视网膜光凝联合雷珠单抗治疗新生血管性青光眼35例的临床疗效观察

Retinal photocoagulation combined with ranibizumab in the treatment of 35 cases of neovascular glaucoma

目的探讨视网膜光凝联合雷珠单抗眼用注射液行球内注射治疗新生血管性青光眼（NVG）的临床疗效。方法选取2014年1月至2015年8月期间河南省焦作煤业（集团）有限责任公司中央医院眼科收治的NVG患者65例（65只眼）作为研究对象。根据治疗方法的不同,将其分为观察组和对照组。对照组患者仅采取视网膜光凝治疗,观察组患者则采取视网膜光凝联合雷珠单抗眼用注射液行球内注射治疗。患者的视力,按照≤4.3、4.3~4.7及≥4.8分为三个等级,采用例数和百分比进行描述,组间比较采用Kruskal-Wallis H秩和检验。新生血管的描述,采用例数和百分比,组间比较采用卡方检验。视野缺损值、视网膜神经纤维层（RNFL）厚度、虹膜新生血管的消退时间、眼压以及静脉的循环时间等以均数±标准差（±s）进行描述,组间比较采用独立样本t检验,组内比较采用配对t检验。结果患者经过治疗后,各组患眼视力按照≤4.3、4.3~4.7及≥4.8三个等级分类统计,结果观察组分别为7例（7只眼,占20.00%）、24例（24只眼,占68.57%）及4例（4只眼,占11.43%）;对照组分别为14例（14只眼,占46.67%）、13例（13只眼,占43.33%）及3例（3只眼,占10.00%）。经过秩和检验,组间比较,差异无统计学意义（Hc=-1.93,P〉0.05）。患者虹膜新生血管明显消退或消失者,观察组为33例（33只眼,占94.28%）,对照组为23例（23只眼,占76.67%）,两组相比差异有统计学意义（χ^2=4.20,P〈0.05）。观察组患者治疗前后患眼视野缺损值分别为（19.05±0.52）d B和（13.43±0.63）d B,对照组分别为（18.88±0.65）d B和（15.91±0.54）d B;组间比较：治疗前组间差异无统计学意义（t=1.11,P〉0.05）,治疗后组间比较差异有统计学意义（t=16.37,P〈0.05）。组内比较：观察组治疗前后比较差异有统计学意义（t=37.68,P〈0.05）;对照组患者治疗前后比较,差异有统计学意义（t=19.25,P〈0.05）。患者治疗前后患眼的RNFL厚度,观察组分别为（71.47±3.14）μm和（91.21±2.04）μm,对照组分别为（71.51±3.29）μm和（85.05±2.17）μm;组间比较：治疗前组间差异无统计学意义（t=0.048,P〉0.05）,治疗后组间比较差异有统计学意义（t=11.33,P〈0.05）。组内比较：观察组治疗前后比较差异有统计学意义（t=28.87,P〈0.05）;对照组治疗前后比较,差异有统计学意义（t=18.25,P〈0.05）。患者经过治疗虹膜新生血管的消退时间,观察组为（6.20±0.41）d,明显短于对照组的（8.39±0.38）d。两组比较,差异有统计学意义（t=21.45,P〈0.05）。患者治疗前后的患眼眼压,观察组分别为（46.19±0.73）mm Hg（1 mm Hg=0.133k Pa）和（18.52±0.49）mm Hg,对照组分别为（46.21±0.69）mm Hg和（23.95±0.51）mm Hg。组间比较：治疗前组间差异无统计学意义（t=0.10,P〉0.05）,治疗后组间比较差异有统计学意义（t=42.05,P〈0.05）。组内比较：观察组治疗前后比较差异有统计学意义（t=172.37,P〈0.05）,对照组治疗前后比较,差异有统计学意义（t=142.09,P〈0.05）。患者治疗前后患眼静脉循环的时间,观察组分别为（11.31±0.38）s和（8.19±0.40）s,对照组分别为（11.30±0.37）s和（9.43±0.29）s。组间比较：治疗前组间差异无统计学意义（t=0.10,P〉0.05）,治疗后组间比较差异有统计学意义（t=13.74,P〈0.05）。组内比较：观察组治疗前后比较差异有统计学意义（t=30.97,P〈0.05）;对照组治疗前后比较,差异有统计学意义（t=21.78,P〈0.05）。结论视网膜光凝联合雷珠单抗眼用注射液行球内注射治疗NVG能良好地改善患者视力和视野缺损,效果较为可靠。

Objective Retinal photocoagulation combined with ranibizumab injection for ophthalmic intraocular injection for the treatment of neovascular glaucoma（ NVG） clinical curative effect.Methods Select during January 2014 to August 2014 Jiaozuo Coal Industry Group Co,Ltd. Central Hospital treated 65 cases（ 65 eyes） of patients with NVG as the rsearch object. According to the different treatments will be divided into the observation group and control group. Patients with the control group only take retinal photocoagulation treatment,patients with the observation group was taken Retinal photocoagulation combined licensed anti clinical agents for injection in the treatment of the ball. Visual acuity in accordance with is less than or equal to 4. 3,4. 3-4. 7 and is more than or equal to 4. 8 points into three grades,the number of cases and the percentage is described, group compared with Kruskal-Wallis H test. Neovascularization were described by the number and percentage,the chi square test was used in the comparison between the groups.The value of visual field defect,retinal nerve fiber layer（ RNFL） thickness,iris neovascularization subsided time,intraocular pressure and venous circulation time as mean standard deviation（± s） is described,comparison between groups using independent sample t-test,the group compared with pairedt-test.Results each group was recorded visual acuity in accordance with is less than or equal to 4. 3,4. 3-4. 7 and is more than or equal to 4. 8 three classification statistics,the results of the observation group were 7 cases（ 7 eyes,20. 00%）,24 cases（ 24 eyes,68. 57%） and 4 cases（ 4 eyes,11. 43%） after the treatment; The control group were 14 cases（ 14 eyes,46. 67%）,13 cases（ 13 eyes,43. 33%） and 3 cases（ 3 eyes,10%）. After Kruskal-Wallis test,there was no significant difference between the two groups（ Hc =- 1. 93,P〈0. 05）. The patients with iris neovascularization significantly faded or disappeared,the observation group was 33 cases（ 33 eyes,94. 28%）,the control group was 23 cases（ 23 eyes,76. 67%）,the difference was statistically significant（ χ^2= 4. 20,P〈0. 05）. Observation group patients before and after treatment with visual field defect values were（ 19. 05 ± 0. 52） d B and（ 13. 43 ± 0. 63） d B,the control group were（ 18. 88± 0. 65） d B and（ 15. 91 ± 0. 54） d B; there was no significant difference between the two groups before treatment（ t = 1. 11,P〈0. 05）,and there was significant difference between the two groups（ t = 16. 37,P〈0. 05）. Within the group comparison： the observation group before and after treatment compared the difference was statistically significant（ t = 37. 68,P〈0. 05）; compared with the control group before and after treatment,the difference was statistically significant（ t = 19. 25,P〈0. 05）. Patients before and after treatment with RNFL thickness of the eye,the observation group respectively（ 71. 47 ± 3. 14） μm and（ 91. 21 ± 2. 04） μm,the control group were（ 71. 51 ± 3. 29） μm and（ 85. 05 ± 2. 17） μm; Comparison between groups： the treatment group before the difference was not significant between（ t = 0. 048,P 0.05）,statistically significant difference between the two groups after treatment（ t = 11. 33,P〈0. 05）. Within the group comparison： the observation group before and after treatment compared the difference was statistically significant（ t = 28. 87,P〈0. 05）; compared with the control group before and after treatment,the difference was statistically significant（ t = 18. 25,P〈0. 05）. Patients after the treatment of iris neovascularization subsided time,the observation group was（ 6. 20 ± 0. 41） d,significantly shorter than the control group（ 8. 39 ± 0. 38） d. The difference was statistically significant between the two groups（ t = 21.45,P〈0. 05）. The intraocular pressure of patients before and after treatment,the observation group respectively（ 46. 19 ± 0. 73） mm Hg and（ 18. 52 ± 0. 49） mm Hg,the control group were（ 46. 21 ± 0. 69）mm Hg and（ 23. 95 ± 0. 51） mm Hg. There was no significant difference between the two groups before treatment（ t = 0. 10,P〈0. 05）,and there was significant difference between the two groups（ t = 42. 05,P〈0. 05）. Group comparison： observation group before and after treatment,the difference was statistically significant（ t = 172. 37,P〈0. 05）,the control group after treatment,the difference was statistically significant（ t = 142. 09,P〈0. 05）. Before and after treatment of patients suffering from eye venous circulation time,the observation group were（ 11. 31 ± 0. 38） s and（ 8. 19 ± 0. 40） s,the control group were（ 11. 30 ± 0. 37） s and（ 9. 43 ± 0. 29） s. There was no significant difference between the two groups before treatment（ t = 0. 10,P〈0. 05）,and there was significant difference between the two groups（ t = 13. 74,P〈0. 05）. Within the group comparison： the observation group before and after treatment were statistically significant differences（ t = 30. 97,P〈0. 05）; the control group before and after treatment,the difference was statistically significant（ t = 21. 78,P〈0. 05）. Conclusion Photocoagulation combined with ranibizumab ophthalmic injection for ball injection in the treatment of NVG can improve the patients＇ visual acuity,visual field.