玻璃体腔注射雷珠单抗联合玻璃体切除术治疗新生血管性青光眼疗效观察

Therapeutic effect of intravitreal injection of ranibizumab combined with vitrectomy for the treatment of neovascular glaucoma

目的 探讨玻璃体腔注射雷珠单抗联合玻璃体切除术治疗新生血管性青光眼（NVG）的疗效.方法 回顾性分析行玻璃体切除术的21例NVG患者的临床资料,均玻璃体腔注射雷珠单抗0.5 mg,3～5 d后行玻璃体切除术,术中完成全视网膜光凝,16例联合行白内障手术,15例联合行睫状突光凝.术后随访6～12个月,观察眼压、视力及虹膜新生血管（NVI）消退情况.结果 术后3周80.95％（17/21）患者NVI完全消退.术后1周、1个月、3个月、6个月眼压明显低于术前[（18.6±5.1）、（14.3±4.8）、（12.8±4.4）、（15.1±3.7）mmHg（1 mmHg=0.133 kPa）比（42.8±7.3）mmHg],差异有统计学意义（P〈0.01）.术后2个月2例因眼压难以药物控制,行经巩膜睫状体光凝术;术后6个月眼压完全控制15例,条件控制6例,无低眼压发生.4例视力没有明显改善,其余均有不同程度提高.结论 对于伴有玻璃体积血和增殖明显的NVG患者,首先玻璃体腔注射雷珠单抗,然后联合玻璃体切除、全视网膜光凝、睫状突光凝可获得较好的效果.

Objective To study the therapeutic effect of intravitreal injection of ranibizumab combined with vitrectomy for the treatment of neovascular glaucoma （NVG）. Methods The clinical data of 21 NVG patients who had underwent vitrectomy were retrospectively analyzed. The patients were treated with intravitreal injection of ranibizumab 0.5 mg, then were given the vitrectomy after 3 to 5 d after treatment. The whole retinal photocoagulation was performed during the operation. Cataract surgery was combined in 16 patients, and ciliary photocoagulation was combined in another 15 patients. All patients were followed up for 6 to 12 months, and the intraocular pressure, visual acuity and neovascularization of iris （NVI） were observed. Results The rate of NVI symptoms resolving completely 3 weeks after operation was 80.95％（17/21）. The intraocular pressure 1 week, 1 month, 3 months and 6 months after operation was significantly lower than that before operation： （18.6 ± 5.1）, （14.3 ± 4.8）, （12.8 ± 4.4）, （15.1 ± 3.7） mmHg （1 mmHg=0.133 kPa） vs. （42.8 ± 7.3） mmHg, and there was statistical difference （P〈0.05）. Two months after operation, 2 cases were not able to control by chemicals, and were treated with transscleral cyclophotocoagulation. Six months after operation, the intraocular pressure was completely controlled in 15 cases, and conditionally controlled in 6 cases. No ocular hypotension occurred. The visual acuity was not improved in 4 cases, but the rest were improved in different degrees. Conclusions For the patients of NVG combined with vitreous hemorrhage and obvious proliferation, intravitreal injection of ranibizumab in the first place, and then combined with vitrectomy, whole retinal photocoagulation and ciliary photocoagulation can obtain good effect.