Ex-PRESS房水引流物植入术联合抗新生血管药物治疗新生血管性青光眼的一年效果

Ex-PRESS miniature glaucoma device implantation combined with anti-VEGF for neurovascular glaucoma

目的评价Ex-PRESS房水引流物植入术联合玻璃体内注射抗血管内皮生长因子（VEGF）治疗新生血管性青光眼的初步效果。设计前瞻性干预性病例系列。研究对象2012年3月至2013年10月北京同仁眼科中心行Ex-PRESS房水引流物植入术的新生血管性青光眼患者16例（16眼）。方法患者在玻璃体内注射雷珠单抗0．5mg治疗后5～10天接受Ex-PRESS房水引流物植入术。术后1、2、3天，1、2、3周，1、3、6、12个月随访。不用药物情况下眼压在21mmHg以下为完全成功，辅助用降眼压药物下眼压在21mmHg以下为条件成功。主要指标眼压、降眼压药物种类及术后并发症。结果术前平均眼压（44．6±17．8）mmHg；术后1、3、6、12个月平均眼压分别为（12．6±3．5）、（13．8±7．5）、（17．5±6．5）、（22．6±9．5）mmHg。术前应用抗青光眼药物（3．2±1．4）种；术后12个月应用（0．6±0．2）种。术后12个月手术完全成功率81．3％，条件成功率87．5％。术后浅前房3眼，脉络膜脱离2眼，前房积血2眼，眼压失控（〉30mmHg）2眼。结论Ex-PRESS房水引流物植入术联合抗新生血管药物治疗新生血管性青光眼安全有效，可作为此类患者的选择性手术治疗方式。

Objective To evaluate the efficacy and safety of Ex-PRESS miniature glaucoma device implantation combined with an- ti-VEGF for neurovascular glaucoma. Design Prospective interventional case series. Participants 16 eyes of 16 patients with neurovas- cular glaucoma who underwent Ex-PRESS miniature glaucoma device implantation in Tongren Hospital from March 2012 to October 2013. Methods All patients underwent Ex-PRESS miniature glaucoma device implantation on 5-10 days after intravitreous injection 0.5 mg ranibizumab. Followed up was performed at day 1, day 2, day 3, week 1, week 2, week 3, month 1, month 3, month 6, and month 12 after surgery. Main Outcome Measures Intraocular pressure （IOP）, numbers of anti-glaucoma medication and postoperative complica- tions. Results Pre-operation mean IOP was 44.6＋17.8 mmHg in 16 patients. IOP after Ex-PRESS surgery was （12.6±3.5）, （13.8±7.5）, （17.5±6.5）, and （22.6±9.5） mmHg respectively at month 1, month 3, month 6, and month 12 after surgery. The number of anti-glaucoma medication was （3.2±1.4） before operation and （0.6±0.2） after operation. At the last following up, the complete success rate was 81.3%, and qualified success rate was 87.5%. The postoperative complications included shallow anterior chamber （3 eyes）, hyphema （2 eyes）, choroidal effusion （2 eyes） and IOP elevation （〉30 mmHg） （2 eyes）. Conclusions Implantation of Ex-PRESS miniature glaucoma device combined with anti-VEGF treatment can stable lowering IOP and has fewer complications for neurovascular glaucoma. It can be consid- ered as alternative method for management of neurovascular glaucoma.