糖尿病白内障术后快速发作的新生血管性青光眼：玻璃体切除联合Ahmed青光眼瓣膜植入术的结果

IF 1.8 4区医学 Q2 OPHTHALMOLOGY

International journal of ophthalmology Pub Date : 2025-09-18 eCollection Date: 2025-01-01 DOI:10.18240/ijo.2025.09.07

Hui-Ping Yao, Ya-Nuo Wang, Yan-Wei Chen, Sha Gao, Yi-Sheng Zhong, Xi Shen

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引用次数: 0

摘要

目的：观察糖尿病患者白内障术后伴玻璃体出血（VH）的新血管性青光眼（NVG）病例，评价玻璃体切割（PPV）联合Ahmed青光眼瓣膜（AGV）植入术的疗效。方法：这是一个回顾性、单中心、连续的病例系列。所有患者在玻璃体内注射雷尼单抗（IVR）后接受23号PPV和AGV植入2-3d。术后最小随访时间为12个月。主要结局指标包括最佳矫正视力（BCVA）、眼内压（IOP）和局部降压药物。结果：15例糖尿病患者（年龄46-81岁）在无并发症超声乳化术后出现快速发作的NVG和VH。白内障手术后至首次诊断NVG的中位时间为4周。PPV联合AGV植入后，平均BCVA （logMAR）从术前1.9（范围：1.0 ~ 2.6）改善到最终随访时的1.2（范围：0.2 ~ 2.6）。在多元回归模型中，基线BCVA和糖尿病肾病（DN）的存在与最终BCVA显著相关。术后随访的平均IOP与基线相比显著降低。在最后随访时，9例患者需要一种或两种局部降压药物，6例不需要。手术成功率87%，再手术率20%。大多数NVG病例（9/15）主要归因于增殖性糖尿病视网膜病变的快速进展。然而，复杂视网膜静脉阻塞或颈动脉阻塞占6只眼。结论：辅助IVR后PPV联合AGV植入术治疗糖尿病性白内障术后快发性NVG合并VH是一种安全有效的治疗方法。基线BCVA和既往DN可能是视力结果的潜在指标。

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Rapid-onset neovascular glaucoma following cataract surgery in diabetes: outcomes of pars plana vitrectomy combined with Ahmed glaucoma valve implantation.

Aim: To present a case series of rapid-onset neovascular glaucoma (NVG) accompanied by vitreous haemorrhage (VH) following cataract surgery in diabetic patients, and to evaluate the efficacy of pars plana vitrectomy (PPV) combined with Ahmed glaucoma valve (AGV) implantation.

Methods: This is a retrospective, single-center, consecutive case series. All patients underwent 23-gauge PPV with AGV implantation 2-3d after intravitreal ranibizumab injection (IVR). The minimum postoperative follow-up period lasted 12mo. The primary outcome measures included best-corrected visual acuity (BCVA), intraocular pressure (IOP), and topical hypotensive medications.

Results: Fifteen diabetic patients (age, 46-81y) with rapid-onset NVG and VH following uncomplicated phacoemulsification were included. The median time to the initial NVG diagnosis following cataract surgery was within 4wk. After PPV combined with AGV implantation, the mean BCVA (logMAR) improved from 1.9 (range: 1.0 to 2.6) preoperatively to 1.2 (range: 0.2 to 2.6) at the final follow-up. Baseline BCVA and the presence of diabetic nephropathy (DN) were significantly associated with the final BCVA in the multiple regression model. The mean postoperative IOP at all follow-up visits was significantly reduced compared to baseline. At the final follow-up, 9 patients required one or two topical ocular hypotensive medications, while the other 6 needed not. Success was achieved in 87%, and the reoperation rate was 20%. The majority of NVG cases (9/15) were primarily attributed to the rapid progression of proliferative diabetic retinopathy. However, a notable subset (6 eyes) was complicated retinal vein occlusion or carotid artery occlusion.

Conclusion: PPV combined with AGV implantation after adjuvant IVR for rapid-onset NVG with VH following diabetic cataract surgery is one of the safe and effective treatments. Baseline BCVA and preexisting DN may be potential indicators for visual outcomes.

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来源期刊

International journal of ophthalmology Medicine-Ophthalmology

CiteScore

2.50

自引率

7.10%

发文量

3141

审稿时长

4-8 weeks

期刊介绍： · International Journal of Ophthalmology-IJO (English edition) is a global ophthalmological scientific publication and a peer-reviewed open access periodical (ISSN 2222-3959 print, ISSN 2227-4898 online). This journal is sponsored by Chinese Medical Association Xi’an Branch and obtains guidance and support from WHO and ICO (International Council of Ophthalmology). It has been indexed in SCIE, PubMed, PubMed-Central, Chemical Abstracts, Scopus, EMBASE , and DOAJ. IJO JCR IF in 2017 is 1.166. IJO was established in 2008, with editorial office in Xi’an, China. It is a monthly publication. General Scientific Advisors include Prof. Hugh Taylor (President of ICO); Prof.Bruce Spivey (Immediate Past President of ICO); Prof.Mark Tso (Ex-Vice President of ICO) and Prof.Daiming Fan (Academician and Vice President, Chinese Academy of Engineering. International Scientific Advisors include Prof. Serge Resnikoff (WHO Senior Speciatist for Prevention of blindness), Prof. Chi-Chao Chan (National Eye Institute, USA) and Prof. Richard L Abbott (Ex-President of AAO/PAAO) et al. Honorary Editors-in-Chief: Prof. Li-Xin Xie(Academician of Chinese Academy of Engineering/Honorary President of Chinese Ophthalmological Society); Prof. Dennis Lam (President of APAO) and Prof. Xiao-Xin Li (Ex-President of Chinese Ophthalmological Society). Chief Editor: Prof. Xiu-Wen Hu (President of IJO Press). Editors-in-Chief: Prof. Yan-Nian Hui (Ex-Director, Eye Institute of Chinese PLA) and Prof. George Chiou (Founding chief editor of Journal of Ocular Pharmacology & Therapeutics). Associate Editors-in-Chief include: Prof. Ning-Li Wang (President Elect of APAO); Prof. Ke Yao (President of Chinese Ophthalmological Society) ; Prof.William Smiddy (Bascom Palmer Eye instituteUSA) ; Prof.Joel Schuman (President of Association of University Professors of Ophthalmology,USA); Prof.Yizhi Liu (Vice President of Chinese Ophtlalmology Society); Prof.Yu-Sheng Wang (Director of Eye Institute of Chinese PLA); Prof.Ling-Yun Cheng (Director of Ocular Pharmacology, Shiley Eye Center, USA). IJO accepts contributions in English from all over the world. It includes mainly original articles and review articles, both basic and clinical papers. Instruction is Welcome Contribution is Welcome Citation is Welcome Cooperation organization International Council of Ophthalmology(ICO), PubMed, PMC, American Academy of Ophthalmology, Asia-Pacific, Thomson Reuters, The Charlesworth Group, Crossref,Scopus,Publons, DOAJ etc.