How to treat neovascular glaucoma?
summary
Neovascular glaucoma is a branch of glaucoma, mainly due to the iris surface with new fiber blood vessels, resulting in adhesion with the surrounding iris, and because the new blood vessels are easy to rupture, repeated bleeding, resulting in the production of neovascular glaucoma. How to treat neovascular glaucoma? Next, I'd like to share my views with you.
How to treat neovascular glaucoma?
Panretinal photocoagulation (PRP): the mechanism of PrP remains unclear. Because retinal ischemia is the key factor of NVI, PrP must eliminate the source of angiogenic factors or antagonize its effect to some extent. Retinal hypoxia can cause chronic dilation of retinal vessels, and then cause retinal neovascularization. Retinal blood vessels support the inner retina, but 2 / 3 of the total oxygen consumption of the retina is in the outer and pigment epithelium. Photocoagulation can selectively destroy the outer layer of high oxygen consumption and make the oxygen component of choroid diffuse to the inner layer of retina, thus alleviating the hypoxia of inner retina. The autoregulation mechanism of retinal vessels is dilation at low oxygen level and contraction at high oxygen level.
Panretinal cryotherapy: when the indication is suitable for PrP treatment, but because the corneal, lens or vitreous opacity obviously affects the fundus visibility, panretinal cryotherapy can be considered. As a major treatment, panretinal cryotherapy causes more obvious inflammation and blood retinal barrier damage than PrP. Its potential complications include tractive and exudative retinal detachment and vitreous hemorrhage. The patients who have lost useful vision can control both NVI and IOP by using panretinal cryotherapy and ciliary cryotherapy at the same time, but the postoperative inflammation and pain are more serious. Therefore, cryotherapy should be used as a last resort only when other treatments fail or are not possible.
Iridocorneal angle photocoagulation: goniocoagulation was first proposed in 1977, when the role and effectiveness of PrP in the treatment of NVG were being evaluated. In some cases, prior to PrP, gonioscopy can provide "a period of respite" to delay the imminent closure of the adhesive angle. However, if PrP can not be carried out after that, the angle photocoagulation itself can not effectively prevent the occurrence of angle adhesion and closure, but often aggravate the inflammation and accelerate the progress of angle neovascularization.
matters needing attention
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