青光眼引流器植入联合康柏西普治疗新生血管性青光眼

Effect of EX-PRESS miniature glaucoma drainage device implantation combined with intravitreal ;injection of Conbercept for neovascular glaucoma

目的：观察EX-PRESS青光眼引流器植入术联合玻璃体内注射康柏西普治疗新生血管性青光眼的效果。方法2014年至2015年我院收治的新生血管性青光眼15例（15眼），先行康柏西普（ Conbercept ）玻璃体内注射，待虹膜新生血管消退后，行EX-PRESS青光眼引流器植入术。观察术后最佳矫正视力（ BCVA）、眼压及并发症的发生。结果玻璃体内注射康柏西普3～5 d后虹膜及前房角新生血管消退， EX-PRESS 青光眼引流器植入术顺利完成。术后1周～9个月BCVA （ Log MAR）由术前的（0．69±0．24），提高至术后的（0．30±0．17）～（0．24±0．14），差异有统计学意义（t＝8．77～9．93，P＝0．000）。术前眼压（38．16±4．99） mmHg（1 mmHg＝0．133 kPa），术后1周，1、3、6和9个月眼压分别下降至（13．46±2．42）、（14．51±3．34）、（16．11±4．55）、（17．13±5．30）及（17．00±5．20） mmHg，差异有统计学意义（t＝17．09，P＝0．00；t＝16．37，P＝0．00；t＝15．26，P＝0．00；t＝14．55，P＝0．00；t＝14．65，P＝0．00）。术后眼压正常者12例，眼压控制有效率80．00％（12／15）。术后并发症有浅前房2例，经加压包扎、散瞳后恢复。滤过泡包裹3例，经针刺分离后改善2例。无其他严重并发症发生。结论玻璃体内注射康柏西普后虹膜及前房角新生血管消退明显，及时行EX-PRESS青光眼引流器植入术，术后视力改善，眼压控制良好，是治疗新生血管性青光眼安全有效的方式。

Objective To observe the efficacy of the EX-PRESS miniature glaucoma drainage device implantation combined with intravitreal injection of Conbercept for neovascular glaucoma （ NVG ） . Methods Fifteen eyes of 15 patients with NVG in our hospital from 2014 to 2015 were enrolled in our observation.Those patients were firstly treated with Conbercept intravitreal injection . After iris neovascularization faded away , EX-PRESS glaucoma drainage device were implanted .The best-corrected visual acuity , intraocular pressure （ IOP） and complications were compared .Results The neovascularization of iris and anterior chamber angle faded away 3-5 days after Conbercept intravitreal injection .The EX-PRESS glaucoma drainage devices were implanted successfully .The BCVA was improved from （ 0.69 ±0.24 ） before the surgery to （0.30 ±0.17） 1 week after the combined surgery and （0.24 ±0.14） in 9 months, the difference was statistically significant （t=8.77,P=0.00; t=9.93,P=0.000）.The IOP before surgery was （38.16 ±4.99 ） mmHg, it was （13.46 ±2.42）,（14.51 ±3.34）,（16.11 ±4.55）,（17.13 ±5.30） and （17.00 ±5.20） mmHg at 1 week, 1, 3, 6 and 9 months after the surgery, respectively.The difference was statistically significant （t=17.09,P=0.00;t=16.37,P=0.00;t=15.26,P=0.00;t=14.55,P=0.00;t=14.65,P=0.00）.The effective rate of the IOP controlling was 80.00%（12/15）.Shallow anterior chamber occurred in 2 eyes, which were solved by pressure dressing and mydriasis .Encapsulated filtering blebs occurred in 3 eyes, which were improved in 2 eyes after by needling exclusion .No other severe complication occurred .Conclusion Conbercept intravitreal injection could make iris and anterior chamber＆nbsp;angle neovascularization tading away obviously , EX-PRESS effectively control the IOP and improve the vision after surgery .The combination of Conbercept intravitreal injection and EX-PRESS miniature glaucoma device implantation is an effective method for NVG .