雷珠单抗联合小梁切除术或Ahmed引流阀植入术治疗新生血管性青光眼的疗效观察

Effects of ranibizumab combined with trabeculectomy or Ahmed glaucoma valve implantation in the treatment of neovascular glaucoma

目的探讨玻璃体腔注射雷珠单抗联合小梁切除术或Ahmed引流阀植入术治疗新生血管性青光眼（neovascular glaucoma，NVG）的临床疗效。方法回顾性分析徐州市第一人民医院2014年10月至2017年3月收治的Ⅱ-Ⅲ期NVG患者44例、46眼的临床资料。所有患者均接受玻璃体腔注射雷珠单抗，3—7d后根据接受手术治疗的方法分为小梁切除术组（A组）21例、22眼；Ahmed引流阀植入术组（B组）23例、24眼。术后随访8—36个月，平均随访（18．13-＋2．54）个月，分别对2组术后眼压、虹膜新生血管、视力变化和并发症发生率进行比较。结果2组术后不同时期眼压均较注药前显著下降，差异有统计学意义（P〈0．01）。2组术后1周和1个月的眼压差异无统计学意义（t=-0．32，P=0．80；t=1．35，P=0．29），但术后6个月、末次随访时B组平均眼压低于A组，差异有统计学意义（t=2．93，P=0．01；t=2．45，P=0．03）。2组玻璃体腔注药3—7d后虹膜新生血管部分或全部消退，有效率为100％。术后视力提高2组之间差异无统计学意义（χ^2=1．07，P=0．30）。术后并发症发生率2组之间差异无统计学意义（χ^2=0．06，P=0．80）。结论玻璃体腔内注射雷珠单抗联合Ahmed引流阀植入术或小梁切除术均可显著降低NVG患者的眼压，但是Ahmed引流阀植入术控制眼压效果更持久且稳定。

Objective To investigate the clinical efficacy of intravitreal injection of ranibizumab combined with trabeculectomy or Ahmed glaucoma valvei mplantation in the treatment of neovascular glaucoma （NVG）. Methods Clinical data from 44 Stages Ⅱ - Ⅲ NVG patients （ with 46 eyes who were admitted into our hospital from October 2014 to March 2017 were analyzed retrospectively. All patients were intravitreally injected with ranibizumab. After 3 to 7 days, they were divided into a trabeculectomy group （GroupA, n = 21, 22 eyes） and an Ahmed glaucoma valve implantation group （ Croup B, n = 23, 24 eyes）. After 8 to 36 months of follow - up visits, the intraocular pressure, the neovascularization of the iris, the change of vision and the incidence of complications were compared between the two groups. Results After treatment, both groups presented decreased intraocular pressure compared with the level before injection （P 〈 0.01 ）. There was no significant difference in intraocular pressure between the two groups 1 week and 1 month after operation （t = - 0.32, P = 0.80 ; t = 1.35, P = 0.29 ）. However, a lower average intraocular pressure was found in Group B at the final follow - up visit 6 months after surgery, in comparison with Group A （ t = 2. 93 ,P = 0. 01 ;t = 2. 45, P = 0.03 ）. Both groups demonstrated partial or complete disappearance of neovascularization in the iris 3 to 7 days after injection, with an effective rate of 100%. There was no significant difference in visual acuity improvement between the two groups after operation （ χ^2 = 1.07, P = 0.30 ）. There was no significant difference in the incidence of postoperative complications between the two groups （ χ^2 = 0.06, P = 0.80）. Conclusions Intravitreal injection of ranibizumab combined with trabeculectomy or Ahmed glaucoma valve implantation can significantly reduce intraocular pressure in NVC patients, but the effect of Ahmed drainage valve implantation on intraocular pressure is more durable and stable.