from ora to ora. The surgical outcome in the two groups was assessed by Kaplan-Meier survival analysis. The criteria for success were a postoperative intraocular pressure (IOP) ≤21 mmHg and a preservation of light perception.Results In the Proliferation group, Kaplan-Meier life-table analysis showed that the success rate was 55.6% after 1 year and 18.5% after 2 years. The success rate in the PC group was 81.2% from 1 to 3 years after surgery. The surgical outcome was significantly better in the PC group than in the Proliferation group (P=0.009). In the Proliferation group, four eyes had preoperative vitreous hemorrhage, three eyes had a fibrovascular membrane, and two eyes had a retinal detachment. Three of four eyes with vitreous hemorrhage achieved good IOP control. On the other hand, the IOP of all eyes with retinal detachment and fibrovascular membrane were not lowered significantly.Conclusions Complete PRP combined with trabeculectomy with MMC can effectively reduce the elevated IOP in eyes with NVG. However, this combined treatment is not effective in eyes with proliferative membranes and retinal detachments.     

Timely vitrectomy without intraocular lens removal for acute endophthalmitis after cataract surgery

AIM: To investigate the clinical features, causative organisms and effects of timely vitrectomy and silicone oil tamponade without intraocular lens (IOL) removal in the treatment of acute-onset endophthalmitis after cataract surgery (APCE). METHODS: We retrospectively analyzed the clinical features and microbiological factors in 10 eyes of 10 patients with APCE at Tianjin Medical University General Hospital from January 2010 to December 2018. Data on the clinical features, causative organisms, visual acuity, intraocular pressure (IOP) and complications were collected. The mean follow-up period was 25.5mo. RESULTS: The mean age of the patients was 71.4y. The mean time between cataract surgery and the onset of endophthalmitis was 2.0d. Preoperative visual acuity ranged from no light perception to hand motion. After vitrectomy, the visual acuity increased in nine eyes (90%), and was unchanged in one eye (10%). A significant difference was observed between the mean preoperative (36.3±7.1 mm Hg) and postoperative IOP (14.9±4.3 mm Hg, P<0.05). Staphylococcus epidermidis was isolated in 5 eyes, S. aureus in 2 eyes, and Enterococcus in 1 eye. Postoperative complications mainly included fibrin exudates in the anterior chamber at the early stages in all eyes and temporary IOP elevation in one eye. No retinal detachment or ocular atrophy was observed during the follow-up period. CONCLUSION: Under systemic antibiotic treatment and timely diagnosis, vitrectomy and silicone oil tamponade without IOL removal is a safe and effective method for APCE.