3种方法治疗新生血管性青光眼的临床观察

Clinical Observation of 3 Kinds of Methods in the Treatment of Neovascular Glaucoma

目的:观察睫状体冷凝术、玻璃体腔内注射康柏西普联合Ahmed青光眼引流阀植入术、玻璃体腔内注射康柏西普联合复合式小梁切除术治疗新生血管性青光眼(NVG)的临床疗效与安全性。方法:选取四川省人民医院2014年6月-2016年8月收治的NVG患者39例(40眼),根据不同治疗方法分为A组(16例,16眼)、B组(13例,14眼)、C组(10例,10眼)。A组患者接受睫状体冷凝术;B组患者于玻璃体腔内注射康柏西普眼用注射液(0.05 mL,连续给药7 d)后,接受Ahmed青光眼引流阀植入术;C组患者于玻璃体腔内注射康柏西普眼用注射液(0.05 mL,连续给药7 d)后,接受复合式小梁切除术。观察3组患者治疗前后眼压水平以及治疗后眼压控制率、视力变化和并发症发生率,并记录不良反应发生情况。结果:治疗前,3组患者眼压比较,差异均无统计学意义(P>0.05)。治疗后7 d、1个月、3个月、6个月时,3组患者的眼压均较治疗前显著降低,且B组患者治疗后7 d、1个月时的眼压显著低于A、C组,C组显著低于A组,差异均有统计学意义(P<0.05);而3组患者治疗后3、6个月时的眼压比较,差异均无统计学意义(P>0.05)。治疗后6个月时,3组患者的眼压控制率分别为62.5%、85.7%、70.0%;A组患者16只患眼视力保持不变,B组3只提高、1只下降、10只保持不变,C组1只提高、1只下降、8只保持不变;3组间患者的眼压控制率、视力比较,差异均无统计学意义(P>0.05)。A组患者前房渗出的发生率显著高于B、C组,差异均有统计学意义(P<0.05),其余并发症发生率组间比较差异均无统计学意义(P>0.05)。A组有2例患者术中出现血压增高,术后经对症处理后恢复正常;其余患者在治疗过程中均未见明显不良反应发生。结论:3种治疗方案均可有效降低NVG患者的眼压,同时不会影响其视力水平,且不良反应较少。其中,玻璃体腔内注射康柏西普联合Ahmed青光眼引流阀植入术或联合复合式小梁切除术2种方案短期内降低眼压的效果更明显,且前者优于后者;上述2种方案的并发症发生率更低。

OBJECTIVE：To observe the clinical efficacy and safety of cyclocryosurgery,intravitreal injection of conbercept combined with Ahmed glaucoma drainage valve implantation, intravitreal injection of conbercept combined with compound trabeculectomy in the treatment of neovascular glaucoma（NVG）. METHODS：A total of 39 NVG patients（40 eyes）selected from Sichuan People’s Hospital during Jun. 2014-Aug. 2016 were divided into group A（16 cases,16 eyes）,B（13 cases,14 eyes）,C（10 cases,10 eyes） according to different treatment methods. Group A received cyclocryosurgery;group B received Ahmed glaucoma drainage valve implantation after given intravitreal injection of Conbercept ophthalmic injection（0.05 mL, for consecutive 7 d）;group C received compound trabeculectomy after given intravitreal injection of Conbercept ophthalmic injection（0.05 mL,for consecutive 7 d）. The intraocular pressures of 3 groups were observed before and after treatment,and the rate of intraocular pressure control,visual changes and the incidence of complications were observed after treatment. The occurrence of ADR was recorded. RESULTS：Before treatment,there was no statistical significance in intraocular pressure among 3 groups（P〉0.05）. Seven days,one month,three months and six months after treatment,intraocular pressures of 3 groups were decreased significantly compared to before treatment;intraocular pressure of group B was significantly lower than those of group A and C;group C was significantly lower than group A,with statistical significance（P〈0.05）. There was no statistical significance in intraocular pressure among 3 groups three and six months after treatment（P〉0.05）. The rates of intraocular pressure control in 3 groups were 62.5%,85.7% and 70.0% six months after treatment. Vision of 16 eyes in group A kept stable;vision of 3 eyes in group B were improved,that of 1 eye was decreased and those of 10 eyes kept stable;vision of 1 eye in group C was improved,that of 1 eye was decreased,and those of 8 eyes kept stable;there was no statistical significance in rate of intraocular pressure or vision among 3 groups（P〉0.05）. The incidence of exudation of anterior chamber in group A was significantly higher than group B and C,with statistical significance（P〈0.05）. There was no statistical significance in the incidence of other complications（P〉0.05）. Two patients of group A suffered from the increase of blood pressure during the operation,and recovered to normal after symptomatic treatment. No obvious ADR was found in other patients during treatment. CONCLUSIONS：Three kinds of therapy plans can effectively reduce intraocular pressure of NVG patients,and do not influence vision with less adverse reactions.Intravitreal injection of conbercept combined with Ahmed glaucoma drainage valve implantation or compound trabeculectomy can effectively reduce intraocular pressure in short time and the fromer is better than the latter. Above 2 regimens cause low incidence of complications.