减压阀引流术治疗新生血管性青光眼

为评价青光眼减压阀引流术治疗新生血管性青光眼,在视网膜血管性疾病、糖尿病、眼外伤所致的新生血管性青光眼２９例２９眼施行青光眼减压阀引流术,植入Ａｈｍｅｄ减压阀２０眼,Ｋｒｕｐｉｎ减压阀９眼。青光眼控制标准为６ｍｍＨｇ≤眼压≤２１ｍｍＨｇ,视功能保持或有所改善。结果：手术总成功率７５．８６％,眼压从术前平均５２．５６±１４．５１ｍｍＨｇ下降到２０．１５±１３．２６ｍｍＨｇ,平均随访１７．８３个月。有７眼在眼压正常后虹膜新生血管完全消退。术后３个月成功率７９．３１％,６个月成功率７６．１９％,１年成功率６６．６７％。主要手术并发症有前房导管口阻塞１３．７９％,浅前房１０．３４％,前房出血３．４５％。结论：青光眼减压阀引流术治疗新生血管性青光眼获得较为满意的疗效,是目前值得推荐的治疗选择。     

贝伐珠单抗联合青光眼阀治疗新生血管性青光眼的早期疗效观察

目的观察玻璃体腔注射贝伐珠单抗联合青光眼阀植入术治疗新生血管性青光眼（NVG）的早期疗效。方法对2013年4月至2014年10月在我科行贝伐珠单抗联合青光眼阀植入术治疗的NVG患者39例（40只眼）,先行玻璃体腔注射贝伐珠单抗0．06 ml（1．5 mg）,手术后1～2周待虹膜新生血管消退后行青光眼阀植入术。术后观察视力、眼压、角膜水肿程度、虹膜新生血管消退情况及术中、术后并发症,随访1个月。结果玻璃体腔注射贝伐珠单抗后1～2周内40只眼虹膜新生血管均明显消退。青光眼引流阀植入术后,38只眼眼压≤21 mmHg,2只眼联合1～2种抗青光眼药物眼压≤21 mmHg,术后1个月检查平均眼压（9．38±5．17）mmHg,与术前平均眼压（44．76±10．59）mmHg比较,差异有统计学意义（t ＝19．62,P ＝0．000）。眼压控制后患者角膜水肿均获得改善。视力较手术前无改善。全部病例在玻璃体腔注射贝伐珠单抗及青光眼阀植入术中未发生并发症。术后早期并发症包括前房消失9只眼,引流管移位2只眼,引流管内口阻塞1只眼,局限出血性脉络膜脱离1只眼。结论贝伐珠单抗联合青光眼阀治疗NVG成功率较高,术后早期眼压控制良好,并发症少,是目前治疗NVG较好的选择,其长期疗效需进一步观察。     

Ahmed青光眼阀植入术治疗新生血管性青光眼临床观察

目的评价Ahmed青光眼阀（AGV）植入术治疗新生血管性青光眼（NVG）的有效性及安全性。方法收集42例（43只眼）行AGV植入术的病例资料,其中实验组30例（31只眼）NVG行AGV植入术,术中采用可松解缝线（可拆缝线＋可吸收6-0Vcryl缝线结扎引流管）,观察术后并发症、眼压、手术成功率,并与既往未采用可松解缝线的12例（12只眼）对照组进行比较分析。结果术后早期Ⅱ级以上浅前房的发生率：实验组2例,2/31（6.45%）,对照组8例,8/12（66.67%）,浅前房的发生率两组间有显著性差异（P〈0.01）。实验组随访6～48个月,平均（12.29±5.18）个月,最后随访平均眼压（23.4±4.0）mmHg,显效率为54.84%,好转率为19.35%,有效率为74.19%;对照组随访6～48个月,平均（11.08±3.08）个月,最后随访平均眼压（27.8±5.0）mmHg,显效率为50.00%,好转率为16.67%,有效率为66.67%。两组眼压控制情况的比较无显著性差异（P=0.902）。结论 Ahmed青光眼阀植入术是NVG的有效治疗手段,联合丝裂霉素C（MMC）可提高手术成功率,采用可松解缝线可减少术后浅前房的发生。     

减压阀引流和睫状体冷冻术治疗新生血管性青光眼疗效分析

目的比较减压阀引流术和睫状体冷冻术治疗新生血管性青光眼的疗效和并发症.方法将1993年1月至1998年9月间分别施行这两种术式的年龄和病因基本匹配的两组患者进行比较,其中减压阀引流术组32例(32眼),睫状体冷冻术组29例(29眼).结果减压阀引流术组出院时成功率为84.4%,平均随访24个月,成功率为52.6%.睫状体冷冻术组出院时成功率为27.6%,平均随访32个月,成功率为47.1%.两组远期效果比较无显著性差异(P＞0.05).减压阀引流术组未见严重并发症,睫状体冷冻术组有2眼发生眼球萎缩.结论减压阀引流术能较安全、有效的治疗新生血管性青光眼,特别是存有视功能的患者,睫状体冷冻术存在严重的并发症,可用于绝对期和近绝对期的患者.     

青光眼引流器植入术在新生血管性青光眼治疗中的疗效观察

目的观察青光眼引流器植入术对新生血管性青光眼的治疗作用。方法回顾性总结33例新生血管性青光眼行青光眼引流器植入术的治疗结果。结果术后眼压控制较好,视力损伤小,并发症少。结论青光眼引流器植入术恢复快,对视力损伤小,对新生血管性青光眼是一种疗效较好的治疗方法。     

Pars plana Ahmed implantation combined with 23-gauge vitrectomy for refractory neovascular glaucoma in diabetic retinopathy

Purpose

To evaluate the efficacy and safety of a pars plana Ahmed valve implantation combined with 23-gauge sutureless vitrectomy in the treatment of patients with medically uncontrolled neovascular glaucoma (NVG) in proliferative diabetic retinopathy (PDR).

Methods

The authors retrospectively reviewed the records of 11 consecutive patients with refractory NVG in PDR who underwent a 23-gauge sutureless vitrectomy combined with pars plana placement of an Ahmed valve implant. Control of intraocular pressure (IOP), pre- and postoperative best-corrected visual acuity and the development of intra- and postoperative complications were evaluated during the follow-up.

Results

The mean follow-up was 12.2 months (range, 8 to 25 months). Mean preoperative IOP was 35.9 ± 6.3 mmHg and mean postoperative IOP at the last visit was 13.3 ± 3.2 mmHg. Control of IOP (8 to 18 mmHg) was achieved in all patients, but 91% (10 of 11 patients) needed antiglaucoma medication (mean number of medications, 1.2 ± 0.6). Postoperative visual acuity improved in 11 eyes, and the logarithmically to the minimum angle of resolution mean visual acuity in these eyes improved from 1.67 ± 0.61 to 0.96 ± 0.67. The complications that occurred were transient hypotony in one case, transitory hypertension in two cases, and postoperative vitreous hemorrhage which spontaneously cleared in two cases.

Conclusions

We suggest the combination of 23-gauge pars plana vitrectomy and Ahmed valve implantation is safe and effective in PDR patients with refractory NVG.     

两阶段房水引流物植入术在新生血管性青光眼治疗中的应用

目的：探讨两阶段房水引流物植入手术在新生血管性青光眼治疗中的应用价值。方法：对１３例新生血管性青光眼患者行两阶段房水引流物植入手术,并根据不同的病因及眼压控制情况采取相应的改良技术和辅助治疗,病人追踪随访时间为６～１２个月。结果：所有病例术前眼压大于等于２３ｍｍＨｇ（３．０５ｋＰａ）,手术治疗后最后一次复查结果显示眼压控制在６～２１ｍｍＨｇ（０．７９８～２．７９３ｋＰａ）之间７例（约占５４％）,加用降眼压药后眼压控制在２１ｍｍＨｇ（２．７９３ｋＰａ）２例,总成功率近７０％。８例视力保持在术前水平或有所提高（占６２．３％）,５例由于原发病恶化及眼压控制不良,视力较术前下降（占３７．６％）。结论：两阶段房水引流物植入手术为新生血管性青光眼的治疗提供了新的选择     

Angle closure glaucoma as initial manifestation of melanocytoma of the optic disc

A 44-year-old man had progressive visual loss and pain due to angle-closure glaucoma associated with a papillary pigmented lesion. The eye was enucleated because of intractable pain and the suspicion of a malignant tumor. Histologic and electron microscopic examination of the enucleated eye revealed a partially necrotic melanocytoma of the optic nerve. There was histologic evidence of vaso-occlusive disease within the optic nerve that resulted in ischemic necrosis of the tumor, hypoxic retinopathy and neovascular glaucoma. This report emphasizes that significant complications may occur in otherwise typical intraocular nevi.     

新生血管性青光眼术中应用甲基纤维素的意义

目的 探讨简单而有效的治疗新生血管性青光眼的手术方法。方法 小梁切除中使用2％甲基纤维素。观察术后10天及术后的效果。结果 术后10天手术成功率为86.96%，术后半年手术成功率为76.92%。结论 小梁切除术中使用甲基纤维素可提高新生血管性青光眼的手术成功率，减少术中及术后并发症。     

Personalized treatment of uveal melanoma

Personalized treatment of uveal melanoma involves the tailoring of all aspects of care to the condition, needs, wishes, and fears of the patient, taking account of the individual''s circumstances. When selecting between radiotherapy, surgical resection, and phototherapy, or when deciding how best to combine these different therapeutic modalities, it is necessary to understand the patients utilities, with respect to tumour control, visual conservation, and preservation of the eye, so as to prioritize outcomes accordingly. For example, such considerations would influence the width of the safety margins when administering radiotherapy, according to whether the patient considers it more important to conserve vision or to guarantee tumour control. With ‘suspicious naevi'', the choice between observation, immediate treatment, and biopsy is complicated by the lack of adequate survival data on which to base rational decisions, making it necessary for both patient and doctor to accept uncertainty. Personalized care should involve close relatives, as appropriate. It must also adapt to changes in the patient''s needs over time. Such personalized care demands the ability to respond to such needs and the sensitivity to identify these requirements in the first place. Personalized treatment enhances not only the patient''s satisfaction but also the ‘job satisfaction'' of all members of the multidisciplinary team, improving quality of care.     

Multicentric recurrent uveal melanoma

Uveal melanoma is a rare malignancy originating from melanocytes within the uveal tract of the eye. True multifocal uveal melanomas (>2melanomas in 1 eye) occurring in the same eye are very rare. We report a clinically and histologically well-documented case of a patient who presented with 3 uveal melanoma lesions in the same eye over a span of 2.5 years. The eye had to be enucleated finally and diagnosis confirmed histologically. This case report highlights the need for a close follow-up, even after successful treatment of the presenting lesion in uveal melanomas.     

冷凝联合810激光治疗新生血管性青光眼

目的 探讨冷凝联合810激光治疗新生血管性青光眼的方法和效果。方法 对12例中11例严重的新生血管性青光眼患者实行分段性治疗，先行赤道部巩膜外冷凝，7天后再行睫状体810激光光凝。另1例直接行810激光光凝，术后前房积血、渗出、反应重。结果 所有病例术中及术后无严重并发症，一次治疗眼压控制10例，占83.33%，2例接受二次治疗。术后眼压控制且视力提高者占75％。讨论 赤道部巩膜外冷凝联合810激光睫状体光凝是一种治疗新生血管性青光眼的有效方法。     

新生血管性青光眼的手术治疗（附76例分析）

报告７６例７８眼新生血管性青光眼各类手术的分析。术前平均眼压为６．８５ｋＰａ。５８眼硅管阀门植入术后平均眼压２．６７ｋＰａ，小梁切除术、冷凝等其他手术２０眼术后平均眼压４．０４ｋＰａ。治疗是不够理想的，应重视预防。本病多因视网膜血管性疾病视网膜贫血缺氧引起，早期可采用视网膜光凝、房角光凝。一旦房角闭锁则考虑施行泸过性手术，如硅管阀门植入术等。术后眼压未控制则加用药物治疗。     

水下电凝改良小梁切除治疗新生血管性青光眼

目的 观察睫状体及虹膜水下透热电凝联合改良式小梁切除术治疗新生血管性青光眼的效果，为新生血管性青光眼的治疗推荐一种新的方法。方法 对8例（8眼）新生血管性青光眼行水下透热电凝部分睫状体及虹膜，同时行改良式小梁切除术。结果 7例术后1周内眼压下降至正常，1例经药物治疗眼压控制在正常范围。末次随访，虹膜新生血管完全消退，眼压控制在正常范围。结论 通过睫状体及虹膜水下透热电凝联合改良式小梁切除术治疗新生血管性青光眼是一种较为安全有效的方法。     

Paediatric uveal melanoma

Uveal melanoma is extremely rare in the paediatric population and can be associated with various pre-existing conditions. We report the case of a 9-year-old girl with no predisposing factor who presented with choroidal melanoma. A review of the literature is presented and various clinical, histopathological and prognostic features of paediatric uveal melanoma are discussed.     

A complicated case of ciliary body melanoma and glaucoma

This clinicopathological case report describes the bilateral ocular pathology in an eldery man suffering from primary open angle glaucoma, aphakia and a ciliary body melanoma which was treated by cryotherapy to preserve vision in the better eye. Liver metastases were detected 18 months after the tumour was recognised. At autopsy, melanoma metastases were found within a renal cell carcinoma which had also metastasised to the lungs. Other abnormalities included aphakic maculopathy, senile macular degeneration, asteroid hyalosis and patchy hyalinisation of the retinal vasculature, which in one eye was the source of preretinal neovascularisation derived from intramural neovascularisation.     

羊膜在新生血管性青光眼手术中应用的临床观察

目的 探讨治疗新生血管性青光眼的有效方法。方法 对３例（３只眼）新生血管性青光眼患者采用新鲜及冷藏保存的羊膜在全视网膜冷凝、显微双巩膜咬切术中应用的方法治疗。结果 术后随访４～６个月,平均５．３个月。眼压控制在１０．２４～１７．３０ｍｍＨｇ（１ｍｍＨｇ＝０．１３３ｋＰａ）。结论 本术式简单、安全、有效、可行、并发症少,未发现排斥反应,是一种较理想的治疗新生血管性青光眼的方法。     

可调节缝线在Ahmed青光眼阀植入术治疗新生血管性青光眼的临床应用

目的探讨可调节缝线在Ahmed青光眼阀植入术治疗新生血管性青光眼(NNG)的临床应用。方法采用Ahmed青光眼阀植入术联合可调节缝线治疗NVG38例,观察手术前后眼压的变化及术后并发症的情况,术后平均随访1~3个月。结果术后根据眼压情况分次拆除可调节缝线,术后第5天平均眼压(15.62±2.52)mmHg,无低眼压、浅前房、前房出血等并发症发生。结论采用Ahmed青光眼阀植入术联合可调节缝线治疗NVG,不但能控制眼压,而且能减少并发症的发生,是治疗NVG的有效方法。     

Secondary glaucoma

Purpose : To review the common causes of secondary glaucoma. Methods : Review of current literature. Results : Secondary open and closed angle glaucomas are an important cause of ocular morbidity and vision loss in our community. Secondary glaucoma occurs with acquired ocular diseases (pigment dispersion, pseudoexfoliation, intraocular infection, intraocular inflammation and retinal vascular disease), blunt anterior segment injury, intraocular surgery (especially corneal grafting and congenital cataract surgery) and topical corticosteroid use. The medical treatment of secondary glaucoma is different from that of primary open angle glaucoma and must be tailored for the individual patient. Surgical treatment of secondary glaucoma carries a higher risk of complications and a lower rate of success than does surgical treatment of primary open angle glaucoma. Conclusions : Secondary glaucoma occurs with a variety of intraocular conditions and after a variety of intraocular insults. Awareness of patients at high risk should enable early detection and referral for appropriate management.