新生血管性青光眼两种手术方式治疗的临床观察

目的:观察两种不同手术方式治疗新生血管性青光眼(neovascular glaucoma,NVG)的临床疗效。方法:回顾2008-04/2011-12在我院住院诊断为NVG的患者30例30眼,根据不同手术方式分为两组,A组采用青光眼引流装置Ahmed青光眼阀(Ahmed glaucoma valve,AGV)植入术治疗12例12眼,B组采用半导体二极管激光经巩膜睫状体光凝术(transscleral cyclophotocoagulation,TSCPC)治疗18例18眼。比较两组术后眼压、视力及并发症的情况。结果:两组术后眼压与术前相比较均有显著下降(P<0.01)。AGV植入组与TSCPC组术后1wk眼压比较有统计学差异(P<0.05),术后1mo比较无统计学差异(P>0.05)。视力:AGV植入组3眼提高,7眼不变,2眼下降;TSCPC组3眼提高,12眼保持不变,3眼下降。术后并发症:AGV植入组术后早期眼球疼痛、角膜水肿5例(41.7%),术后浅前房3例(25%),前房纤维样渗出2例(16.7%),前房积血3例(25%);TSCPC组术后早期眼球疼痛10例(55.6%),角膜水肿11例(61.1%),前房纤维样渗出5眼(27.8%),前房出血6眼(33.3%)。结论:AGV植入术及TSCPC术对于治疗NVG都是有效的方法。AGV植入术是一种滤过性手术,相对较为安全。TSCPC更为经济,适用于晚期或绝对期青光眼。     

康柏西普辅助小梁切除联合手术治疗前房角关闭期新生血管性青光眼

目的:分析康柏西普辅助小梁切除联合广泛视网膜光凝治疗前房角关闭期新生血管性青光眼的效果。方法:回顾性分析解放军第944医院2017年3月至2019年11月前房角关闭期新生血管性青光眼82例(82只眼)的临床资料。患者分为两组:观察组,43例(43只眼),行康柏西普玻璃体内注射辅助小梁切除联合广泛视网膜光凝术;对照组,39例(39只眼),行单纯小梁切除术联合广泛视网膜光凝术。观察两组手术后视力、眼压及手术并发症。术后随访6个月。结果:观察组视力提高率为13.95%(6/43),对照组为10.26%(4/39),差异有统计学意义(χ²=6.125,P=0.030)。两组患者术后眼压均下降,观察组眼压低于对照组(t=11.910,P<0.001),观察组总有效率高于对照组(χ²=8.510,P=0.003);观察组术后并发前房积血发生率低于对照组(χ²=6.125,P=0.001),两组均无眼内大出血、感染性眼内炎、巩膜坏死、视网膜脱离或睫状环阻塞性青光眼等严重并发症发生。结论:玻璃体内注射康柏西普辅助小梁切除术联合广泛视网膜光凝术治疗前房角关闭期新生血管性青光眼,效果确切,安全性好。     

Ahmed青光眼阀植入术治疗新生血管性青光眼

目的:探讨Ahmed青光眼引流阀植入术治疗新生血管性青光眼的疗效及其并发症的防治。方法:回顾性分析18例18眼新生血管性青光眼行Ahmed青光眼阀植入术的疗效,主要观察指标为手术前后视力、眼压、并发症及手术成功率等,术后随访6~18mo。结果:术后最佳矫正视力不变11眼,提高5眼,下降2眼。术后眼压控制的有效率达到89%,术后并发症主要是早期的短暂性浅前房和高眼压、前房积血以及晚期的滤过道瘢痕纤维化。结论:Ahmed引流阀植入术是治疗新生血管性青光眼的一种比较有效的方法。     

玻璃体腔注射康柏西普联合Ahmed青光眼阀植入和全视网膜光凝治疗有视功能新生血管性青光眼

目的:探讨玻璃体腔注射康柏西普联合Ahmed青光眼阀植入及全视网膜光凝治疗有视功能的新生血管性青光眼的疗效和安全性.方法:回顾分析我院2015-01/12有视功能的新生血管性青光眼患者12例12眼,行玻璃体腔注射康柏西普0.5mg,待虹膜新生血管消退后,行Ahmed青光眼阀植入术,2wk后行全视网膜光凝,术后随访3mo,观察视力、眼压和手术并发症等情况.结果:随访3mo后,患者视力提高10眼,无变化1眼,视力下降1眼.平均眼压由术前41.22±8.29mmHg降至术后3mo的16.08±4.92mmHg,差异有统计学意义(P＜0.05).青光眼阀植入术后1眼患者发生了浅前房,1wk后完全恢复.1眼患者术后出现了少量前房积血,3d后完全吸收.1眼激光光凝术后1 mo发生了玻璃体积血,行玻璃体切割后视力部分恢复,眼压控制良好.结论:玻璃体腔注射康柏西普后植入Ahmed青光眼阀和进行全视网膜光凝是治疗有视功能的新生血管性青光眼的一种安全有效的方法.     

Bevacizumab联合Ex-press引流管治疗新生血管性青光眼

目的:探讨玻璃体腔注射贝伐单抗(bevacizumab)联合Ex-press青光眼引流管植入术治疗新生血管性青光眼的疗效和安全性。方法:对18例19眼新生血管性青光眼患者,先行玻璃体腔注射bevacizumab,待虹膜新生血管消退或萎缩后,再行Ex-press青光眼引流管(P-200)植入术,其中6例6眼联合超声乳化白内障吸除术。根据患者屈光介质情况术前或术后尽量行全视网膜光凝。Ex-press植入术后随访12mo,观察视力、眼压和手术并发症情况。结果:玻璃体腔注药后2~7d,16眼新生血管全部消退。术后平均眼压:1mo:13.05±2.46mmHg,3mo:13.80±1.88mmHg,6mo:14.30±1.38mmHg;12mo:14.60±1.43mmHg,术后1,3,6,12mo眼压与术前相比均有显著性差异(P<0.05),且术后1,3,6,12mo眼压相比均无显著性差异(P>0.05)。19眼术后视力有提高者4眼,无明显改变15眼,无视力下降眼,完全成功11眼(58%),部分成功5眼(26%),总手术成功率84%(16/19)。术后并发症:有2例术后早期短暂浅前房,散瞳1wk后前房恢复正常,1例前房少量积血,无排斥反应和严重并发症。结论:玻璃体腔注射bevacizumab可使新生血管青光眼虹膜新生血管迅速消退或萎缩,为下一步青光眼手术创造良好的条件。Ex-press青光眼引流管植入术是新的滤过性手术,该手术创伤小,不用切除虹膜,减少了术中、术后出血的风险,联合bevacizumab是治疗新生血管性青光眼的安全而有效的术式。     

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。     

Ahmed青光眼阀植入术中联合应用透明质酸钠治疗NVG

目的：探讨Ahmed青光眼阀植入术治疗新生血管性青光眼(neovascular glaucoma,NVG)术中联合前房内注入透明质酸钠对手术疗效及术后并发症发生率的影响。

方法：回顾性病例对照研究。选择我院2009/2011年因新生血管性青光眼住院手术的患者49例49眼,按病历号奇偶随机分为两组。对照组行单纯Ahmed青光眼阀植入术,术中前房内不予注入透明质酸钠,研究组术中在将Ahmed青光眼阀硅胶管置入前房前往前房内注入透明质酸钠0.2～0.3mL,术后定期随访1mo,比较两组间术后眼压、最佳矫正视力变化及术后浅前房、前房出血、脉络膜脱离等并发症发生情况。组间手术前后眼压对比采用独立样本秩和检验(非正态分布),组间并发症比较采用χ²检验。

结果：新生血管性青光眼术后随访1mo,研究组27眼眼压由42.8±5.56mmHg降至17.7±3.77mmHg,对照组22眼由42.5±5.36mmHg降至18.6±5.39mmHg; 术后并发症：研究组术后浅前房2例,术后出血1例; 对照组术后浅前房4例,术后出血5例,研究组前房硅胶管位置欠佳1例。

结论：Ahmed青光眼阀植入术治疗新生血管性青光眼术中联合前房内注入透明质酸钠,可有效减少术后前房出血的发生,术后短期内会导致患者眼压升高,而对患者远期眼压无明显影响。     

Ex-PRESS青光眼引流器植入治疗新生血管性青光眼的疗效观察

目的：比较Ex－PRESS青光眼引流器植入术和小梁切除术治疗新生血管性青光眼的疗效和并发症情况。
　　方法：前瞻性随机对照临床试验研究,选择新生血管性青光眼34眼,排除前房浅的患者,随机分为两组。第一组（ A组）15眼行Ex－PRESS青光眼引流器植入术,术中应用丝裂霉素;第二组（ B组）19眼行小梁切除术,术中应用丝裂霉素。随访1 a,观察两种手术前后眼内压,视力变化,以及随访期间联合应用降眼压药物情况,并发症情况,结果进行统计学分析。
　　结果：两组治疗前后的平均眼压均有明显的下降（P＝0．01）。两组在治疗后1,4wk;6,12mo的眼压变化相似,没有明显差异（ P＝0．451）。两组1,4wk;6,12mo的最佳矫正视力与治疗前相比没有明显变化（ P＝0．832）。 Ex－PRESS青光眼引流器植入术组和小梁切除组成功率分别是66．7％和63．1％。小梁切除组8例患者出现了前房出血,Ex－PRESS青光眼引流器植入术组有3例患者发生了前房出血。术后早期小梁切除组6例患者发生了脉络膜脱离,Ex－PRESS青光眼引流器植入术组有3例患者出现了脉络膜脱离。
　　结论：Ex－PRESS青光眼引流器植入术治疗新生血管性青光眼相对简便、安全、微创、学习曲线短,患者痛苦小,并发症少,是治疗新生血管性青光眼的一种有效方法。     

四环单结调整缝线引流管结扎技术在Ahmed青光眼阀植入术中的应用

目的:评估四环单结调整缝线引流管结扎技术在Ahmed青光眼阀(AGV)植入术中的应用效果。方法:回顾性分析。纳入2020-05/2022-01本院眼科中心进行AGV植入术治疗的难治性青光眼患者78例78眼,按手术方式分为改良AGV植入术组(43眼,使用四环单结调整缝线对引流管进行结扎)和传统AGV植入组(35眼,不使用四环单结调整缝线对引流管进行结扎)。随访6mo,观察两组患者术后1d, 1、2wk, 1、6mo眼压,手术成功率和并发症发生情况。结果:两组患者术后1d, 1、2wk, 1、6mo眼压均较术前明显降低(均P<0.05);两组组间各时间点眼压比较均无差异(均P>0.05)。术后1wk,改良AGV植入术组和传统AGV植入组浅前房发生率分别为5%和23%(P<0.05)。术后6mo,改良AGV植入术组总体成功率为98%,传统AGV植入组为89%(P>0.05)。结论:AGV植入术中采用四环单结调整缝线结扎引流管可以有效降低眼压,减少术后早期浅前房的发生率,手术安全有效。     

Efficacy and safety of intravitreal ranibizumab with panretinal photocoagulation followed by trabeculectomy compared with Ahmed glaucoma valve implantation in neovascular glaucoma

AIM: To evaluate the efficacy and safety of intravitreal ranibizumab (IVR) with panretinal photocoagulation (PRP) followed by trabeculectomy compared with Ahmed glaucoma valve (AGV) implantation in neovascular glaucoma (NVG). METHODS: This was a retrospective comparative study. We reviewed the cases of a total of 45 eyes from 45 NVG patients among which 23 eyes underwent AGV implantation and the other 22 underwent trabeculectomy. The causes of neovascular glaucoma included: diabetic retinopathy (25 eyes), and retinal vein occlusion (20 eyes). All patients received preoperative IVR combined with postoperative PRP. The mean best-corrected visual acuities (BCVA) were converted to the logarithms of the minimum angle of resolution (logMAR) for the statisitical analyses. Intraocular pressure (IOP), the logMAR BCVA and surgical complications were evaluated before and after surgery. The follow-up period was 12mo. RESULTS: A total of 39 cases showed complete regression of iris neovascularization at 7d after injection, and 6 cases showed a small amount of residual iris neovascularization. The success rates were 81.8% and 82.6% at 12mo after trabeculectomy and AGV implantation, respectively. In the trabeculectomy group, the logMAR BCVA improved at the last follow-up in 14 eyes, remained stable in 6 eyes and decreased in 2 eyes. In 4 cases, slight hyphemas developed after trabeculectomy. A shallow anterior chamber developed in 2 cases and 2 vitreous hemorrhages. In the AGV group, the logMAR BCVA improved in 14 eyes, remained stable in 5 eyes and decreased in 4 eyes. Slight hyphemas developed in 3 cases, and a shallow anterior chamber in 3 cases. The mean postoperative IOP was significantly lower in both groups after surgery (F=545.468, P<0.05), and the mean postoperative logMAR BCVA was also significantly improved (F=10.964, P<0.05) with no significant difference between two groups. CONCLUSION: It is safe and effective to treat NVG with this combined procedure, and we found similar results after IVR+AGV implantation+PRP and IVR+trabeculectomy+PRP in eyes with NVG.     

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.     

Ahmed青光眼阀植入术治疗青少年难治性青光眼疗效观察

目的：：研究Ahmed青光眼阀( AGV)植入术治疗青少年难治性青光眼的临床效果。方法：选取2012-10/2014-10期间在我院眼科进行Ahmed青光眼阀植入术的青少年难治性青光眼患者27例27眼,随访12 mo。观察手术成功情况,术后眼压、视力以及并发症等。结果：本组试验手术成功率85%。经过随访数据统计27例患者平均眼压由术前48.3±8.3 mmHg 下降到21.4±8.1mmHg,差异具有统计学意义(P<0.05);视野缺损：术前平均为-23.7±4.1dB,术后12mo -27.5±4.7dB,平均下降3.9dB,差异具有统计学意义(P<0.05)。视力提高和不变者占85%。术后早期并发症：浅前房5眼(19%),一过性高眼压3眼(11%),前房出血4眼(15%),引流管内口阻塞1眼(4%),前房硅胶管位置欠佳1眼(4%),未出现复视、引流管侵蚀与外露、引流盘脱出、脉络膜脱离、巩膜植片发生免疫排斥反应等并发症。术后中远期并发症：瞳孔欠圆8眼(30%),后部盘周包裹3眼(11%),并未出现因单纯植入引流阀而导致角膜变性的严重并发症。结论：Ahmed青光眼阀植入术具有成功率高、手术操作简单、并发症少等特点,是治疗难治性青少年青光眼有效手段。     

Ahmed阀植入联合超声乳化术治疗NVG合并白内障

目的:观察Ahmed阀植入联合超声乳化术治疗新生血管性青光眼(NVG)的疗效。方法:回顾性分析我院2015-04/2018-09收治的NVG合并白内障患者93例93眼的临床资料,玻璃体腔抗VEGF注药后行Ahmed阀植入术,根据术中是否联合超声乳化术分为联合组(41眼)与单阀组(52眼)。术后随访6mo以上,记录最佳矫正视力(BCVA)、眼压及并发症发生情况,评定临床疗效。结果:末次随访时,联合组视力提高16眼(39%),不变11眼(27%),降低14眼(34%);单阀组视力提高15眼(29%),不变13眼(25%),降低24眼(46%),两组视力变化情况无差异(P>0.05)。两组患者术前、玻璃体腔注药后、Ahmed阀植入术后1d,1wk,1mo眼压均无差异(P>0.05),但Ahmed阀植入术后3、6mo及末次随访时眼压均较术后1mo增高,且单阀组眼压高于联合组(P<0.05)。末次随访时,联合组绝对治愈率51%,条件治愈率22%,失败率27%,单阀组分别为44%、25%、31%,两组临床疗效无差异(P>0.05)。联合组和单阀组术后并发症总发生率无差异(51%vs 46%,P>0.05),联合组以炎性渗出(56%)为主,前房积血(46%)次之,单阀组以浅前房(35%)居多,其次为炎性渗出(31%)、前房积血(25%),两组间除浅前房、炎性渗出发生率有差异(P<0.05),其余并发症发生率均无差异(P>0.05),且无严重并发症。结论:Ahmed阀植入联合超声乳化术能有效控制眼压、改善视力,减少浅前房发生率,且便于眼底疾病后续诊疗,是NVG合并白内障的有效治疗方式。     

新生血管性青光眼手术治疗方法探讨

目的：对比观察两种手术方法治疗新生血管性青光眼（ NVG）的疗效。 方法：对46例57眼手术治疗的NVG患者进行回顾性分析和随访,根据手术方式分Ahmed青光眼阀（ AGV）植入术组（ A组,24例31眼）和半导体二极管激光经巩膜睫状体光凝术（ TSCPC）组（ B组,22例26眼）,比较手术前后眼压、视力变化及术后并发症情况。 结果：两组术后眼压均较术前显著降低（P〈0.05）,但组间无统计学差异（P〉0.05）;两组术后视力变化比较无统计学差异（P〉0.05）;A组术后并发症明显低于B组,其中眼球疼痛、前房出血发生率比较有统计学差异（P〈0.05）。 结论：AGV 植入术与 TSCPC 治疗 NVG 均有效,但 AGV植入术是滤过性手术,而TSCPC是睫状体破坏性手术,后者术后并发症更高。     

The efficacy of Ahmed glaucoma valve drainage devices in cases of adult refractory glaucoma in Indian eyes

Aim:

To evaluate the efficacy of Ahmed glaucoma valve (AGV) drainage devices in cases of adult refractory glaucoma in Indian eyes.

Settings and Design:

Retrospective interventional case series study.

Materials and Methods:

Fifty two eyes of 32 patients of refractory glaucoma in the age group of 35 to 60 years who underwent AGV implantation with or without concomitant procedures from January 2003 to Jan 2007 were studied. Of these, 46 eyes (88%) had undergone filtering surgery earlier whereas remaining eyes underwent primary AGV implantation following failure of maximal medical therapy. The follow up ranged between 12 months to 48 months

Results:

Eighteen eyes (35%) had undergone phacoemulsification with AGV implantation, penetrating keratoplasty (PK) with AGV and intraocular lens (IOL) implantation in 13 eyes (25%), AGV over preexisting IOL in eight eyes (15%). AGV implantation alone was done in six (11%) eyes. Anterior chamber (AC) reconstruction with secondary IOL and AGV was performed in the remaining eyes. The mean intra ocular pressure (IOP) decreased from 36.3 ± 15.7 mm Hg to 19.6 ± 9.2 mm Hg. Complete success as per criteria was achieved in 46 eyes (88%). None of the eyes had failure to maintain IOP control following AGV.

Conclusion:

The AGV resulted in effective and sustained control of IOP in cases of adult refractory glaucoma in intermediate follow up.     

玻璃体切割术联合透明质酸钠植入术治疗开角型青光眼

目的:调查玻璃体切割术联合透明质酸钠植入术治疗开角型青光眼的临床效果,为合理选择手术方法提供参考。方法:开角型青光眼600例600眼根据入院顺序平分为两组,治疗组与对照组各300例,治疗组行玻璃体切割术联合透明质酸钠植入术,对照组采用玻璃体切割联合小梁切除术。结果:治疗后两组裸眼视力明显提高,治疗组视力改变更好(P＜0.05)。两组眼压经过治疗后有明显下降,治疗组在术后各个时间点的眼压都好于对照组(P＜0.05)。两组术后前房丁达尔征、前房积血和低眼压性黄斑病变发生率对比,均无明显差异(P＞0.05)。结论:玻璃体切割术联合透明质酸钠植入术治疗开角型青光眼能降眼压,视力恢复好,术后并发症少,值得推广应用。