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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。
Objective To observe the clinical effect of laser diode transscleral ciliary body photocoagulation combined with retinal ablation (panretinal photocoagulation or anterior retinal condensation) in the treatment of neovascular glaucoma. Methods Twelve patients with neovascular glaucoma who were uncontrollable by 12 drugs were treated. 8 eyes ciliary body photocoagulation and panretinal photocoagulation, 4 eyes with ciliary body photocoagulation and anterior retinal condensation. Postoperative follow-up 6 to 19 months, comparative analysis of intraocular pressure in June, visual acuity and iris neovascular changes. Results Ciliary body photocoagulation before IOP 36 ~ 67mmHg (1mmHg = 0.133kPa), an average of 45.52mmHg. 6 eyes (50%) had 9 ~ 17mmHg at 6 months after the last treatment without ophthalmic anti-glaucoma medication; 4 eyes (33.33%) had a lower IOP after topical 0.5% timolol eye drops 21mmHg, 2 eyes (16.67%) intraocular pressure higher than 21mmHg. 2 eyes with decreased vision, 2 eyes elevated, 8 eyes unchanged. Iris neovascularization disappeared completely 8 eyes, partially disappeared 4 eyes. Conclusions Semiconductor laser scleral ciliary body photocoagulation combined with retinal ablation for neovascular glaucoma can reduce intraocular pressure in time and reduce retinal ischemia to save the existing or potential visual acuity.