关键词: 青光眼／继发性, 睫状体光凝

Abstract:

Objective To compare the clinical efficacy of vitrectomy combined with cyclophotocoagulation and trans-scleral cyclophotocoagulation to treat secondary glaucoma. Design Retrospective cases series. Participants 68 cases (68 eyes) of secondary glaucoma in Beijing Tongren Hospital from July 2011 to December 2014. Methods All cases were divided into two groups. 37 cases in one group were treated by vitrectomy combined with cyclophotocoagulation and 31 cases in the other group were treated by trans-scleral cyclophotocoagulation(TSCP). The postoperative follow-up periods were 1 to 50 months．The operative parameters of laser, changes of intraocular pressure(IOP), postoperative best corrective visual acuity (BCVA)and postoperative complications were observed and compared between the two groups. Main Outcome Measures Parameters of laser, postoperative BCVA, IOP and complications. Results Preoperative IOP of two groups was 28~55 mmHg(37.4±7.5 mmHg) and 30~53 mmHg(39.8±6.0 mmHg) respectively and there was no significant difference (P>0.05) between the two groups. The number of patients who got BCVA improvements within the two groups was 20 (54.1%) and 8 (25.8%) respectively. The difference was significant (χ2=23.92, P<0.001). The amplitudes of IOP decrease on the first postoperative day in the TSCP group was 10~29 mmHg (19.4±5.3 mmHg) , significantly less than that of the vitrectomy combined with cyclophotocoagulation group 12~33 mmHg(23.9±5.9 mmHg), and the last follow-up IOP of was significantly lower in the vitrectomy combined with cyclophotocoagulation group 12~30 mmHg(17.6±3.8 mmHg) than the TCSP group 16~32 mmHg(20.4±4.1 mmHg) respectively. While the energy and duration time of laser was different. Postoperative complications included hyphema, transient low IOP, fibrous exudates in anterior chamber, and exudative choroidal detachment in both groups. Moreover there was vitreous hemorrhage in vitrectomy combined with cyclophotocoagulation group and bulbar conjunctival congestion and edema in TSCP group. All those complications were recovered soon and no serious complications such as bulbi phthisis occurred. Conclusions Both these two operative models are safe and effective procedures in management of secondary glaucoma and have their own advantages. Vitrectomy combined with cyclophotocoagulation contributes to improve visual acuity and TSCP is simple and affordable, and they can be used jointly when necessary. （Ophthalmol CHN， 2016, 25： 330-334）

Key words: glaucoma /secondary, cyclophotocoagulation