青光眼/新生血管性,难治性%视网膜中央静脉阻塞%糖尿病/并发症,视网膜病变%临床特点%预后
青光眼/新生血管性,難治性%視網膜中央靜脈阻塞%糖尿病/併髮癥,視網膜病變%臨床特點%預後
청광안/신생혈관성,난치성%시망막중앙정맥조새%당뇨병/병발증,시망막병변%림상특점%예후
Glaucoma/neovascular,refractory%Central retinal vein occlusion%Diabetic mellitus/complication,retinopathy%Clinical characteristic%Prognosis
背景 新生血管性青光眼(NVG)是一种可迅速致盲的难治性疾病,而引起NVG的主要病理机制是不同原发病导致的缺血性视网膜病变,以视网膜中央静脉阻塞(CRVO)和糖尿病视网膜病变(DR)居多,二者引起的NVG的临床特点不同,目前这方面的研究报道较少.目的 探讨和比较CRVO与DR引起NVG的临床特点及发展规律,为NVG的有效防治提供依据.方法 采用系列病例观察的方法,收集2009年1月至2012年6月在青岛大学医学院附属海慈医院眼科治疗的由CRVO和DR引起的NVG患者27例29眼,其中由CRVO引起者10例10眼,由DR引起者17例19眼.对两种NVG患者的原发病病程、NVG病程、眼压、眼底表现及治疗后的并发症进行分析和对比.所有患者均接受全视网膜光凝术、改善微循环治疗、抗青光眼(药物和手术)及原发病治疗,部分患者接受了玻璃体切割或/和白内障摘出术,每组患者中均有2眼接受雷珠单抗玻璃体腔内注射.两组患者随访时间分别为(14.00±10.13)个月和(17.89±12.52)个月,差异无统计学意义(t=-0.83,P＞0.05). 结果 CRVO和DR所致的NVG患者原发病病程的中位数分别为3.3个月(2周～6个月)和11.1个月(4～36个月),两组间差异有统计学意义(Z=-2.40,P＜O.05).CRVO所致NVG患者的病情进展快,而DR所致NVG患者的病情进展稍慢.CRVO所致10例10眼NVG者中,治疗后视力升高者2眼,视力不变或下降者8眼；而DR所致NVG的17例19眼中,治疗后视力升高者15眼,视力不变或下降者4眼,二者比较,差异有统计学意义(x2=9.38,P＜0.01).两组患者治疗前的眼压分别为(48.40±7.96) mmHg(1 mmHg=0.133 kPa)和(25.34±10.51)mmHg,治疗后分别为(11.40±5.15) mmHg和(16.42±3.63) mmHg,两组患者治疗前后的眼压差比较差异有统计学意义(t=6.30,P＜0.01).CRVO所致NVG患者治疗前6眼可见视盘水肿、视网膜出血水肿和静脉扩张,4眼可见轻度视盘水肿及视网膜出血；治疗后4眼眼底窥不见,2眼隐约见视盘苍白,视网膜陈旧性激光斑,2眼视盘苍白,视网膜血管闭塞,2眼视网膜动脉呈银丝状.DR所致NVG患者中治疗前8眼眼底窥不见,11眼眼底呈DRⅢ～Ⅳ期改变；治疗后16眼眼底病变稳定,3眼眼底病变发展到V～Ⅵ期.两组患者治疗后并发症的发生率分别为100.0％和21.1％,两组比较,差异有统计学意义(x2 =5.18,P＜O.05). 结论 CRVO与DR引起NVG的临床特点有所不同,可以依据两种NVG患者不同的临床表现来指导NVG的防治.
揹景 新生血管性青光眼(NVG)是一種可迅速緻盲的難治性疾病,而引起NVG的主要病理機製是不同原髮病導緻的缺血性視網膜病變,以視網膜中央靜脈阻塞(CRVO)和糖尿病視網膜病變(DR)居多,二者引起的NVG的臨床特點不同,目前這方麵的研究報道較少.目的 探討和比較CRVO與DR引起NVG的臨床特點及髮展規律,為NVG的有效防治提供依據.方法 採用繫列病例觀察的方法,收集2009年1月至2012年6月在青島大學醫學院附屬海慈醫院眼科治療的由CRVO和DR引起的NVG患者27例29眼,其中由CRVO引起者10例10眼,由DR引起者17例19眼.對兩種NVG患者的原髮病病程、NVG病程、眼壓、眼底錶現及治療後的併髮癥進行分析和對比.所有患者均接受全視網膜光凝術、改善微循環治療、抗青光眼(藥物和手術)及原髮病治療,部分患者接受瞭玻璃體切割或/和白內障摘齣術,每組患者中均有2眼接受雷珠單抗玻璃體腔內註射.兩組患者隨訪時間分彆為(14.00±10.13)箇月和(17.89±12.52)箇月,差異無統計學意義(t=-0.83,P＞0.05). 結果 CRVO和DR所緻的NVG患者原髮病病程的中位數分彆為3.3箇月(2週～6箇月)和11.1箇月(4～36箇月),兩組間差異有統計學意義(Z=-2.40,P＜O.05).CRVO所緻NVG患者的病情進展快,而DR所緻NVG患者的病情進展稍慢.CRVO所緻10例10眼NVG者中,治療後視力升高者2眼,視力不變或下降者8眼；而DR所緻NVG的17例19眼中,治療後視力升高者15眼,視力不變或下降者4眼,二者比較,差異有統計學意義(x2=9.38,P＜0.01).兩組患者治療前的眼壓分彆為(48.40±7.96) mmHg(1 mmHg=0.133 kPa)和(25.34±10.51)mmHg,治療後分彆為(11.40±5.15) mmHg和(16.42±3.63) mmHg,兩組患者治療前後的眼壓差比較差異有統計學意義(t=6.30,P＜0.01).CRVO所緻NVG患者治療前6眼可見視盤水腫、視網膜齣血水腫和靜脈擴張,4眼可見輕度視盤水腫及視網膜齣血；治療後4眼眼底窺不見,2眼隱約見視盤蒼白,視網膜陳舊性激光斑,2眼視盤蒼白,視網膜血管閉塞,2眼視網膜動脈呈銀絲狀.DR所緻NVG患者中治療前8眼眼底窺不見,11眼眼底呈DRⅢ～Ⅳ期改變；治療後16眼眼底病變穩定,3眼眼底病變髮展到V～Ⅵ期.兩組患者治療後併髮癥的髮生率分彆為100.0％和21.1％,兩組比較,差異有統計學意義(x2 =5.18,P＜O.05). 結論 CRVO與DR引起NVG的臨床特點有所不同,可以依據兩種NVG患者不同的臨床錶現來指導NVG的防治.
배경 신생혈관성청광안(NVG)시일충가신속치맹적난치성질병,이인기NVG적주요병리궤제시불동원발병도치적결혈성시망막병변,이시망막중앙정맥조새(CRVO)화당뇨병시망막병변(DR)거다,이자인기적NVG적림상특점불동,목전저방면적연구보도교소.목적 탐토화비교CRVO여DR인기NVG적림상특점급발전규률,위NVG적유효방치제공의거.방법 채용계렬병례관찰적방법,수집2009년1월지2012년6월재청도대학의학원부속해자의원안과치료적유CRVO화DR인기적NVG환자27례29안,기중유CRVO인기자10례10안,유DR인기자17례19안.대량충NVG환자적원발병병정、NVG병정、안압、안저표현급치료후적병발증진행분석화대비.소유환자균접수전시망막광응술、개선미순배치료、항청광안(약물화수술)급원발병치료,부분환자접수료파리체절할혹/화백내장적출술,매조환자중균유2안접수뢰주단항파리체강내주사.량조환자수방시간분별위(14.00±10.13)개월화(17.89±12.52)개월,차이무통계학의의(t=-0.83,P＞0.05). 결과 CRVO화DR소치적NVG환자원발병병정적중위수분별위3.3개월(2주～6개월)화11.1개월(4～36개월),량조간차이유통계학의의(Z=-2.40,P＜O.05).CRVO소치NVG환자적병정진전쾌,이DR소치NVG환자적병정진전초만.CRVO소치10례10안NVG자중,치료후시력승고자2안,시력불변혹하강자8안；이DR소치NVG적17례19안중,치료후시력승고자15안,시력불변혹하강자4안,이자비교,차이유통계학의의(x2=9.38,P＜0.01).량조환자치료전적안압분별위(48.40±7.96) mmHg(1 mmHg=0.133 kPa)화(25.34±10.51)mmHg,치료후분별위(11.40±5.15) mmHg화(16.42±3.63) mmHg,량조환자치료전후적안압차비교차이유통계학의의(t=6.30,P＜0.01).CRVO소치NVG환자치료전6안가견시반수종、시망막출혈수종화정맥확장,4안가견경도시반수종급시망막출혈；치료후4안안저규불견,2안은약견시반창백,시망막진구성격광반,2안시반창백,시망막혈관폐새,2안시망막동맥정은사상.DR소치NVG환자중치료전8안안저규불견,11안안저정DRⅢ～Ⅳ기개변；치료후16안안저병변은정,3안안저병변발전도V～Ⅵ기.량조환자치료후병발증적발생솔분별위100.0％화21.1％,량조비교,차이유통계학의의(x2 =5.18,P＜O.05). 결론 CRVO여DR인기NVG적림상특점유소불동,가이의거량충NVG환자불동적림상표현래지도NVG적방치.
Background Neovascular glaucoma (NVG) is a serious ocular disease which may cause blindness.The primary pathogenesis of NVG is ischemic retinopathy derived by central retinal vein occlusion (CRVO) and diabetic retinopathy (DR).Clinical characteristics of NVG are variable based on the difference of primary diseases,such as CRVO and DR.However,there is a few studies regarding the diffcrcnces of NVG initiated by CRVO and DR.Objective This study was to compare the clinical characteristics in NVG patients secondary to CRVO and DR.Methods A series case observational study was carried out in Hiserve Hospital of Qingdao University from January 2009 to June 2012.Twenty-nine eyes of 27 patients with NVG caused by CRVO (10 eyes of 10 patients) and DR (19 eyes of 17 patients) were included.The history of underlying diseases,course of NVG,intraocular pressure(IOP),fundus findings and complications after treatment were analyzed and compared between the CRVO-derived NVG and DR-derived NVG.All patients underwent panretinal photocoagulation,improving microcirculation therapy,anti-glaucoma (drug or surgery) and causative disease treatment,and some of them received vitrectomy or/and cataract surgery.Two eyes from each group received intravitreal injection of ranibizumab.The follow-up time in both groups was (14.00±10.13) months and (17.89±12.52) months,respectively.Results The median time of underlying disease was 3.3 months (2 weeks to 6 months) in the CRVO patients and 11.1 months (4 to 36 mouths) in the DR patients,with a significant difference between them (Z =-2.40,P＜0.05).CRVO-derived NVG progress was much faster than that of DR-derived NVG.The number of the eyes with visual acuity improvement after treatment was 2 in the CRVO-derived NVG and 15 in the DR-derived NVG;while the number of the eyes with unchanged or worse visual acuity was 8 and 4 in the CRVO-derived NVG eyes and the DR-derived NVG eyes (x2 =9.38,P＜0.01).The difference of IOP in pre-and post-treatment was (37.00±9.91)mmHg in the CRVOderived NVG eyes and (8.92±12.05)mmHg in the DR-derived NVG eyes,showing a significant difference between them (t =6.30,P＜0.01).In the CRVO-derived NVG eyes,optic disc edema,retinal hemorrhage,and vein dilatation were seen in 6 eyes,and mild optic disc edema and retinal hemorrhage were observed in 4 eyes.After treatment,fundus could not be seen in 4 eyes,in other 2 eyes optic disc and retinal laser spots were unclearly observed.In addition,pale optic disc and retinal vessel occlusion appeared in 2 eyes,and silver wire-like arteries exhibited in 2 eyes.In pre-treated DR-derived NVG eyes,fundus could not be seen in 8 eyes and Ⅲ-Ⅳv stages of DR findings appeared in 11 eyes.After treatment,retinopathy was stabilized in 16 eyes of 15 cases.Advanced retinopathy(V-Ⅵ stages of DR findings) was revealed in 3 eyes of 3 cases.The incidence of the complication after treatment was 100.0％ in the CRVO-derived NVG eyes and 21.1％ in the DR-derived NVG eyes (x2=5.18,P＜0.05).Conclusions The clinical characteristics of NVG secondary to CRVO and DR are variable,an appropriate treatment option should be selected according to different features of NVG.
