玻璃体腔注射Bevacizumab联合Ahmed青光眼阀植入治疗新生血管性青光眼

Intravitreal bevacizumab and Ahmed glaucoma valve implantation in patients with neovascular glaucoma

目的观察玻璃体腔注射Bevacizumab联合Ahmed青光眼阀植入治疗新生血管性青光眼（NVG）的术后疗效和并发症。方法回顾性临床病例对照研究。选择新乡医学院第一附属医院眼科在2007年至2008年2月间接受过玻璃体腔注射Bevacizumab0．05mL／1．25mg和Ahmed青光眼阀植入术的NVG患者，术前及术后定期随访检查，记录抗青光眼药物数量、Snellen视力、Godmann压平式眼压计测量的IOP等项目。手术成功标准：术后IOP处于6～21mmHg范围内，不再使用或不需额外增加抗青光眼药物治疗，不需进一步抗青光眼手术治疗，术眼视力未丧失光感。结果纳入分析35例（35只眼），随访时间（24．6±14.2）月。Ahmed青光眼阀植入术后IOP比术前降低（P〈0．01），其中术前、术后6月、1年和3年分别为（44．9±4．8）mmHg、（1822±4．0）mmHg、（15．5±3．3）mmHg和（9．8±2．6）mmHg（1mmHg=0．133kPa）；抗青光眼药物数量术后较术前减少（P〈0．01），其中术前、术后6月、1年和3年分别为（3．3±0．5）种、（0．9±0．5）种、（0．8±0．9）种和（0．8±0．6）种。最后一次随访时，视力较术前保持稳定19例（54．3％），改善4例（11．4％），下降12例（34．3％），丧失光感3例（8．6％）。经3年随访，失败病例7例（20．0％o经Kaplan—Meier生存分析，术后1年、2年、3年累计生存率分别为82．9％、74．1％和71．0％。经Cox逐步回归分析，术前视力较差（〈20／400）与术后生存时间具有相关性（RR=3．571，P〈0．05）。术后并发症8例（22．9％），其中前房出血2例（5．7％），脉络膜渗液2例（5．7％），其余并发症较少见，未发生需要取出引流阀的并发症。结论玻璃体腔注射Bevacizumab联合Ahmed青光眼阀植入术安全有效，可作为新生血管性青光眼临床治疗方法之一。

Objective To explore the efficacy and complication of intravitreal bevacizumab and Ahrned glaucoma valve implantation in patients with neovascular glaucoma （NVG）. Methods NVG patients received the treatment of intravitreal bevacizumab 0.05mL/1.25mg and Ahmed glaucoma valve implantation were retrospectively selected. Subjects received ocular examinations before operation and routine follow-ups after operation, and information including the number of anti-glaucoma medications, Snellen visual acuity and IOP measured by Goldmann applanation tonometer was recorded. Success was defined as an IOP between 6-21mmHg, without any or with no more additional anti-glaucoma medicationsl no need of additional glaucoma surgery, and none loss of light perception. Results Thirty-five cases （35eyes） were included and follow up time was 24.6：1： 14.2m. After Ahmed valve implantation, lOP was decreased compared with pre-IOP （P 〈0.01）, of which were 44.9± 4.8mmHg （pre-op）,18.2± 4.0mmHg （6 m）, 15.5± 3.3mmHg （1 y） and 9.8±2.6mmHg （3 y）. The number of anti-glaucoma medications was decreased compared with pre-number （P 〈0.01）, of which were 3.3 ± 0.5 （pre-op）, 0.9± 0.5 （6 m）, 0.8± 0.9 （1 y） and 0.8± 0.6 （3 y）. At last follow up, there were 19 cases （54.3%） with stable visual acuity, 4 cases （11.4%） with visual improvement, 12 cases （34.3%） with worse visual acuity, 3 （8.6%） loss light perception. There were 7 cases （20.0%） failed during 3-year follow up period. The cumulative survival rates were 82.9% （1 y）, 74.1% （2 y） and 71.0% （3 y） respectively by Kaplan-Meier survival analysis. Cox stepwise regression analysis found that the survival time was significant associated with the preop-visual acuity 〈2/400 （RR=3.571, P 〈0.05）. Post-op complications occurred in 8 eyes （22.9%）, of which hyphema in 2 eyes （5.7%）, choroidal effusion in 2 eyes （5.7%）. Other complications occurred infrequently and implants were not removed in any of the patients. Conelusiorts Being safe and effective, the procedure of intravitreal bevacizumab and Ahmed glaucoma valve implantation should be one of treatments to NVG.