玻璃体腔内注射康柏西普后行小梁切除术联合丝裂霉素及全视网膜激光光凝治疗新生血管性青光眼的效果

Effect of trabeculectomy after intravitreal injection of conbercept combined with mitomycin and whole retina laser photocoagulation in the treatment of neovascular glaucoma

目的研究玻璃体腔内注射康柏西普后行小梁切除术联合丝裂霉素及全视网膜激光光凝治疗新生血管性青光眼的效果。方法选择2013年1月至2016年12月在渭南市中心医院进行诊治的新生血管性青光眼患者60例(60眼)作为研究对象,所有患者均先给予玻璃体腔内注射0.05 m L康柏西普,然后行小梁切除术,再行全视网膜激光光凝术。术后随访6个月,观察患者术后的视力、眼压、治疗效果、虹膜新生血管和并发症发生情况。结果术前,视力无光感3例,光感、手动/眼前12例,指数～0.05者34例,0.05～0.2者11例;术后6个月,38例患者的视力稍有提高[其中,17例手动～眼前/指数,10例光感～手动,11例眼前/指数～0.04,19例患者的视力不变,3例患者的视力出现减退(手动～光感)]。术后6个月,患者的平均眼压为(18.23±6.15)mm Hg,明显低于术前的(40.37±5.62)mm Hg,差异具有统计学意义(P<0.05);且有46例患者的眼压<21 mm Hg,成功率为76.67%。60例患者经过治疗后显效25例,有效21例,无效14例,治疗总有效率为76.67%(46/60)。术后6个月,虹膜新生血管全部回退者33例,部分回退者19例,无回退者8例,总退回率为86.67%。术中有7例患者出现少量前房出血,在术后第1天前房少量积血,第3天积血完全被吸收。术中和术后无1例患者发生脉络膜上腔出血、脉络膜脱离等并发症。结论玻璃体腔内注射康柏西普后行小梁切除术联合丝裂霉素及全视网膜激光光凝术治疗新生血管性青光眼的效果确切,并发症发生率低,且安全可靠,具有较高的临床应用价值。

Objective To investigate the effect of trabeculectomy after intravitreal injection of conbercept combined with mitomycin and whole retina laser photocoagulation in the treatment of neovascular glaucoma. Methods Sixty patients(60 eyes) with neovascular glaucoma treated in Weinan Central Hospital from January 2013 to December 2016 were selected as the study objects. All patients were given intravitreal injection of 0.05 mL conbercept, followed by trabeculectomy and whole retina laser photocoagulation. The patients were followed up for 6 months to observe the visual acuity, intraocular pressure, treatment effects, iris neovascularization and complications. Results Before operation, there were 3 cases visual acuity without light perception, 12 cases with light perception, hand movement/nearby eyes, 34 cases of checking finger-0.05, 11 cases of 0.05-0.2. At 6 months after operation, the visual acuity of 38 patients improved slightly [among them 17 cases were hand movement-nearby eyes/checking finger, 10 cases were light perception-hand movement, 11 cases were nearby eyes/checking finger-0.04, the visual acuity of 19 patients remained unchanged, and the visual acuity of 3 patients decreased(hand movement-light perception)]. At 6 months after operation, the average intraocular pressure was(18.23 ±6.15) mmHg, which was significantly lower than the(40.37±5.62) mmHg of the preoperative, the difference was statistically significant(P<0.05), and there were 46 patients with the intraocular pressure of <21 mmHg, with a success rate of 76.67%.After treatment, 25 cases were markedly effective, 21 cases were effective and 14 cases were ineffective. The total effective rate of treatment was 76.67%(46/60). At 6 months after operation, there were 33 cases of iris neovascularization returned completely, 19 cases of partial regression and 8 cases of no regression, with a total regression rate of 86.67%. A small amount of anterior chamber hemorrhage occurred in 7 patients during the operation, a small amount of anterior chamber hemorrhage was accumulated on the first day after operation, and the hemorrhage was completely absorbed on the third day.No complications such as suprachoroidal hemorrhage and choroidal detachment occurred during and after operation.Conclusion Trabeculectomy after intravitreal injection of conbercept combined with mitomycin and whole retina laser photocoagulation in the treatment of neovascular glaucoma has definite curative effect, with low incidence of complications,and is safe and reliable, which has high clinical application value.