Hanna Rana, Tiosano Beatrice, Graffi Shmuel, Gaton Dan
Department of Ophthalmology, Hillel Yaffe Medical Center, affiliated to the Rappaport Faculty of Medicine, The Technion, Hadera, Israel.
Department of Ophthalmology, Baruch Padeh Medical Center, affiliated to the Faculty of Medicine, Bar Ilan University, Galilee, Israel.
Case Rep Ophthalmol. 2018 Jan 23;9(1):61-69. doi: 10.1159/000479363. eCollection 2018 Jan-Apr.
The prognosis of conventional filtration surgery in eyes with neovascular glaucoma (NVG) is limited due to increased fibrovascular proliferation or bleeding. This study aims to evaluate the safety and efficacy of the EX-PRESS filtration device in the management of NVG associated with proliferative diabetic retinopathy (PDR).
In this retrospective case series, we reviewed the medical records of patients diagnosed as having NVG associated with PDR who underwent EX-PRESS filtration surgery. The main outcome measures were: postoperative intraocular pressure (IOP), the percent of IOP drop, the number of glaucoma medications, visual acuity, and complications of surgery. Successful surgery was defined as an IOP <22 mm Hg and >5 mm Hg with or without additional glaucoma surgery, and no loss of light perception or less than a 2-line decrease on the Snellen chart of the best corrected visual acuity (BCVA).
Five patients (5 eyes) were included in this study. The mean preoperative IOP was 33.4 ± 5.9 mm Hg compared to an IOP of 17.0 ± 3.0 mm Hg at the last follow-up ( = 0.003). The mean number of preoperative anti-glaucoma medications was 3.8 ± 0.4 compared to 2.2 ± 1.5 ( = 0.06) at the last follow-up visit. Final visual acuity improved or stabilized within 1 Snellen line in all 5 patients. Three patients had a "hypertensive phase" (defined as an IOP >21 mm Hg during the first 6 postoperative months) which resolved within 2 months. Two patients developed a hyphema that resolved spontaneously. None of the patients experienced any serious complications.
EX-PRESS filtration device has a good IOP-lowering effect and a low rate of complications in patients with advanced NVG associated with PDR. In addition, there was no loss of light perception or no line decrease of the BCVA.
由于纤维血管增生或出血增加，新生血管性青光眼（NVG）患者行传统滤过手术的预后有限。本研究旨在评估EX-PRESS滤过装置治疗与增殖性糖尿病视网膜病变（PDR）相关的NVG的安全性和有效性。
在这个回顾性病例系列中，我们回顾了被诊断为患有与PDR相关的NVG并接受EX-PRESS滤过手术的患者的病历。主要观察指标包括：术后眼压（IOP）、眼压下降百分比、青光眼药物使用数量、视力及手术并发症。成功的手术定义为眼压<22 mmHg且较术前下降>5 mmHg，无论是否需要额外的青光眼手术，无光感丧失或最佳矫正视力（BCVA）在Snellen视力表上下降不超过2行。
本研究纳入5例患者（5只眼）。术前平均眼压为33.4±5.9 mmHg，末次随访时眼压为17.0±3.0 mmHg（P = 0.003）。术前平均抗青光眼药物使用数量为3.8±0.4种，末次随访时为2.2±1.5种（P = 0.06）。所有5例患者的最终视力在1行Snellen视力表范围内改善或稳定。3例患者出现“高血压期”（定义为术后前6个月眼压>21 mmHg），2个月内缓解。2例患者出现前房积血，均自行吸收。所有患者均未发生任何严重并发症。
EX-PRESS滤过装置在治疗与PDR相关的晚期NVG患者中具有良好的降眼压效果和较低的并发症发生率。此外，无光感丧失或BCVA无下降。
