贝伐珠单抗玻璃体腔内注射联合复合式小梁切除术治疗NVG的临床观察

Observation of Bevacizumab intravitreal injection combined with compound trabeculectomy for NVG

目的:观察贝伐珠单抗玻璃体腔内注射联合复合式小梁切除术治疗新生血管性青光眼(neovascular glaucoma,NVG)的疗效。方法:收集2014-01/2016-07我院眼科确诊的NVG患者36例36眼,所有患者均采用贝伐珠单抗玻璃体腔内注射联合丝裂霉素处理的小梁切除术治疗。分别于术前、术后1d(玻璃体腔注射后1d),1、3、6、12mo(小梁切除术后1、3、6、12mo)观察患眼虹膜表面新生血管消退、眼压、视力、滤泡形态、抗青光眼药物使用等情况。结果:随访1a,本组病例手术完全成功26眼,部分成功7眼,失败3眼。术后1、3、6、12mo眼压(18.183±6.993、19.586±6.198、18.722±5.263、19.089±4.133mm Hg)均明显低于术前(39.997±5.827mm Hg)和术后1d(39.647±5.690mm Hg),差异均有统计学意义(P<0.05);术后1、6mo眼压均明显低于术后3mo,差异均有统计学意义(P<0.05);其余术后各时间点眼压两两比较,差异均无统计学意义(P>0.05)。术后1、3、6、12mo Log MAR视力(0.686±0.202、0.622±0.157、0.631±0.179、0.711±0.177)均明显优于术前(0.833±0.207)和术后1d(0.806±0.188),差异均有统计学意义(P<0.05);术后3、6mo Log MAR视力均明显优于术后1mo和术后12mo,差异均有统计学意义(P<0.05)。手术前后使用抗青光眼药物的数量差异有统计学意义(t=11.131,P<0.05)。结论:贝伐珠单抗玻璃体腔内注射联合复合式小梁切除术治疗NVG疗效确切。

AIM： To observe the efficacy of Bevacizumab intravitreal injection combined with compound trabeculectomy in the treatment of neovascular glaucoma（NVG）. METHODS： The 36 eyes were with bevacizumab intravitreal injection 1wk before surgery, and then were treated with trabeculectomy combined with mitomycin. The visual acuity, intraocular pressure, follicle, anterior chamber, regression of iris neovascularization, the number of anti-glaucoma drugs used and others were observed before injection, 1d after intravitreal injection, 1, 3, 6, and 12mo after surgery, respectively. RESULTS： Total success was achieved in 26 eyes, partial success in 7 eyes and failure in 3 eyes at 1a after surgery. The IOP of 1mo（18.183±6.993mmHg）, 3mo（19.586±6.198mmHg）, 6mo（18.722±5.263mmHg）and 12mo（19.089±4.133mmHg）after surgery were significantly lower than those before injection（39.997±5.827mmHg）and 1d after injection（39.647±5.690mmHg; all P〈0.05）. The IOP of 1mo and 6mo after surgery was significantly lower than that of 3mo after surgery, and the difference was statistically significant（P〈0.05）. There was no statistically significant difference between the other two time points postoperatively（all P〉0.05）. The LogMAR visual acuity of 1mo（0.686±0.202）, 3mo（0.622±0.157）, 6mo（0.631±0.179）and 12mo（0.711±0.177）after surgery were significantly higher than that before injection（0.833±0.207）and 1d after injection（0.806±0.188）, and the differences were statistically significant（all P〈0.05）. The LogMAR visual acuity of 3mo and 6mo after surgery were significantly higher than that of 1mo after surgery（all P〈0.05）. The LogMAR visual acuity of 12mo after surgery was significantly worse than that of 3mo and 6mo after surgery（all P〈0.05）. There was a significant difference in the number of anti-glaucoma drugs used before and after treatment with this method（t=11.131, P〈0.05）. CONCLUSION： The bevacizumab intravitreal injection combined with compound trabeculectomy is effective in the treatment of NVG.