复合小梁切除术联合Ranibizumab治疗新生血管性青光眼

Complex Trabeculectomy and Ranibizumab in Treatment of Neovascular Glaucoma

目的评估复合小梁切除术联合玻璃体腔内注射Ranibizumab以及全视网膜光凝术在新生血管性青光眼治疗的有效性及安全性。方法研究对象为方便选取2015年5月—2016年2月于昆明医科大学第一附属医院眼科就诊的新生血管性青光眼患者20例(22只眼),入选患者均行玻璃体腔注射Ranibizumab(0.5 mg/0.05 m L),待虹膜新生血管消退或萎缩后,再行复合小梁切除术,以穹窿部为基底作结膜瓣,术中联用丝裂霉素C(0.4 mg/m L,3~5 min)。根据患者屈光介质情况术前或术后行全视网膜光凝。小梁切除术后随访6个月,观察视力、眼压和手术并发症情况。结果新生血管性青光眼的原因包括视网膜静脉阻塞,其中中央静脉阻塞(11只眼)、分支静脉阻塞(6只眼),糖尿病视网膜病变(5只眼)。玻璃体腔注药后1 d,新生血管开始逐渐消退,2~5 d 22只眼新生血管全部消退。术前眼压平均为(42.27±2.95)mm Hg,术后1个月平均眼压降至(12.05±2.78)mm Hg,术后3个月(14.22±2.70)mm Hg,术后6个月降至(15.09±4.21)mm Hg,术后各随访时间点眼压与术前相比均差异有统计学意义(P<0.05),术后随访中眼压相比均差异无统计学意义(P>0.05)。术前抗青光眼药物的使用数量为(3.14±0.71)种,术后数量降至(0.82±1.14)种。完全成功12眼(54.5%),部分成功6眼(27.3%),总手术成功率81.8%(18/22)。手术并发症:术后浅前房4例,经散瞳药物治疗2周内恢复正常;前房积血2例;脉络膜脱离1例,药物治疗后恢复;无其他严重并发症出现。结论复合小梁切除术联合玻璃体腔注射Ranibizumab和全视网膜光凝术是治疗新生血管性青光眼的安全而有效的方式。

Objective To evaluate the effectiveness and safety of complex trabeculectomy and intravitreal injection of Ranibizumab and panretinal photocoagulation in treatment of neovascular glaucoma. Methods convenient 20 cases of patients with neovascular glaucoma(22 eyes) diagnosed in our hospital from May 2015 to February 2016 were selected, and the selected patients underwent the intravitreal injection of Ranibizumab(0.5 mg/0.05 m L), and complex trabeculectomy after the regression or atrophy of iris neovascularization, and combined with mitomycin C in operation(0.4 mg/m L, 3~5 min),and the panretinal photocoagulation was conducted before and after surgery according to the dioptric media condition, and the patients were followed up for six months after the trabeculectomy, and the vision, eye pressure and operative complications were observed. Results The causes of neovascular glaucoma included the retinal vein occlusion, including the central retinal vein occlusion(11 eyes), branch retinal vein occlusion(6 eyes), diabetic retinopathy(5 eyes), and the neovascularization begun to gradually subside after 1 d of intravitreous druginjection, and the neovascularization of 22 eyes after 2 ~5 d subsided, and the average eye pressure before operation was(42.27±2.95)mm Hg, and decreased to(12.05±2.78)mm Hg in1 month after operation and(14.22±2.70) mm Hg in 3 months after operation and(15.09±4.21)mm Hg in 6 months after surgery,and there were obvius differences in the eye pressures at various follow-up points before and after surgery(P<0.05), and there was no obvious difference in the eye pressure in the follow-up after surgery(P>0.05), and the use number of antiglaucoma drugs was(3.14±0.71), and decreased to(0.82±1.14) after operation and 12 eyes were completely successful(54.5%),6 cases were partially sucessful(27.3%), and the total operation success rate was 81.8%(18/22), and in terms of operation complications, 4 cases were with shallow anterior chamber after operation, and returned to normal in 2 weeks after mydriasis drugs treatment, and there were 2 cases with hyphema and 1 case with choroidal detachment and the patients were recovered after the drugs treatment, and there were no other severe complications. Conclusion The complex trabeculectomy and intravitreal injection of Ranibizumab andpanretinal photocoagulation in treatment of neovascular glaucoma is a safe and effecitve method in treatment of neovascular glaucoma.