玻璃体切割联合青光眼Baerveldt植入物治疗难治性青光眼

摘要

AIM:To investigate the clinical efficacy of pars plana vitrectomy and Baerveldt glaucoma implant(PPV-BGI) in the treatment of refractory glaucoma.METHODS:One hundred twenty-nine refractory glaucoma patient's clinical data from March 2013 to December 2015 that underwent PPV-BGI were retrospectively reviewed.Among them,63 eyes were neovascular glaucoma (NVG) and 69 eyes were other types of glaucoma (non-NVG).The changes of intraocular pressure(lOP),surgical results,visual acuity (VA),the number of glaucoma medications,complications,and the success rate of surgery were analyzed.RESULTS:Cumulative success rates for the NVG group and non-NVG group were 46.0％ and 81.2％,respectively,within 1a after surgeries,the difference was significantly (P＜ 0.05).Preoperative lOP was 30.4 ± 10.2mmHg in the non-NVG group and 40.1±10.4mmHg in the NVG group,and lOP was reduced to 14.9±4.1mmHg in the non-NVG group and 17.8±4.9mmHg in the NVG,and the difference was significantly (P＜0.05).Number of glaucoma medications decreased from 2.7 ± 1.2 in the non-NVG group and 2.9 ± 1.4 in the NVG group preoperatively to 0.51 ±0.96 in the non-NVG group and 0.96±1.18 in the NVG group,and the difference was significantly (P＜0.05).Improvement in VA of in the NVG group and non-NVG group were observed in 14 eyes of 13 patients and 38 eyes and 37 patients respectively,and the difference was significantly (P＜0.05).The postoperative complications of 1d and 1a follow-up in NVG group was significantly higher than non-NVG group (P＜0.05).CONCLUSION:PPV-BGI is a viable surgical option for eyes with refractory glaucoma,but visual outcomes are frequently poor because of ocular comorbidities,especially in eyes with NVG.%目的:探讨玻璃体切割联合青光眼Baerveldt植入物(pars plana vitrectomy and Baerveldt glaucoma implant,PPV-BGI)治疗难治性青光眼的临床疗效.方法:回顾性分析2013-03/2015-12本院收治并实施PPV-BGI的129例132眼难治性青光眼患者的临床治疗资料,其中63眼为新生血管性青光眼(neovascular glaucoma,NVG),69眼为其他类型的青光眼(non-NVG).分析两组患者的术后眼压(intraocular pressure,IOP)变化、手术结果、视力(visual acuity,VA)、青光眼药物的使用数量、并发症和手术成功率.结果:NVG组患者和non-NVG组患者1a累计成功率分别为46.0％、81.2％,差异有统计学意义(P＜0.05).NVG组患者IOP术后1a从术前40.1±10.4mmHg下降至17.8±4.9mmHg,non-NVG组患者则从30.4±10.2 mmHg下降至14.9±4.1mmHg,术前与术后1a相比,差异有统计学意义(P＜0.05).NVG及non-NVG组患者术前青光眼药物使用数量分别为2.9±1.4和2.7±1.2种,术后1a NVG及non-NVG组患者青光眼药物使用数量分别下降为0.96±1.18和0.51±0.96种,差异有统计学意义(P＜0.05).术后NVG组视力改善患者13例14眼,non-NVG组患者改善37例38眼,差异有统计学意义(P＜0.05).术后1d及术后随访1a结果表明,NVG组患者并发症发生情况明显高于non-NVG组,差异有统计学意义(P＜0.05).结论:PPV-BGI是难治性青光眼手术的一种可行性手术选择,但术后视力恢复效果往往不理想,因为术后往往会有并发症的发生,特别是新生血管性青光眼.