| Purpose:To Compare the result of Ex-press drainage device implantation and trabeculectomy combined with cyclocryotherapy for neovascular glaucoma(NVG) and explore the best treatment.Methods:51 eyes in 48 cases with neovascular glaucoma in the First Affiliated Hospital of Kunming Medical University from Jan2012 to Dec2014 were analyzed retrospectively, all patients were treated with intravitreal injection of Lucentis 0.1ml (1.0mg) Pars plana at first.3-5 days after the injection, based on the surgical managements,they were divided into two groups:Group A (Ex-press drainage device implantation):26 eyes were treated by Ex-press glaucoma drainage device implantation. Group B (trabeculectomy combined with cyclocryotherapy):25 eyes were treated by trabeculectomy combined with cyclocryosurgery.Pre and post-operative (1week,1month,3month,6month) intraocular pressures (IOP), visual acuity,the number of glaucoma medications, total success (the proportion of the complete and qualified success of the number in total number of each group), complications were observed and compared between the two groups Separately.Results:1.In group A and group B, the average IOP at 1 week,l,3 and 6 months after surgery was significant lower than the preoperative level. In the group A were reduced by 29.93mmhg,31mmHg,31.66mmHg,31.62mmHg respectively;In the group B were reduced by 22.64mmHg,23.6mmHg,24.2mmHg,26.16mmhg respectively.the difference was statistically significan (P<0.001).2.In group A, the average IOP at 1 week,l, and 3 months after surgery Was higher than group B(5.46mmhg,5.57mmhg,5.63mmhg respectively), the difference was statistically significant (P< 0.05). the average IOP at 6 months after surgery was 14.73±5.02mmhg,18.36±10.23mmhg respectively, group A Was 3.63mmhg higher than group B, there is no significant different between the two groups (P=0.1)3.In group A and group B, the number of glaucoma medications after surgery was (0.42+0.95), (1.24±1.64).3.2 drug,2.64 drug less than the preoperative respectively, the difference was statistically significant (P< 0.05).Group A was 8.2 drug less than group B, the difference was statistically significan (t=2.1681,P=0.03647)4.In group A and group B, the success rate at 6 months after surgery was 88.5%, 60.0% respectively. Group A was higher than group B, the difference was statistically significant (x2=6.7436,P=0.009)5.In group A and group B,the total complication rates were 19.2%,60.0% respectively, the difference was statistically significant between the two groups (P=0.006).The rates of anterior chamber hemorrhage were 7.7%,32% respectively,group B was significantly higher than that in A group,the difference was statistically significant (P=0.02). there is no significant different between the two groups about the rates of shallow anterior chamber,hypotony,anterior chamber exudation, choroidal detachment, eyeball atrophy (P> 0.05).Conclusion:1. Ex-press drainage device implantation and Trabeculectomy combined with cyclocryotherapy can reduce intraocular pressure effectively.2. Ex-press drainage device implantation had a better result in lowering intraocular pressure,higher success rate of operation,more simple operation, less postoperative medication,less postoperative complications,and maintain a better eyesight.lt is a more safe and effective treatment method for the patients with visual acuity.3.Trabeculectomy combined with cyclocryotherapy is a destructive operation.It has more postoperative complications.However,this operation is simple so that it can be repeated easily. To grasp the indications strictly and control the refrigeration, it should be a good method for neovascular glaucoma. |
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