睫状体冷凝术联合玻璃体注射曲安奈德治疗新生血管性青光眼

目的 评价睫状体冷凝术联合玻璃体腔注射曲安奈德(TA)治疗新生血管性青光眼的效果.方法 对15例(15眼)新生血管性青光眼行睫状体冷凝180°范围6个点,每个点冷凝时间90～120 s,冷凝后玻璃体腔注射TA混悬液4 mg/0.1 mL.结果 眼压控制正常者13眼(86.67%),其余2眼眼压仍较高,但无眼痛症状.虹膜新生血管大部分消退13眼,部分消退2眼,无发生眼球萎缩者.结论 睫状体冷凝术联合玻璃体腔注射TA是治疗新生血管性青光眼的一种有效方法.     

睫状体冷凝联合睫状前动脉结扎及广泛视网膜光凝治疗新生血管性青光眼

目的睫状体冷凝联合睫状前动脉结扎及广泛视网膜光凝治疗新生血管性青光眼的临床效果。方法新生血管性青光眼20例,在球后麻醉下行睫状体冷凝联合睫状前动脉结扎术及广泛视网膜光凝,观察术后眼压、视力变化及虹膜新生血管消退情况。结果手术前后眼压变化有统计学意义（P〈0．05）、虹膜新生血管明显消退。结论该术式治疗新生血管性青光眼是一种安全,有效的方法。能有效地消退虹膜新生血管,控制眼压,消除眼痛症状。     

两种三联手术治疗新生血管性青光眼的疗效比较

目的:比较视网膜冷凝联合睫状体冷冻联合小梁切除术与视网膜冷凝联合睫状体冷冻联合全视网膜光凝术两种三联手术治疗新生血管性青光眼的疗效。方法:回顾分析2006-01/2010-04中国医科大学附属第一医院收治的69例71眼新生血管性青光眼病例,其中视网膜冷凝联合睫状体冷冻联合小梁切除术治疗37例37眼,视网膜冷凝联合睫状体冷冻联合全视网膜光凝术治疗32例34眼,观察治疗前后视力、眼压、虹膜新生血管消退情况及术后并发症。结果:两种方法治疗的患者术前与术后视力、眼压及虹膜新生血管消退情况均有统计学差异。术后并发症视网膜冷凝联合睫状体冷冻联合全视网膜光凝术低于视网膜冷凝联合睫状体冷冻联合小梁切除术。结论:视网膜冷凝联合睫状体冷冻联合小梁切除术及视网膜冷凝联合睫状体冷冻联合全视网膜光凝术两种方法治疗新生血管性青光眼均有明显疗效,但视网膜冷凝联合睫状体冷冻联合全视网膜光凝术术后并发症发生率较低。     

睫状体光凝与视网膜消融术治疗新生血管性青光眼

目的观察半导体激光经巩膜睫状体光凝联合视网膜消融术(全视网膜光凝或前部视网膜冷凝)治疗新生血管性青光眼的临床效果。方法12例12眼药物不能控制的新生血管性青光眼接受治疗。8眼睫状体光凝和全视网膜光凝，4眼同时行睫状体光凝和前部视网膜冷凝。术后随访6～19月，对比分析6月时的眼压、视力及虹膜新生血管改变。结果睫状体光凝前眼压36～67mmHg(1mmHg=0．133kPa)，平均45．52mmHg。末次治疗后6月，在不用抗青光眼药物的情况下，6眼(50％)眼压在9～17mmHg；局部滴用0．5％噻吗心胺滴眼液后4眼(33．33％)眼压低于21mmHg，2眼(16．67％)眼压高于21mmHg。视力下降者2眼，提高者2眼，不变者8眼。虹膜新生血管完全消失8眼，部分消失4眼。结论半导体激光经巩膜睫状体光凝联合视网膜消融术治疗新生血管性青光眼，既能及时降低眼压，又能减少视网膜缺血，拯救现有或潜在视力。     

部分睫状体冷凝联合小梁切除治疗新生血管性青光眼

目的评价部分睫状体冷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（32眼）药物难于控制的新生血管性青光眼,首先进行180°范围内睫状体冷凝然后联合施行巩膜瓣下小梁切除与虹膜周边切除,术中巩膜瓣下应用丝裂霉素C。术后处理同常规小梁切除术。随访时间6～12个月。结果32例术后第1周眼压较术前明显降低。随访期间眼压控制良好。功能性滤过泡（Ⅰ型和Ⅱ型）87．96％,非功能性滤过泡（Ⅲ型）5．06％,薄壁滤过泡3．65％。结论采用180°范围内睫状体冷凝联合施行巩膜瓣下小梁切除联合应用MMC治疗新生血管性青光眼,是一种较安全有效的综合治疗方法。     

新生血管性青光眼不同手术疗法的疗效对比

目的:对比经巩膜睫状体光凝术和睫状体冷凝术对于新生血管性青光眼的疗效。方法:选取2006年在我院住院的38例43眼新生血管性青光眼患者,一组采用常规睫状体冷凝术18眼,另一组采用810nm激光经巩膜睫状体光凝术治疗25眼,术后处理相同,术后12wk随诊期内观察患者眼部表现、视力、眼压情况。结果:睫状体冷凝组11眼(61%)、睫状体光凝组20眼(80%)术后3mo眼压稳定于11~24mmHg之间,各组术前、后眼压对比,差异均有高度统计学意义(P=0.000);组间术后眼压对比,差异无统计学意义(P=0.669)。睫状体冷凝组10眼(56%)、睫状体光凝组21眼(84%)视力保存,差异有统计学意义(P=0.040)。所有患者术后2wk虹膜新生血管开始逐渐减少,睫状体冷凝患者术后均有明显球结膜充血水肿,并颜面浮肿、眼痛、头痛;睫状体光凝患者术后仅有轻度球结膜混合充血,无颜面部浮肿、头痛及眼痛、前房出血。结论:治疗新生血管性青光眼,睫状体冷凝术及经睫状体激光光凝术控制眼压效果确切;而睫状体激光光凝术手术具有视力保存率高、并发症少,患者术后痛苦少等优点。     

全周边视网膜及睫状体冷凝治疗新生血管性青光眼12例

目的：探讨因某种原因不能行全视网膜光凝治疗的新生血管性青光眼进行全周边视网膜睫状体冷凝治疗的效果。方法：对失明的屈光间质混浊或小瞳孔不能行全视网膜光凝治疗的新生血管性青光眼12例12眼进行全周边视网膜及睫状体冷凝术,根据病史长短及高眼压程度不同选择不同数量的冷凝点,每点冷凝30～40s。结果：所有病例眼压均得到控制症状缓解,虹膜新生血管消失,眼球萎缩2例。结论：对于屈光间质混浊等无法进行全视网膜光凝治疗的新生血管性青光眼,尤其是已丧失视功能全周边视网膜及睫状体冷凝是一种有效的治疗方法。     

前部视网膜冷凝联合复合式小梁切除治疗新生血管性青光眼

目的观察前部视网膜冷凝联合丝裂霉素C浸润小梁切除术治疗新生血管性青光眼的临床效果。方法采用前部视网膜冷凝联合丝裂霉素C浸润小梁切除术治疗新生血管性青光眼37例（37眼）,以降低眼压,解除症状。术后随访4～12个月。结果30眼1次手术眼压控制,4眼2次手术眼压控制（第2次手术为睫状体冷凝术）,13眼视力不同程度提高,1眼术后长期观察眼压高且症状不能缓解行眼球摘除术。结论对于晚期新生血管性青光眼采用本术式可以有效控制眼压,保留残余视力。     

全视网膜冷凝联合睫状体冷冻治疗晚期新生血管性青光眼

目的探讨全视网膜冷凝联合睫状体冷冻术治疗晚期新生血管性青光眼的疗效。方法对2011年1月到2013年2月间在我院住院的18例18眼晚期新生血管性青光眼患者使用全视网膜冷凝加睫状体冷冻术治疗的临床资料进行回顾性分析。结果所有患者出院后随访12-15月,15眼眼压控制正常,虹膜表面新生血管消退,成功率达83%。2眼术后眼压在31-34mm Hg,给予贝特舒眼药水后眼压控制正常。1眼术后眼压大于35 mm Hg,一月后给予第2次冷冻治疗,术后眼压控制正常。结论全视网膜冷凝联合睫状体冷冻治疗晚期新生血管性青光眼不仅是一种简单、经济、而且是一种控制晚期新生血管性青光眼的眼压,解除患者临床症状的有效方法。     

激光光凝联合小梁切除术与睫状体冷冻术治疗新生血管性青光眼疗效观察

评价氪多波长激光视网膜广泛光凝或虹膜局部光凝联合小梁切除术治疗新生血管性青光睛与睫状冷冻术治疗的疗效比较。方法新生血管性青光眼64眼,其中32眼先用氪激光对视网膜广泛光凝或虹膜局部光凝后再进行小梁切除术另外32眼行睫状体冷冻治疗。结果术后（1～12）个月观察及随访,激光光凝联合小梁切除术32眼,28眼眼压〈21mmHg;睫状体冷冻术治疗的32眼,14眼（43.1%）眼压〈21mmHg,10眼术后降眼压药物治疗眼压仍不能控制,8眼眼球萎宿。结论激光光凝联合小梁切除术治疗新生血管性青光眼,疗效确定,较睫状体冷冻术治疗成功率高。     

睫状体冷凝小梁切除联合丝裂霉素C治疗新生血管性青光眼

目的探讨新生血管性青光眼的治疗方法。方法 30例（30眼）新生血管性青光眼临床随机分为睫状体冷凝组（17例）和睫状体冷凝联合小梁切除术及丝裂霉素C（MMC）应用组（13例）。两组术后均局部应用典必殊滴眼液及预防性抗感染治疗。术后随访1个月～5a。结果睫状体冷凝组的治疗成功率为47.06%,睫状体冷凝联合小梁切除及MMC应用组的成功率为92.31%,二者差异有统计学意义（P〈0.05）。结论睫状体冷凝联合小梁切除术及MMC的应用是一种治疗新生血管性青光眼的较有效的方法。     

新生血管性青光眼联合治疗疗效分析

目的：观察抗血管内皮生长因子( vascular endothelial growth factor,VEGF)药物玻璃体腔内注射及全视网膜光凝( panretinal photocoagulation,PRP)后联合滤过手术治疗新生血管性青光眼的疗效。方法：对21例23眼患者中屈光介质透明者行抗 VEGF药物玻璃体腔内注射及PRP后新生血管消退后行复合式小梁切除术,屈光介质混浊患者行白内障或玻璃体切除术及全视网膜光凝联合复合式小梁切除术,随访3mo,对治疗前后眼压情况进行比较。结果：患者1例1眼视力提高显著,其余患者视力稳定或略有提高,所有患者虹膜新生血管均有不同程度消退。治疗前后眼压比较有统计学差异(P<0.01),所有患者均未出现术中术后严重并发症。结论：抗VEGF药物玻璃体腔内注射及PRP清除虹膜新生血管后联合滤过手术可以较快、较好地控制眼压,可有效治疗新生血管性青光眼。     

On the relevance of the long-time follow-up of the cyclocryotherapy

In spite of the availability of cyclocryodestructive laser therapy there still appears to be an indication for cyclocryotherapy in different kinds of glaucoma. PURPOSE: Cyclocryotherapy very often appears to be the operation of choice in cases of progressive functional visual loss if a patient is not sufficiently helped with the maximum tolerated medical therapy. We investigated long-term IOP effects and possible complications in our group of patients undergoing cyclocryotherapy. PATIENTS: Cyclocryotherapy was performed on 109 eyes of 97 patients from 1988 to 1994. Cyclocryotherapy was performed as follows: 67 of 109 eyes were controlled for IOP for an average of 10 months (3-41 months). We applied cryotherapy six times 3-4 mm behind the limbus for an average duration of 50 to 60 s over half of the circumference. RESULTS: We achieved satisfactory IOP control (IOP K 22 mm Hg) in 40 eyes, however, with 30 additional operations. One eye developed phthisis bulbi, and 3 other eyes became blind because of complications in neovascular glaucomas. Neovascular glaucoma cases responded the least. CONCLUSIONS: Cyclocryotherapy produced a statistically significant IOP reduction in eyes with primary open-angle glaucoma or secondary glaucoma. Close long-term follow-up appears advisable in order to check the eyes for possible increase in IOP or complications of surgery.     

睫状体冷冻联合小梁切除术治疗晚期新生血管性青光眼

目的　探讨睫状体冷冻联合小梁切除术治疗晚期新生血管性青光眼的疗效。方法　对 2 2例 2 2眼不同原因引起的新生血管性青光眼采取该术式 ,以降低眼压 ,解除症状 ,术后随访 3～ 36个月。结果　术后各眼视力基本保持不变 ;眼压控制在 6 .46～ 2 0 .5 5 m m Hg(1k Pa=7.5 mm Hg)者 12眼(5 4.5 % ) ;2 0 .5 5～ 2 8.0 1mm Hg者 5眼 (2 2 .7% )配合眼球按摩后眼压下降 ;眼压 >2 8.0 1mm Hg者 4眼 (18.2 % ) ;<6 .46 mm Hg者 1例 ,术后 1a眼球萎缩。眼部刺激症状消失或减轻者 19眼 (86 .3% ) ,不能缓解者 3眼 (13.6 % ) ,于术后 2～ 6个月行眼球摘除术。虹膜表面及瞳孔缘新生血管均减少 ,13眼 (5 9% )术后 0 .5 a冷冻区域新生血管消失。结论　对于较晚期视功能差 ,眼部不适症状明显的新生血管性青光眼采用本术式可有效控制眼压 ,缓解症状 ,减少眼球摘除机会     

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。     

Retrobulbar catheter technique for postoperative titratable analgesia after glaucoma surgery

PURPOSE: To assess an indwelling retrobulbar catheter for delivery of intraoperative anesthesia and postoperative analgesia in patients undergoing painful cyclodestructive and retinal destructive procedures as treatment of neovascular glaucoma. PATIENTS AND METHODS: The prospective clinical interventional study included all 11 patients undergoing cyclocryocoagulation and/or retinal exocryocoagulation as treatment of neovascular glaucoma due to proliferate ischemic retinopathies. Using a commercially available retrobulbar needle with a diameter of 0.80 mm and a length of 38 mm, 7 mL of a local anesthetic were injected. Through the same needle, a 28-gauge commercially available flexible catheter was introduced into the retrobulbar space, the needle was withdrawn, and the catheter was fixed in place. When the patients began to feel pain during or after surgery, 2 mL of a local anesthetic were reinjected through the catheter. The catheter was removed 24 hours after surgery. RESULTS: Due to increasing pain in the postoperative period, 8 (72.7%) patients received a reinjection 156.3 +/- 94.6 minutes after the preoperative injection. Seven (63.6%) patients requested a second reinjection 268.6 +/- 45.7 minutes after the preoperative injection, and three (27.3%) patients requested a third postoperative injection 333.3 +/- 79.1 minutes after the preoperative injection. Reinjection of the local anesthetic through the catheter markedly decreased the pain within 5 minutes of injection in all patients. CONCLUSIONS: Avoiding side effects of systemic analgesics and sedatives, an indwelling retrobulbar catheter for repeat postoperative injections of local anesthetics is useful and effective for titratable postoperative analgesia after painful cyclodestructive or retinal destructive surgery as treatment of neovascular glaucoma.     

超全视网膜光凝联合玻璃体腔注射康柏西普治疗新生血管性青光眼

目的:观察玻璃体腔注射康柏西普联合超全视网膜光凝(extra-panretinal photocoagulation,E-PRP)治疗新生血管性青光眼的临床疗效.方法:回顾总结2015-01/12我院住院和门诊就诊的视网膜中央静脉阻塞(central retinal vein obstruction,CRVO)继发性青光眼16例16眼患者,行玻璃体腔注射康柏西普1.0mg,再联合E-PRP.观察治疗前后眼压、视力、新生血管消退情况及并发症出现情况.结果:末次随访16眼,虹膜及房角新生血管全部消退.治疗前眼压42 ～ 65(平均50.85±6.97)mmHg,治疗后平均眼压在各观察节点均有显著下降,治疗前后眼压相比较有统计学差异(P＜0.05).末次随访时视力与术前相比不变者12眼,提高2行以上者2眼,下降2行以上者2眼,末次随访时视力与术前相比无统计学差异(P＞0.05).未发生眼内炎、视网膜脱离等严重并发症.结论:玻璃体腔注射康柏西普联合超全视网膜光凝治疗新生血管性青光眼疗效可靠.     

Life expectancy of patients with neovascular glaucoma drained by Molteno implants

PURPOSE: To determine the survival of patients with sighted eyes who had Molteno implants inserted for neovascular glaucoma. METHODS: Patients who had Molteno implants inserted for neovascular glaucoma between October 1977 and March 2001 at Dunedin Hospital, New Zealand, were reviewed. Relative survival analysis was then used to compare survival in this group to survival of the New Zealand population of the same age. RESULTS: A total of 114 patients had 131 Molteno implants inserted for neovascular glaucoma. Neovascular glaucoma was secondary to central retinal vein occlusion in 66 eyes (50%) and diabetes in 42 eyes (32%), and patients lost 52% or 6.53 years of their expected remaining life span. Age, sex and postoperative intraocular pressure control did not predict survival. The only predictor of improved survival was a preoperative visual acuity of 6/48 or better. These patients lost 21% (or 2.43 years) of expected remaining life compared to 62% (or 10.78 years) in those patients who had a presenting visual acuity of 6/60 or worse. CONCLUSIONS: Patients with neovascular glaucoma had a markedly reduced life expectancy, which has improved in recent years when compared to that of the normal sex and age-matched New Zealand population. Patients presenting with better vision (6/48 or better) survived significantly longer than those presenting with poorer vision.     

玻璃体内注射康柏西普联合手术及全视网膜光凝治疗新生血管性青光眼

目的　观察玻璃体内注射康柏西普联合复合式小梁切除术或青光眼引流阀植入术及全视网膜光凝治疗新生血管性青光眼的临床效果。方法　对１７例（１７眼）新生血管性青光眼患者行玻璃体内注射康柏西普眼用注射液０．０５ｍＬ（１０ｇ·Ｌ－１）,待新生血管消退后行复合式小梁切除术或青光眼引流阀植入术及全视网膜光凝,术后平均随访３个月。结果　所有患者治疗后眼压控制完全成功者１０眼（５８．８２％）,部分成功者７眼（４１．１８％）。末次随访时７眼（４１．１８％）矫正视力提高,８眼（４７．０６％）视力稳定,２眼（１１．７６％）视力降低。所有患者均未出现与玻璃体内注射药物相关并发症。结论　玻璃体内注射康柏西普联合手术及激光治疗新生血管性青光眼是安全有效的。