高海拔地区新生血管性青光眼不同治疗方式的疗效及对房水中PEDF、VEGF水平的影响

Efficacy of different treatment modalities and the influence on PEDF and VEGF in patients with neovascular glaucoma in high altitude area

目的:观察高海拔地区新生血管性青光眼(neovascular glaucoma,NVG)不同治疗方式的疗效及对房水中色素上皮衍生因子(pigment epithelium-derived factor,PEDF)、血管内皮生长因子(vascular endothelial growth factor,VEGF)水平的影响。方法:选取我院收治的NVG患者90例90眼作为研究对象,术前两组均给予甘露醇降眼压和抗炎滴眼液治疗,按照手术方式不同分为A组和B组,各45例45眼,其中A组给予Ex-press青光眼引流器植入术,B组给予小梁切除术联合睫状体冷凝术。观察两组临床疗效、眼压和视力水平,检测房水中PEDF、VEGF水平,比较术后并发症情况。结果:A组临床疗效显著高于B组,差异有统计学意义(P<0.05)。术后2wk,2、4mo,两组眼压水平均显著低于术前(P<0.05),且A组显著低于B组(P<0.05);术后6mo,两组眼压水平比较差异无统计学意义(P>0.05)。术后1wk,两组视力比较,差异有统计学意义(P<0.05)。术后1wk,两组患者房水中PEDF水平均显著高于术前(P<0.05),且A组显著高于B组(P<0.05),两组患者房水中VEGF水平均显著低于术前(P<0.05),且A组显著低于B组(P<0.05)。术后随访6mo,A组并发症发生率(4%)显著低于B组(18%),差异有统计学意义(P<0.05)。结论:Ex-press青光眼引流器植入术、小梁切除术联合睫状体冷凝术均可用于治疗高海拔地区NVG,但前者可有效维持视力,改善房水中PEDF、VEGF水平,并发症少,疗效更确切。

AIM： To observe the clinical efficacy of different treatment modalities and the influence on the levels of pigment epithelium-derived factor（PEDF）and vascular endothelial growth factor（VEGF）in patients with neovascular glaucoma（NVG）in high altitude area.METHODS： Ninety cases of patients（90 eyes）with NVG treated in our hospital were selected as the study objects, and they were divided into Group A and Group B according to different surgery methods, 45 cases in each groups. Group A was given Ex-press glaucoma drainage device implantation, and Group B was given trabeculectomy combined with cyclocryotherapy. We observed the clinical efficacy, intraocular pressure and visual acuity in the two groups, detected the PEDF and VEGF levels in the aqueous humor, and recorded the postoperative complications. RESULTS： The total effective rate of Group A was 91%, significantly higher than that of Group B 76%（P〈0.05）. At 2wk, 2 and 4mo after surgery, IOP levels were significantly lower than that before surgery（P〈0.05）, and those in Group A were significantly lower than those in Group B（P〈0.05）. There was no significantly difference in IOP levels at 6mo after surgery between the two groups（P〉0.05）. At 1wk after operation, the incidence of visual reduction in Group A was 7%, significantly lower than that in Group B 22%（P〈0.05）. At 1wk after operation, PEDF levels were significantly higher than those before operation in the two groups（P〈0.05）, and that in Group A was significantly higher than that in Group B（P〈0.05）; VEGF levels were significantly lower than that before operation in the two groups（P〈0.05）, and that in Group A was significantly lower than that in Group B（P〈0.05）. The incidence rate of complications in Group A was 4%, significantly lower than that of 18% in Group B at 6mo postoperatively（P〈0.05）.CONCLUSION： Ex-press glaucoma drainage device implantation, trabeculectomy combined with cyclocryotherapy can both be used to treat patients with NVG in high altitude area. But the former can effectively maintain visual acuity, and improve PEDF and VEGF levels in aqueous humor, with fewer complications and more accurate curative effect.