【摘要】 目的:糖尿病新生血管性青光眼十分顽固难治。本文探索新的治疗方法以提高其疗效。方法:严格控制好血糖,配合降眼压药物应用,采用结膜下注射α-干扰素联合青光眼阀植入术。在虹膜新生血管消退,角膜恢复透明,眼压正常,眼底清楚的情况下,即可作全视网膜光凝。结果:糖尿病性视网膜病变并发新生血管性青光眼虹膜红变患者6例,术后眼压控制正常,为12～17mmHg(1mmHg=0.133kPa),5例视力增进至0.03～0.3,虹膜新生血管完全消退或仅余很少,角膜透明,前房已无积血,眼底均可见到糖尿病性视网膜病变,无视网膜脱离。4例术后作全视网膜光凝。随访6月～1a,4例患者视力保持在0.03～0.2,眼压正常。1例未能及时作全视网膜光凝,再次出血,虽眼压正常,视力仅存手动;另1例术后眼压正常,视力不变,虹膜新生血管减少,由于玻璃体出血机化,建议作玻璃体切割术,患者未同意手术。结论:α-干扰素通过抑制DNA合成来干扰细胞增殖,使血管内皮细胞对VEGF的刺激丧失应答能力,有效地抑制血管内皮细胞的增殖和移行,发挥抗新生血管生成的作用,联合青光眼阀植入手术,达到持久降低眼压,消除虹膜新生血管,恢复部分视力。更多还原

【Abstract】 AIM: To find a new method to improve the treatment of neovascular glaucoma caused by diabetes.· METHODS: As blood sugar was under control, drug was used to decrease the intraocular pressure (IOP). Then α-interferon subconjunctival injection was used and Ahmed glaucoma valve was implanted. Pan- retina photocoagulation was done when the new vessels in iris decreased or disappeared, cornea became transparent, IOP returned to normal and fundus became clear.· RESULTS: After the operation, IOP of 6 patients with diabetic retinopathy and rubeosis iridis caused by neovascular glaucoma was brought to normal, about 12-17mmHg. In 5 patients of them, vision improved to 0.03-0.3, the iris new vessels decreased or regressed, cornea became transparent, no hyphema occured, diabetic retinopathy was found but no retinal detachment. After operation, 4 patients were treated with pan-retina photocoagulation and their vision maintained 0.03-0.2 and IOP was normal during the follow-up of 6 months to 1 year. One patient was not treated with pan-retina photocoagulation in time and hemorrhage recurred and vision was only hand move though IOP returned to normal; in another patient, IOP was normal, iris new vessels decreased and vision did not improve. · CONCLUSION: α-interferon can inhibit neovasculigation by inhibiting the synthesis of DNA to interfere cell proliferation, thus making the vascular endothelial cell lose the ability to respond to the VEGF stimulation and prohibiting the proliferation and migration of the vascular endothelial cell. α-interferon used with Ahmed glaucoma valve implantation can lower IOP over a long time, decrease or regress the iris new vessels and bring back some vision. ·更多还原