多种方法联合治疗新生血管性青光眼的疗效

Therapeutic effects of combination therapy for neovascular glaucoma

目的:探讨多种方法联合治疗新生血管性青光眼的临床疗效。方法:选取新生血管性青光眼处于青光眼期患者34例34眼,根据患者发病时情况采取不同的治疗方案,分为抗VEGF药物雷珠单抗眼内注射联合全视网膜光凝组11例11眼(A组),810nm激光睫状体光凝联合全视网膜光凝组10例10眼(B组),三种方法联合应用组6例6眼(C组)以及810nm激光睫状体光凝治疗青光眼,并配合配戴高透氧性角膜接触镜治疗角膜大疱7例7眼(D组)等多种方法,观察多种方法联合治疗前后最佳矫正视力,眼内压的变化。分别于治疗后1,4wk;6,12mo进行随诊,记录最佳矫正视力、眼内压检查结果及并发症等情况。结果:多种联合治疗方案对处于青光眼期的新生血管性青光眼患者,均可将眼压控制在23mmHg左右,较治疗前明显下降(P<0.05),随访4wk后各时间段眼压未见明显变化(P>0.1),个别患者需配合一种降眼压药物局部点眼。抗VEGF药物雷珠单抗眼内注射及全视网膜光凝组治疗后1,4wk;6mo的最佳矫正视力比治疗前有明显提高,具有统计学意义(P<0.05),其余各组最佳矫正视力治疗前后未见明显变化(P>0.1),2例患者出现了睫状体光凝术后的前房出血。结论:经过抗VEGF药物眼内注射、810nm激光睫状体光凝以及全视网膜光凝的联合应用,大部分新生血管性青光眼疾病患者均能得到有效的治疗,可以有效控制眼压,并保有部分视功能,明显改善患者生活质量,联合治疗操作相对程式化、易于推广、患者痛苦小,是治疗新生血管性青光眼的一种有效策略。

AIM： To investigate therapeutic effects of combination therapy for neovascular glaucoma（ NVG）.METHODS： This retrospective study comprised 34 eyes of 34 patients who suffered from NVG. All patients were assigned to group A, B, C and D according to the different combination therapies. Group A（ 11 eyes of 11patients） was treated with intravitreal injection of ranibizumab and panretinal photocoagulation（ PRP）.Group B（ 10 eyes of 10 patients） was treated with transcleral cyclophotocoagulation and PRP. Group C（ 6eyes of 6 patients） was treated with 3 therapies together.Group D（ 7 eyes of 7 patients） was treated with 810 nm transcleral cyclophotocoagulation and soft gas-permeable contact lenses. All the patients were followed- up for 1a. The best- corrected visual acuity（ BCVA）,intraocular pressure（ IOP） were recorded and analyzed prior to operation and 1, 4wk, 6 and 12 mo after operation.RESULTS： All the post treatment IOP decreased significantly（ P 〈 0. 05） from the values before therapy,and the IOP values after 4wk, 6, 12 mo were not significantly different（ P 〉 0. 05） in statistics. Most patients’ IOP can be controlled below 23 mmHg after combination therapy. The visual acuity in group A after 1,4wk,6mo compared with those before treatment was significantly increased（ P 〈 0. 05） in statistics and other groups did not significantly change before and after treatment（ P 〉0. 05）. Anterior chamber bleeding occurred to 2 cases after 1wk of transcleral cyclophotocoagulation.No other ocular or systemic adverse events were found during the follow- up duration.CONCLUSION： After the combination of intraocular injection of the anti- VEGF drugs, 810 nm laser cyclophotocoagulation and PRP,most patients with NVG disease can be effectively treated,can effectively control IOP,and retain part of the visual function,significantly improve the quality of life. In the short- term,combination therapy is safe and effective for NVG,which provides us an available strategy to conquer NVG by simply programmable operation and less suffering.