联合治疗新生血管性青光眼的效果观察

Observation on the efficacy of combined treatment for neovascular glaucoma

目的观察玻璃体内注射贝伐单抗（Bevacizumab）后行复合式小梁切除联合广泛视网膜光凝术治疗新生血管性青光眼的效果。方法回顾性分析2014年9月至2016年8月收治的新生血管性青光眼45例（48只眼）的临床资料。所有患者均先行贝伐单抗玻璃体内注射，注药后1周行复合式小梁切除联合生物羊膜移植术，术后2周眼压降至正常后，再行广泛视网膜光凝术。随访12个月，观察视力、眼压及并发症。结果所有患者行玻璃体内注药后2～7d虹膜新生血管全部或大部分消失。末次随访最佳矫正视力提高者16只眼（33．33％），不变者22只眼（45．83％），下降者10只眼（20．83％）。术前眼压为（43．73±9．64）mmHg，术后末次随访眼压为（19．21±3．18）mmHg（1mmHg=0．133kPa）。治疗前后眼压比较差异有统计学意义（t=22．704，P=0．000）。结论贝伐单抗玻璃体内注射后行复合式小梁切除联合广泛视网膜光凝术治疗新生血管性青光眼，能有效控制眼压，改善视网膜缺血、缺氧的状态，保护患者视功能。

Objective To observe the efficacy of complex trabeculectomy combined with panretinal photocoagulation after intravitreal injection of Bevacizumab for the treatment of neovascular glaucoma. Methods The data of 48 eyes of 45 cases with neovascular glaucoma from Sep. 2014 to Aug. 2016 were enrolled and analyzed retrospectively. All patients were treated with Bevacizumab intravitreal injection first. Trabeculectomy combined with biological amniotie membrane transplantation were performed 1 week after injection. All patients underwent panretinal photocoagulation after intraocular pressure returned to normal range 2 weeks postoperatively. The follow-up time was 12 months. The visual acuity, intraocular pressure and complications were observed. Results All or most new vessels of iris disappeared 2-7 days after injection. The best corrected visual acuity at the last follow-up improved in 16 eyes （33.33%0）, unchanged in 22 eyes （45.83%）, and decreased in 10 eyes （20.83%）. Preoperative intraocular pressure was （43.73±9.64） mmHg, at the last follow-up of intraocular pressure was （19.21 ± 3.18 ） mmHg（ 1 mmHg = 0. 133 kPa）. The differenee in intraoeular pressure was statistieally significant between before and after treatment. Conclusion Complex trabeeuleetomy combined with panretinal photoeoagulation after intravitreal injection of Bevacizumab for neovaseular glaueomaean ean effectively eontrol the intraoeular pressure, improve the retinal ischemia hypoxia status and protect the visual funetion.