康柏西普玻璃体腔注射联合Ahmed青光眼阀植入治疗新生血管性青光眼效果分析

The efficacy of intravitreal injection of Conbercept combined with Ahmed glaucoma valve implantation for the management of neovascular glaucoma

目的 对比研究康柏西普玻璃体腔注射联合Ahmed青光眼阀植入与单纯Ahmed青光眼阀植入对眼压控制及视力恢复的效果.方法 临床病例对照研究.对2013年1～12月至2014年3～5月在中医科学院眼科医院纳入康柏西普玻璃体腔注药联合Ahmed青光眼阀植入术治疗的10例新生血管性青光眼患者共10只眼为试验组,纳入单纯Ahmed青光眼阀植入术治疗的10例新生血管性青光眼患者共10只眼作为对照组.比较两组患者术后12周内最佳矫正视力,眼压（NCT）,房角及虹膜新生血管消退及并发症情况,并进行统计学分析.结果 试验组术后1、4、8、12周平均眼压分别为（11.0±1.8）、（12.7±1.9）、（14.0±2.3）、（14.7±3.2） mmHg;对照组术后1、4、8、12周平均眼压分别为（12.1±2.0）、（15.5±3.0）、（17.4±3.7）、（17.4±2.3） mmHg.试验组和对照组术后各时间点眼压明显低于术前差异有统计意义（P＜0.05）.试验组术后4、8、12周眼压均低于对照组,且差异具有统计学意义（P＜0.05）.试验组术后8、12周眼压控制成功率明显高于对照组,且差异具有统计学意义（P＜0.05）.试验组术后1周、8周、12周虹膜及房角新生血管消退比例均高于对照组.两组术前及术后12周最佳矫正视力差异无统计学意义（P＞0.05）.结论 康柏西普玻璃体腔注药是新生血管性青光眼Ahmed青光眼阀植入术前安全和有效的辅助措施,可降低手术并发症,降低术后12周内眼压水平.术后眼底原发病的治疗及全视网膜光凝术可避免玻璃体腔重复注药,为维持新生血管性青光眼的术后眼压及视力发挥了作用.

Objective To study the safety and efficacy of intravitreal injection of Conbercept followed by Ahmed glaucoma valve implantation for the management of neovascular glaucoma （NVG）.Methods Ten patients （10 eyes） with NVG were treated with Conbercept intravitreal injection followed by Ahmed glaucoma valve implantation were included （IVC group）,while a historical group of 10 NVG eyes treated with Ahmed glaucoma valve implantation was used for comparison （control group）.Injection of Conbercept （1.25 mg/0.05 mL） was performed under topical anesthesia,and Ahmed valve was implanted within 1-2 weeks in the IVC group.All eyes received postoperative panretinal photocoagulation.The BCVA,IOP,the rate of complete neovascular regression on iris and anterior chamber angle and complications of the two groups were recorded and compared with 12 weeks postoperatively.Results The average IOP in the IVC group was （11.0±1.8） mmHg,（12.7 ±1.9） mmHg,（14.0±2.3） mmHg,（14.7±3.2） mmHg 1 week,4 weeks,8 weeks and 12 weeks postoperatively,while the average IOP in the control group was （12.1±2.0） mmHg,（15.5±3.0） mmHg,（17.4±3.7） mmHg,（17.4±2.3） mmHg respectively.The postoperative IOP was significantly lower than preoperative IOP in both IVC and control groups.The IOP in the IVC group was significantly lower than that of control group 4 weeks,8 weeks and 12 weeks postoperatively （P 〈0.05）.The success rate of IOP control in IVC group was significantly higher that that of control group 12 weeks postoperatively （P 〈0.05）.The rate of neovascular regression in the IVC group was significantly higher than that of control group postoperatively.The BCVA between the 2 groups showed no significant difference.Conclusions Intravitreal injection of conbercept is a useful preparatory step before safely and effectively implanting an Ahmed glaucoma valve implantation in eyes with NVG.It helps to decrease the postoperative IOP and increase the success rate of IOP control within 12 weeks postoperatively.Postoperative panretinal photocoagulation reduces the recurrence of neovascular activity and decrease the time of repeated Conbercept injection.