| Background Neovascular glaucoma(neovascular glaucoma,NVG)as the refractory glaucoma is considered to be a high blinding eye disease.It is mainly secondary to diabetic retinopathy,central retinal vein occlusion,ocular ischemic syndrome and other diseases.Meanwhile,ocular traum a,ocular tumor and other diseases can also lead to neovascular glaucoma.NVG is the retinal blood flow to reduce the supply of a variety of reasons that cause retinal ischemia and hypoxia,leading to retinal vascular endothelial growth factor(Vascular endothelial growth factor,VEGF)have increased,a large number of new blood vessel at the iris angle and trabecular have produced caused by trabecular obstruction and angle of closed so as to prevent the normal aqueous outflow channel,so that the pressure rising,causing eye pain.At the same time,with the increas e of intraocular pressure,the eye ischemia and hypoxia are not controlled,and then damage to the optic nerve,resulting in visual impairment.However,there are many methods for the treatment of NVG,mainly through the application of reducing drug and sur gical treatment of intraocular pressure,but the effect of these two methods is not obvious.With the development and clinical use of anti-VEGF drugs,new ideas have been put forward for the treatment of NVG.Prior to surgical treatment of NVG,anti-VEGF agents are administered until the surface of the iris and trabecular meshwork has com pletely subsided or most of them have subsided.But every patient condition is not exactly the same,so according to the actual situation of patient selection and rational comprehensive therapy for the treatment of individual NVG new the idea.Objective The objective of this study was to evaluate and explore the effect of individualized comprehensive treatment through the comprehensive treatm ent of NVG patients,and to provide a basis for clinical treatment of NVG.Materials and methods From October 2014 to January 2016 in the people' s Hospital of Zhengzhou University(Henan Province People's Hospital)patients and NVG patients treated 70 eyes of 67 cases,including 32 eyes of 30 male patients,38 eyes of 37 female patients,aged 29 to 76 years old,the average age(57.9±12.2)years old,the diabetic retinopathy secondary to NVG of the 32 patients with 34 eyes,29 eyes of 30 cases patients with NVG secondary to central retinal vein o cclusion and other diseases caused by NVG in 6 eyes of 6 cases.,were retrospectively analyzed.The IOP?21mmHg,there were 20 eyes of 19 cases have iris neovas cularization,the IOP>21mmHg patients with a tota l of 48 eyes of 50 cases.Excluded,Glaucom a patients,patients who underwent eye surgery and retinal lase rphotocoagulation,non vision patient.The IOP?21mmHg(rubeosis of iris)20 eyes received PRP treatment alone,IOP > 21 mmHg were injected with 0.05 ml prior to completion,different treatments were taken according to the iris neovascularization,IOP,and the refractive condition of the eyes within 3-7 days:(1)after injection the 18 eyes IOP?21mmHg give the PRP treatment,among the 18 eyes,10 eyes with vitreous hemorrhage in the vitreous body surgery to improve the refractive;(2)after injection the IOP > 21 mmHg,19 eyes received trabeculectomy + PRP treatment,13 eyes received trab eculectomy + vitrectomy+PRP treatment.The IOP?21mmHg were recorded before and after treatment for 1 weeks,1 m onths,3 months,6 months of intraocular pressure;IOP > 21 mmHg were recorded before injection and after receiv ing individualized and comprehensive treatmenttreatment for 1 weeks,1 months,3 m onths,6 m onths of intraocular pressure,at the same time,the intraocular pressure before and after the total treatment was recorded.Using SPSS 24 statistical software for statistical analysis,for the treatment of intrao cular pressure before and aft er treatment application each time point of the single factor analys is of variance of repeated measurement,and IOP before injection of contrast before surgery was analyzed by pairedt test analysis for treatment before and after injection results in P < 0.05,the difference was statistically significant.Results(1)The IOP ? 21 mmHg(rubeosis of iris)20 eyes have 14 eyes iris neovascularization disappeared completely in PRP after treatment during the follow-up period,6 eyes received intravitreal injection of ranibizumab during follow-up after neovascularization of iris.The IOP > 21 mmHg in 50 eyes,intraocular pressure underwent intravitreal ranibizumab injection after 22 eyes in iris neovascularization within 3 days completely disappeared,in 1 weeks after injection 45 eyes with iris neovascularization disa ppeared completely,most of their is neovascularization subsided of 5 eyes and 9 days co mpletely subsided.After receiving individualized treatment,5 patients de veloped recurrent iris neovascularization and subsided after receiving the injections again.(2)The IOP ?21mmHg(rubeosis of iris)of 20 eyes,7 eyes at the end of the follow-up visual acuity was improved,11 eyes visual acuity remained undisturbed,visual acuity of 2 eyes was less than before.The IOP > 21 mmHg of the 50 eyes,at the end of the follow-up 20 eyes had visu al acuity was improved,21 eyes maintain the original shape,9 eyes the visual acuity have decreased than before.(3)The IOP?21mmHg(rubeosis of iris)20 eyes before treatment,after treatment 1 weeks,1 m onths,3 months,6 months the IOP were(18.35 ± 1.04)mmHg;(18.25 ± 1.58)mmHg;(17.80 ± 1.79)mmHg;(17.85 ±1.53)mmHg;(17.95 ± 1.53)mmHg,the dif ference in IOP between before and after treatm ent was had not significant P > 0.05.The IOP > 21 mmHg in 50 eyes before injectionis(47.60± 6.46)mmHg,received individualized treatment after 1 weeks,1 months,3 months and 6 months respectively.The IOP(17.62 ±5.12)mmHg;(17.40± 4.91)mmHg;(17.34 ± 4.20)mmHg;(17.02±4.47)mmHg.intraocu lar pressure individualized comprehensive treatment at each time point in before injection were compared with statistical significance P < 0.05.(4)Of all 32 eyes treated with combined trabeculectomy,20 had functional follicles and 12 had scar filtering blebs at the last follow-up.(5)All patients had no retinal detachment,choroidal detachment and other complications,individualized comprehensive treatment after 3 cases of patients with shallow anterior chamber,to atropine mydriasis bandaged after 3 days to return to normal,6 eyes out of hyphema,after 3-7 days away.Conclusion 1.Simple PRP treatment can effectively reduce iris neovascularization in patients with iris 2.Intravitreal injection combined with PRP can effectively reduce their is neovascularization and reduce intraocular pressure 3.Compound trabeculectomy combined with improved refractive surgery can be safe and effective treatment of NVG.4.According to the different circumstances of patients with a reasonable choice of individual comprehensive treatment for the treatment of NVG is safe,effective,safe and effective control of intraocular pressure. |
PDF Full Text Request