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    雷珠单抗联合小梁切除术和Ahmed引流阀植入术治疗新生血管性青光眼的疗效观察

    The effect of Ranibizumab combined with trabeculectomy and Ahmed glaucoma valve implantation in the treatment of neovascular glaucoma

    • 摘要: 目的 探讨玻璃体腔注射雷珠单抗联合小梁切除术和Ahmed引流阀植入术治疗新生血管性青光眼的临床疗效。方法 回顾性分析我院2014年10月至2017年03月收治的Ⅱ~Ⅲ1期新生血管性青光眼患者35例37眼的临床资料。所有患者均接受玻璃体腔注射雷珠单抗,3~7d后根据接受手术治疗的方法分为小梁切除术组(A组,16眼),Ahmed引流阀植入术(B组,21眼)。术后随访8~36个月,分别对两组术后眼内压、虹膜新生血管、视力变化和并发症发生率进行比较。结果 两组注药后及术后不同时期眼内压均较注药前显著下降,差异有统计学意义(P<0.01)。两组术后1周和1个月的眼内压差异无统计学意义(t=-0.23,P=0.82;t=1.01,P=0.32),但术后6个月、末次随访时B组平均眼内压低于A组,差异有统计学意义(t=3.03,P=0.005; t=2.51,p=0.02)。两组玻腔注药3~7d后虹膜新生血管部分或全部消退,有效率为100%。术后视力提高两组之间差异无统计学意义(χ2=1.67,P=0.20)。术后并发症发生率两组之间差异无统计学意义(χ2=0.64,P=0.42)。结论 治疗新生血管性青光眼,玻璃体腔内注射雷珠单抗联合Ahmed引流阀植入术对比小梁切除术,可以更持久地控制眼内压。

       

      Abstract: Objective To investigate the clinical efficacy of intravitreal injection of ranibizumab combined with trabeculectomy and Ahmed glaucoma valve implantation in the treatment of neovascular glaucoma. Methods The clinical data of 35 patients with 37 eyes of stage II ~ III 1 neovascular glaucoma who were treated in our hospital from October 2014 to March 2017 were analyzed retrospectively. All patients received intravitreal injection of r anibizumab. After 3~7d, they were divided into trabeculectomy group (group A, 16 eyes) and glaucoma valve implantation (B group, 21 eyes) according to surgical treatment. After 8~36 months of follow-ups, the intraocular pressure, the neovascularization of the iris, the change of vision and the incidence of complications were compared in the two groups. Results The intraocular pressure of the two groups after the injection and the different periods after the operation were significantly lower than that before the injection, and the difference was statistically significant (P < 0.01). There was no significant difference in intraocular pressure between the two groups at 1 weeks and 1 months after operation (t=-0.23, P=0.82, t=1.01, P=0.32), but the average intraocular pressure in the B group was lower than that in the A group at 6 months and at the last follow-up period (t=3.03, P=0.005, t=2.51, p=0.02). In the two groups, the neovessels of iris partially or all disappeared after 3~7d injection, and the effective rate was 100%. There was no significant difference in visual acuity between the two groups after operation (x 2=1.67, P=0.20). There was no significant difference in the incidence of postoperative complications between the two groups (x 2=0.64, P=0.42). Conclusion Compared with trabeculectomy, intravitreal injection of r anibizumab combined with glaucoma drainage valve implantation can control intraocular pressure in a more sustainable way

       

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