复合式小梁切除术联合玻璃体腔注射康柏西普治疗新生血管性青光眼的临床研究

The Clinical Research of Intravitreal Injecfion of Conbercept Combined with Complex Trabeculectomy For the Management of Neovascular Glaucoma

目的探讨玻璃体腔注射康柏西普(Conbercept)后行复合式小梁切除术治疗新生血管性青光眼的临床疗效。方法回顾性分析2015年1月至2017年6月在我院眼科确诊新生血管性青光眼患者31例(31眼),采用玻璃体腔内注射0.5 mg(0.05 ml)康柏西普5 d后行复合式小梁切除术治疗,观察术前及术后虹膜表面新生血管消退情况、最佳矫正视力、眼压变化以及术中、术后并发症情况,并进行统计分析。结果玻璃体腔注射康柏西普5 d后,30只眼虹膜表面新生血管全部消退,平均消退时间(3.2±1.1)d,1只眼虹膜表面仍有少量新生血管,复合式小梁切除术术后1周、1个月及3个月未见患眼虹膜新生血管复发。术后25只眼视力提高,6只眼视力未变。注药前平均眼压(51.13±11.05)mmHg(范围31~76 mmHg),复合式小梁切除术后1周平均眼压为(38.71±3.71)mmHg(范围22~42 mmHg),术后1月平均眼压为(20.12±7.50)mmHg(范围19~29 mmHg),术后3月平均眼压为(18.33±7.26)mmHg(范围11~24 mmHg)。1只眼术中出现少量前房出血,术后第4日积血全部吸收。31只眼术后均无浅前房和脉络膜脱离等并发症发生。结论玻璃体腔注射康柏西普后行复合式小梁切除术在新生血管性青光眼的治疗中能够显著减少虹膜新生血管,有效控制眼压,手术成功率高。

Objective To investigate therapeutic effects of intravitreal injecfion of Conbercept combined with complex trabeculectomy in the treatment of neovascular glaucoma.Methods A retrospective analysis about intravitreous injection of Conbercept combined with complex trabeculectomy was performed on 31 patients(31 eyes)with neovascular glaucoma between January 2015 and June 2017.Best corrected visual acuity and changes in IOP were observed after complex trabeculectomy.The regression of iris neovascularization and surgery complications were also recorded.Results Iris neovascularization completely regressed after 5 days in30 eyes after the injection of Conbercept.The average regression time was(3.2±1.1)d.No neovascular was found on the iris 1 week,1 month and 3 months after complex trabeculectomy.The Best corrected visual acuity improved in 25 eyes,remained unchanged in 6 eyes.The average IOP was51.13±11.05 mm Hg before injection,and(38.71±3.71)mmHg in a week,(20.12±7.50)mm Hg in one month,(16.33±7.26)mm Hg in three months after complex trabeculectomy.Anterior chamber hyphema was happened in one eye,the hyphema disappeared 4 days after operation.No serious complications such as shallow anterior chanber and detached choroid were observed after intravitreal injection and complex trabeculectomy.Conclusion Therapeutic effects of intravitreal injecfion of Conbercept combined with complex trabeculectomy for neovascular glaucoma can make the Iris neovascularization regress and to lower the IOP.