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。

Treatment of neovascular glaucoma secondary to hemodialysis of uremia

Objective To investigate the clinical effects of ciliary body cryocoagulation combined with trabeculectomy for neovascular glaucoma(NVG) secondary to hemodialysis of uremia.Methods Ten patients(13 eyes) with NVG secondary to hemodialysis of uremia were retrospectively analyzed,and all cases underwent ciliary body cryocoagulation combined with trabeculectomy.All patients were followed up from 12 months to 18 months.Postoperative anterior chamber reaction,angle and iris neovascularization,intraocular pressure(IOP),visual acuity and complications were observed.Results The postoperative visual acuity in 13 eyes was not changed.Temporary high IOP appeared in 5 eyes,hyphema in 4 eyes,and anterior uveitis in 4 eyes,which were recovered from 1 week to 2 weeks after symptomatic treatment.Angle neovascularization in 3 eyes and iris neovascularization in 7 eyes completely disappeared,1 eye reduced,and the other 2 eyes with unchanged or increased again disappeared after treatment of ciliary body cryocoagulation.IOP in 11 eyes were controlled within normal limits,and 2 eyes were controlled with drug.At the final follow-up,except for 1 cases died of infection after underwent the operation of kidney transplantation,the other 9 cases were able to maintain hemodialysis with no high IOP.Conclusion Multiple factors of hemodialysis induce retinal microcirculation disorder,which is the major reason of NVG.Ciliary body cryocoagulation combined with trabeculectomy is effective for NVG secondary to hemodialysis of uremia.