A pars plana filtering procedure combined with lensectomy and vitrectomy for neovascular for neovascular glaucoma

In 14 eyes undergoing a pars plana filtration procedure combined with pars plana lensectomy and vitrectomy, the most common complication was a severe sterile fibrinous vitritis. However, after a mean follow-up period of 6.3 months, intraocular pressure was controlled in five eyes (36%) after the procedure alone, in two (14%) after subsequent medical therapy, and in three (21%) after subsequent cyclocryotherapy. Preoperative visual acuity was maintained or improved in nine of the eyes (64%), whereas four eyes (28%) had no light perception.     

玻璃体切割联合引流阀植入治疗伴玻璃体积血的新生血管性青光眼

目的:评价玻璃体切割联合引流阀植入治疗伴玻璃体积血的新生血管性青光眼的效果。方法:对30例(30眼)伴玻璃体积血的新生血管性青光眼患者采用玻璃体切割联合Ahmed青光眼引流阀植入术治疗,术后随访10~20(平均12)mo。结果:术后眼压控制在6.0~21.0mmHg25眼(其中3例需加用一种降眼压药物),3例眼压>21.0mmHg,2例长期低眼压,成功率83%。结论:玻璃体切割联合引流阀植入治疗伴玻璃体积血的新生血管性青光眼,术后成功率高,视力有所提高,并发症少。     

Ahmed青光眼阀植入联合玻璃体切割术治疗伴玻璃体积血的新生血管性青光眼的临床观察

目的探讨Ahm ed青光眼阀植入联合玻璃体切割术治疗伴有玻璃体积血新生血管性青光眼的效果。方法回顾性分析48例(52只眼)因新生血管性青光眼伴有玻璃体积血接受玻璃体切割及联合白内障摘除、全视网膜光凝及Ahm ed青光眼阀植入患者的病例资料。手术前视力光感~0.3,眼压平均42mmHg(38~65mmHg)(1mmHg=0.133kPa),平均随访10个月(6~15个月)。结果手术后视力光感~0.3;眼压平均18mmHg(10~34mmHg),显著低于手术前眼压(P<0.05);并发症主要包括前房及玻璃体内炎性渗出(3只眼)、玻璃体内再出血(3只眼)、术后一过性低眼压(5只眼)、1~2周内高眼压(4只眼)、手术后脉络膜上腔出血(2只眼)、视网膜脱离(1只眼)。结论玻璃体切割联合白内障摘除、全视网膜光凝及Ahm ed青光眼阀植入术可能是治疗某些新生血管性青光眼伴有玻璃体积血的有效方法.     

睫状体平坦部青光眼阀植入联合玻璃体切除全视网膜光凝治疗新生血管性青光眼的临床观察

目的:评估平坦部青光眼阀植入联合玻璃体切除全视网膜光凝术治疗继发性闭角型新生血管性青光眼(neovascular glaucoma,NVG)的临床效果。方法:对2007-05/2008-08在我科治疗的连续伴玻璃体积血的继发性闭角型NVG患者14例16眼行玻璃体切除视网膜光凝联合平坦部青光眼阀植入术并随访观察。结果:术后追踪随访3～13(平均7.3)mo。16只术眼中,除3眼外视力均不同程度提高。经秩和检验术前和术后两组相差显著。眼压由术前用降压药后的38～67(平均48.5±9.3)mmHg降至15.6～25.3(平均16.5±6.9)mmHg,两组相差有统计学意义。4眼出现术后并发症。其中2眼角膜水肿、前房炎症。1眼脉络膜脱离。经药物对症治疗后缓解。1眼出现医源性白内障。结论:玻璃体切除全视网膜光凝联合平坦部青光眼阀植入术是有效和安全的。特别是对于伴浅前房的NVG患者是一种新的治疗选择。     

Cataract surgery results after pars plana vitrectomy

Continuous refinements in vitreoretinal surgical techniques and an increasing number of posterior segment disorders are being successfully managed with pars plana vitrectomy (PPV). This has resulted in an increase in the number of vitrectomized eyes seen by cataract surgeons. Cataract surgery in previously vitrectomized eyes has been reported to be more challenging than in eyes without previous vitrectomy. Special considerations and precautions are often required before, during, and after the surgery to successfully address these challenges. Several studies have reported that phacoemulsification with intraocular lens implantation after PPV is a relatively safe procedure that can improve visual acuity and quality of life. The extent of visual improvement may be limited only by retinal comorbidity.     

增生型糖尿病视网膜病变微创玻璃体切割手术后新生血管性青光眼的危险因素分析

目的分析增生型糖尿病视网膜病变(PDR)25G玻璃体切割手术(PPV)后发生新生血管性青光眼(NVG)的危险因素。方法回顾性病例研究。2017年1月至2018年12月在天津医科大学眼科医院首次行PPV治疗的PDR合并玻璃体积血(VH)患者340例340只眼纳入研究。其中,男性185例,女性155例;平均年龄(55.79±10.82)岁。患者平均糖尿病病程(13.01±7.70)年;平均空腹血糖(7.55±2.15)mmol/L。合并冠心病19例,合并脑梗死20例。所有患眼均行最佳矫正视力(BCVA)、眼压、间接检眼镜、彩色眼底照相等检查。BCVA检查采用国际标准Snellen视力表进行,并将结果换算为最小分辨角对数(logMAR)视力记录。患眼平均logMARBCVA2.04±0.73,平均眼压(15.45±2.93)mmHg(1 mmHg=0.133kPa)。VH持续时间3周?6个月,平均时间(2.98±1.46)个月。340只眼中,Ⅳ期93只眼(27.35%),Ⅴ期107只眼(31.47%),Ⅵ期116只眼(34.12%);伴牵引性视网膜脱离(TRD)83只眼。所有患眼均行25G标准经睫状体平坦部三通道PPV。57只眼手术前3d行玻璃体腔注射抗血管内皮生长因子(VEGF)药物治疗,234只眼手术中剥除内界膜,262只眼同时行白内障超声乳化手术,141只眼手术完毕时行玻璃体腔注射抗VEGF药物治疗。手术后随访至少12个月,平均随访时间(10.80±5.79)个月。以裂隙灯显微镜或房角镜检查发现虹膜和(或)房角存在新生血管且眼压〉21mmHg者诊断为NVG。采用Kaplan-Meier法和Cox单因素、多因素回归分析手术前基线因素、眼部因素、手术因素与手术后NVG发生的关系。结果340只眼中,PPV后发生NVG者66只眼(19.41%);发生NVG的时间为手术后6?335 d,平均时间为(98.00±5.79)d。PPV后第3、6、12个月,NVG发生风险比分别为11.50%、15.29%、20.75%。单因素Cox分析结果表明,年龄、合并冠心病或脑梗死疾病等手术前基线因素对手术后发生NVG有影响(P<0.05);PDR分期、合并TRD、手术前logMAR BCVA、手术前眼压等眼部因素对手术后发生NVG无影响(P>0.05);联合白内障超声乳化手术、手术中剥除内界膜、手术前3d玻璃体腔注射抗VEGF药物等手术因素对手术后发生NVG有影响(P<0.05)。将Cox单因素分析有意义的变量纳入多因素Cox比例风险模型进行分析,逐步回归探索手术后NVG的影响因素。结果显示,年龄、合并冠心病或脑梗死、联合白内障超声乳化和手术中内界膜剥除是手术后发生NVG的独立风险预测因素(P<0.05)。结论低龄、合并冠心病或脑梗死、联合白内障超声乳化手术是PDR患者PPV后发生NVG的危险因素,手术中剥除内界膜可减少NVG的发生。     

Long-term results of silicone tube in filtering surgery for eyes with neovascular glaucoma

We operated on 59 eyes with advanced neovascular glaucoma (37 eyes in diabetic patients and 22 eyes in patients with central retinal vein occlusion) using a trabeculectomy technique that includes a simple silicone tube as the draining element. Mean (+/- 1 S.D.) intraocular pressure preoperatively was 57 +/- 8.7 mm Hg. During follow-up periods ranging from one to five years, the mean intraocular pressure decreased to 27 +/- 16.5 mm Hg. Adequate control of intraocular pressure (24 mm Hg or less) was achieved in 37 eyes (63%). Only four eyes required enucleation. Nine silicone tubes had to be removed because of necrosis of the scleral flap and conjunctival perforation or because they were expulsed. Surgery relieved the severe ocular pain even when intraocular pressure was not satisfactorily controlled.     

前部视网膜冷凝联合玻璃体切除术治疗中早期NVG

摘要目的:探讨前部视网膜冷凝联合玻璃体切除术治疗中早期新生血管青光眼(neovascular glaucoma,NVG)的临床效果。方法:采用前部视网膜冷凝联合玻璃体切除术治疗中早期新生血管青光眼31例31眼,术中全视网膜光凝。结果:患者31眼,术前眼压41.1±6.2mmHg,术后观察3~25(平均9.8)mo,眼压22.6±6.9mmHg,术前术后眼压差别具有统计学意义(P=0.002);25例眼压控制正常,眼压19.8±2.4mmHg,6例眼压34±8.2mmHg,其中3例局部药物治疗眼压控制正常,2例行二次手术,玻璃体腔青光眼阀植入术后,眼压控制满意,1例无效,患眼无光感,疼痛,行眼内容摘除术。20眼视力有不同程度的提高,5例视力不变,5例视力下降,1例无光感。30例虹膜面新生血管绝大部分或完全消退,角膜透明,前房无积血,所有病例眼部疼痛消失或明显缓解。结论:前部视网膜冷凝联合玻璃体切除术可消退虹膜面的新生血管,有利于术后眼压的控制,恢复部分视力,为中早期新生血管性青光眼提供了一个行之有效的治疗方案。     

Anterior pars plana vitrectomy for phakic malignant glaucoma

Phakic malignant glaucoma was seen in five eyes of four patients: it occurred in four eyes after trabeculectomy and in one eye after peripheral iridectomy. They were treated by anterior pars plana vitrectomy combined with intracapsular lens extraction through a corneal incision. In all eyes the anterior chamber regained its normal depth, and the intraocular pressure could be controlled by medical treatment in three eyes. The remaining two eyes required further filtering procedure and subsequently the intraocular pressure was controlled by medical treatment. No serious complications were encountered throughout the postoperative follow-up period of 7-26 months.     

Ahmed阀平坦部植入联合MMC治疗眼外伤玻切术后难治性青光眼

目的 观察Ahmed引流阀平坦部植入术联合MMC对眼外伤玻切术后难治性青光眼的治疗效果.方法 回顾性分析采用Ahmed引流阀平坦部植入术联合MMC治疗的17例眼外伤玻切术后难治性青光眼.结果 随访时间10～32个月,平均(14.5±2.3)个月.手术成功率为82.4％,其中完全成功率76.5％,视力保持不变和提高者88.2％,并发症为2例少量玻璃体积血,3例早期低眼压.结论 AGV平坦部植入联合MMC治疗眼外伤玻璃体切除术后无晶状体的难治性青光眼患者是一种有效的方法.     

Combined Molteno implantation and pars plana vitrectomy for neovascular glaucomas

Ten patients underwent combined Molteno implantation and pars plana vitrectomy as the primary nonlaser surgical treatment of neovascular glaucoma associated with diabetic retinopathy (9 patients) or central retinal vein occlusion (1 patient). Combined surgery was performed most frequently because media opacities precluded adequate preoperative retinal ablation. Follow-up ranged from 3 to 43 (mean +/- standard deviation, 18.0 +/- 13.2) months. Six patients achieved final intraocular pressures less than 22 mmHg. Visual acuities remained the same or improved in four patients. Four patients had uncomplicated courses. Among the other patients, complications included: recurrent vitreous hemorrhage and retinal detachment (3 patients each); hyphema (2 patients); and tube block, extensive fibrin formation, epiretinal membrane, and total retinal necrosis (1 patient each).     

Long-term results of pars plana vitrectomy in the management of complicated uveitis.

This retrospective study evaluates the long term efficacy of pars plana vitrectomy on the preservation of vision in complicated chronic uveitis, including endogenous intermediate uveitis and other entities. Combined vitrectomy-lensectomy was performed in 10 eyes with complicated cataracts, and 18 vitrectomies were done without lensectomies. The mean follow up was 45 months. Additional retinal surgery (for example, scleral buckling) was performed in five eyes. Visual acuity improved in 23 eyes (82.8%) following surgery, with 16 eyes (57%) achieving a vision better than 6/24. The main causes for vision less than 6/24 were persistent cystoid macular oedema (three eyes), macular puckers (one eye), retinal vascular obliterations (four eyes), optic atrophy (five eyes), and chorioretinal scars (seven eyes). Postoperative complications were cataract formation (seven eyes), cystoid macular oedema (one eye), and tractional retinal detachments (three eyes). The surgical intervention resulted in a remarkable reduction of the severity of inflammation or frequency of exacerbations, and allowed significant tapering (11 eyes) or withdrawal (11 eyes) of the topical steroids, or oral corticosteroids (10 cases). Pre-existent cystoid macular oedema resolved in three eyes. Pars plana vitrectomy, eventually combined with lensectomy, may visually rehabilitate eyes with chronic uveitis and media opacities, and may reduce the activity of disease postoperatively.     

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.     

Sutureless single-port transconjunctival pars plana limited vitrectomy combined with phacoemulsification for management of phacomorphic glaucoma

We describe a technique that uses a small-gauge, single-port, sutureless transconjunctival limited pars plana vitrectomy to facilitate phacoemulsification in eyes with a shallow anterior chamber and high intraocular pressure (phacomorphic glaucoma). These eyes have positive vitreous pressure, and anterior chamber formation with an ophthalmic viscosurgical device may not be possible. Surgery is difficult and prone to various intraoperative complications.     

眼前后段联合手术治疗复杂性眼病的远期疗效评价

目的 探讨临时人工角膜下行前后段联合手术治疗复杂性眼病的远期疗效。方法1994年6月至2001年6月,107例(107只眼)眼前后段复杂病变的患者于我院在临时人工角膜下行玻璃体视网膜手术,再联合穿透性角膜移植术,术后局部及全身应用糖皮质激素,并随访观察患者视力、眼压、角膜植片及眼底情况。手术治愈标准:(1)植片透明;(2)视网膜复位;(3)眼压正常或经药物控制眼压正常。结果 达到手术治愈标准者78只跟(72.9％),手术后眼球保存者92,只眼(86.0％),术后发生植片免疫排斥者34只眼(31.8％),眼球萎缩13只眼(12.2％),继发性青光眼15只眼(14.0％)。术前存在增生性玻璃体视网膜病变(PVR)患眼的视网膜手术治愈率与无PVR者比较,差异有显著意义(x2=3.90,P<0.05)。结论 临时人工角膜下眼球前后段联合手术是治疗角膜明显混浊合并玻璃体视网膜病变的有效方法。远期失败的主要原因是角膜植片内皮功能失代偿和增生性玻璃体视网膜病变。(中华眼科杂志,2004,40:514-516)     

睫状体平坦部滤过术与小梁切除术治疗新生血管性青光眼的比较

目的:比较睫状体平坦部滤过术(PPF)和小梁切除术(TRA)治疗新生血管性青光眼(NVG)的安全性和有效性。方法:回顾性分析2020-04/2021-04在我院治疗的NVG患者27例27眼,将行睫状体平坦部滤过术的患者12例12眼纳入PPF组,行小梁切除手术的患者15例15眼纳入TRA组。随访至术后3mo,观察患者的眼压、手术完全成功率、周边前房深度、术后前房形态改变、视力及并发症情况。结果:术后1、3d, 1wk, 1、3mo两组患者眼压均较术前显著降低(P<0.05),但两组间眼压无差异(P>0.05)。术后3mo, PPF组手术完全成功率显著高于TRA组(92%vs 53%,P<0.05)。术后1wk, PPF组周边前房深度较术前显著加深(P<0.05),TRA组周边前房深度较术前无显著改变(P>0.05),但PPF组周边前房深度较TRA组显著加深(P<0.05)。PPF组术后房角开放、前房加深。两组患者术前和术后3mo视力均无差异(P>0.05),且两组术后3mo视力较术前均无显著改变(P>0.05)。PPF组术后前房出血发生率低...