玻璃体腔注药联合不同时间段引流物植入术治疗新生血管青光眼的降眼压效果

Clinical observation of intravitreal ranibizumab injection combined with Ahmed valve implantation for reducing intraocular pressure （IOP） at different times

目的 观察玻璃体腔注射雷珠单抗后不同时间段联合Ahmed青光眼阀植入术对新生血管性青光眼的治疗效果.方法 回顾性临床病例系统研究.对2013年6月至2014年8月在光明眼科医院,选择药物无法控制眼压的新生血管性青光眼患者20例20只眼.将经济条件较好者9例9只眼归为A组;由于家庭条件限制11例11只眼患者选择择日行青光眼引流物降眼压归为B组.所有患眼均接受玻璃体腔注射雷珠单抗（lucentis） 0.05 mL,A组于注药1周后行Ahmed青光眼阀门植入术;B组患者选择3～4周行青光眼阀门植入术,所有患者阀门植入术后及时行眼底荧光血管造影及视网膜光凝术.结果 注药后2～7 d,A组1只眼虹膜瞳孔领处残留血管,B组2只跟虹膜纹理处残留少许血管.A组玻璃体腔注药前眼压为35.0～51.5 （43.5±7.5） mmHg,注药后1周眼压为36.5～45.0 （40.5±5.5） mmHg,植入青光眼阀门手术后3个月眼压14.5～21.0 （17.3±2.5） mmHg,6个月眼压为12.5～22.0 （16.0±3.5） mmHg;B组玻璃体腔注药前眼压为35.0～53.0 （44.5±6.5） mmHg,注药后1周眼压为29.5～47.0 （37.0±5.6） mmHg,植入青光眼阀门手术后3个月眼压13.0～18.0 （15.0±2.1） mmHg,6个月眼压为14.5～20.0 （17.0±2.5） mmHg.A、B两组在注药前后,植入青光眼阀门前后眼压变化差异均有统计学意义（P＜0.05）,但两组术后眼压下降差异无统计学意义（P＞0.05）,青光眼阀植入术后随访6个月,所有患者眼压控制在正常范围.A组中2例术后前房浅近消失,未发生明显渗血等炎症反应;B组3例患者术中发生前房渗血,且术后第2天前房消失,炎症反应重.另随访中B组2例患者由于原发病加重前房渗血视力下降.青光眼阀植入术后视力提高者14例,视力无明显变化者5例.结论 两组不同时间段植入的青光眼阀手术本身对患者长期降眼压效果影响无明显差异,但为了尽可能减少术中、后并发症的发生及保护患者残存视力,建议有条件患者尽快选择青光眼阀门植入术.

Objective To observe intravitreal ranibizumab injection combined with Ahmed valve implantation for reducing intraocular pressure （IOP） at different times.Methods Twenty eyes with neovascular glaucoma （NVG） whose IOP could not be controlled by medicine were chosen （9 cases in group A,whose economic condition was better,another 11 cases in group B）,all the cases were injected with ranibizumab （Lucentis） 0.05 mL,after 1 week the Ahmed valve implantation were performed in group A,while group B were performed at 3-4 weeks.Then the FFA and the retinal laser photocoagulation treatment were taken promptly.Results The iris neovessels were exist in 1 case （group A） from 2 days to 7 days after the injection,while in group B were 2 cases.In group A：The IOP before injection was 35.0-51.5 （43.5±7.5）mmHg,1 week after injection was 36.5-45.0 （40.5±5.5）mmHg,3 months after implantation was 14.5-21.0 （17.3±2.5）mmHg,6 months was 12.5-22.0 （16.0±3.5）mmHg;in group B：The IOP before injection was 35.0-53.0 （44.5±6.5） mmHg,1 week after injection was 29.5-47.0 （37.0±5.6）mmHg,3 months after implantation was 13.0-18.0 （15.0±2.1）mmHg,6 months was 14.5-20.0 （17.0±2.5）mmHg,there was no statistical difference （P 〉0.05） in two groups after implantation.In group A：anterior chamber disappearance happened in 2 cases,but no hyphema after implantation;group B：in the operation hyphema happened in 3 cases,and the anterior chamber disappeared in the next day,the visual acuity in 2 cases were decreased due to hyphema during follow-up period.In all the cases,the visual acuity in 14 cases was increased after implantation,unchanged in 5 cases.Conclusions There is no statistical difference about intravitreal ranibizumab injection combined with Ahmed valve implantation for reducing intraocular pressure （IOP） at different times,but it is suggested that implanting Ahmed valve as soon as possible for reducing complications.