TSCPC联合改良小梁切除术治疗新生血管性青光眼的临床疗效观察

目的　观察半导体二极管激光经巩膜睫状体光凝术（ｔｒａｎｓｓｃｌｅｒａｌｃｙｌｏｐｈｏｔｏｃｏａｇｕｌａｔｉｏｎ，ＴＳＣＰＣ）联合改良小梁切除术治疗新生血管性青光眼（ｎｅｏｖａｓｃｕｌａｒｇｌａｕｃｏｍａ，ＮＶＧ）的临床疗效。方法　选取２０１１年１月至２０１２年１２月就诊于我院的ＮＶＧ患者４６例（４６眼），均采用ＴＳＣＰＣ治疗联合改良小梁切除术，术后随访６～１２个月，观察患者术后一般疗效、视力、眼压及并发症等情况。结果　４６眼中手术完全成功３８眼，条件成功６眼，失败２眼，手术成功率为９５．７％。与术前比较，术后１周、１个月、６个月视力均有不同程度提高，差异均有统计学意义（均为Ｐ＜０．０５）。术前眼压为（３８．９±３．２）ｍｍＨｇ（１ｋＰａ＝７．５ｍｍＨｇ），术后１周、１个月、６个月眼压分别为（１８．２±１．２）ｍｍＨｇ、（１７．８±１．６）ｍｍＨｇ、（１７．２±１．５）ｍｍＨｇ，与术前比较，差异均有显著统计学意义（均为Ｐ＜０．０１）。术后１周形成功能性滤过泡３９眼（８４．８％），非功能性滤过泡７眼（１５．２％）；术后６个月形成功能性滤过泡４２眼（９１．３％），非功能性滤过泡４眼（８．７％）。术后并发症主要包括前房积血、浅前房、前部葡萄膜炎、玻璃体出血等。结论　ＴＳＣＰＣ联合改良小梁切除术能显著控制ＮＶＧ患者眼压，并发症较少。

Clinical study of improved trabeculectomy combined with TSCPC for neovascular glaucoma

Objective To evaluate the clinical effects of improved trabeculectomy combined with transscleral cylophotocoagulation ( TSCPC) for neovascular glaucoma ( NVG) . Methods Forty-six cases (46 eyes) with NVG received improved trabeculectomy combined with TSCPC , the follow-up time was from 6 months t0 12 months , the general therapeutic effect . visual acuity ,intraocular pressure and complications were observed after operation. Results In 46 eyes, the surgery was successful totally in 38 eyes,conditional successful in 6 eye,failed in 2 eyes, the successful rate was 95. 7% . Compare with pre-operation, the visual acuity at postoperative I week, I month and 6 months were increased to certain degree ( all P < 0. 05 ) . The preoperative intraocular pressure was ( 38. 9 + 3. 2) mmHg ( I kPa = 7. 5 mmHg) , the postoperative I week, I month and 6 months were ( 18. 2 + 1. 2 ) mmHg , ( 17. 8 + 1. 6) mmHg and ( 17. 2 + 1. 5 ) mmHg , respectively , there were statistical differences compared with pre-operation ( all P < 0. 01) . The functional filtering bleb were formed in 39 eyes ( 84. 8% ) and 42 eyes (91. 3% ) at postoperative I week and 6 months,the dysfunctional filtering blebs were in 7 eyes ( 15. 2% ) and 4 eyes ( 8. 7% ) , respectively. Conclusion Improved trabeculectomy combined with TSCPC for NVG can obviously control the intraocular pressure with less complication.