玻璃体腔内注射雷珠单抗联合小梁切除术及视网膜光凝术治疗新生血管性青光眼

Intravitreal injection of Lucentis combined with trabeculectomy and pan retinal photocoagulation for neovascular glaucoma

目的 :探讨玻璃体腔内注射雷珠单抗联合小梁切除术后行全视网膜光凝术治疗新生血管性青光眼的治疗效果。方法:15例(17眼)新生血管性青光眼玻璃体内注射0.5 mg雷珠单抗后1周行小梁切除术,术后2周行全视网膜光凝术。全视网膜光凝术后观察术眼的视力、眼压变化及手术并发症。结果:术后1周,15例(17眼)虹膜和前房角新生血管均完全消退。术后6个月,6眼视力有不同程度的提高,10眼视力无改变,1眼视力从眼前指数降到眼前手动。治疗前眼压与术后各个时间点眼压对比,差异具有统计学意义(t=12.75、10.26、9.73、10.77,P<0.01)。所有病例均无术中及术后眼内大出血、视网膜脱离、眼内炎等严重并发症。结论:玻璃体腔内注射雷珠单抗可有效消退虹膜及前房角的新生血管,为小梁切除术提供有利的条件。玻璃体注射雷珠单抗联合小梁切除术后行全视网膜光凝术,对新生血管性青光眼具有稳定可靠的疗效。

Objective To investigate the clinical efficacy of intravitreal injection of Lucentis combinedwith pan retinal photocoagulation and trabeculectomy for neovascular glaucoma（NVG）. Methods Seventeen eyes of15 patients with NVG were treated by 0.5 mg Lucentis intravitreal injection first. Trabeculectomy was performed 7days later and Pan retinal photocoagulation 2 weeks later. Iris,anterior chamber angle neovascularization,intraocu-lar pressure,and visual acuity were observed in the following 6 months. Results Iris and anterior chamber angleneovascularization were completely regressed 7 days after the injection in 17 eyes. Six months after photocoagulation,6 eyes had different degrees of improvement in visual acuity,10 eyes no change in visual acuity and 1 eye decreasedfrom anterior index to immediate manual. There was significant difference in pre-treatment IOP and postoperativeIOP（t = 12.75,10.26,9.73,10.77,P 〈0.01）. No serious complications were observed after intravitreal injec-tion and trabeculectomy. Conclusions Intravitreal injection of Lucentis could significantly accelerate the regres-sion of iris and anterior chamber angle neovascularization,which could improve the successful rate of trabeculecto-my and pan retinal photocoagulation. Intravitreal injection of Lucentis combined with trabeculectomy and panretinalphotocoagulation is safe and effective for NVG.