玻璃体切除术中直视下睫状体光凝术联合雷珠单抗治疗新生血管性青光眼疗效观察

Curative Effect of Cyclophotocoagulation Combined with Ranibizumab under Direct Vision of Vitrectomy in the Treatment of Neovascular Glaucoma

目的观察玻璃体切除术中直视下睫状体光凝术联合雷珠单抗治疗新生血管性青光(NVG)眼临床疗效。方法回顾性分析2014年5月-2016年4月我院住院治疗NVG患者58例(63只眼)的临床资料,根据治疗方式分为玻璃体切除术中内窥镜直视下睫状体光凝术(A组32只眼)和经巩膜睫状体光凝术(B组31只眼),比较治疗期间两组患者所用激光参数,术前和术后1周、1个月、3个月、6个月眼压及术后视力变化情况,手术成功率,术后并发症及抗青光眼药物使用情况。结果 A组患者激光能量和激光持续时间显著低于B组(t=35.477,32.965,P<0.05),两组患者在光凝范围差异不显著(t=0.390,P>0.05)。两组患者治疗后1周、1个月、3个月和6个月眼压较治疗前显著降低(t=13.018,10.932,11.838,10.786和t=11.426,8.501,9.525,8.933,P<0.05),且A组患者治疗后1、3、6个月眼压显著低于B组(t=4.486,3.767,2.325,P<0.05)。A组患者在术后视力提高比例上显著高于B组(χ2=8.586,P<0.05)。两组手术成功率比较,差异不具有统计学意义(χ2=0.716,P>0.05)。A组患者结膜灼伤水肿发生率显著低于B组(χ2=4.893,P<0.05),两组患者在治疗前后抗青光药物使用上差异不具有统计学意义(χ2=0.003,0.394,P>0.05)。结论两种手术方式治疗NVG均具有明显疗效,直视下睫状体光凝术联合雷珠单抗治疗在提高患者术后视力和减少术后并发症上具有明显优势。

Objective To observe the curative effect of cyclophotocoagulation combined with ranibizumab under direct vi-sion of vitrectomy in the treatment of neovascular glaucoma （NVG）. Methods The clinical data of 58 inpatients （63 eyes） with NVG treated in our hospital between May 2014 and April 2016 was retrospectively analyzed. According to the treatment methods, those patients were divided into group A （32 eyes, treated with endoscopic cyclophotocoagulation under direct vision of vitrecto-my） and group B （31 eyes, treated with trans-scleral cyclophotocoagulation）. The laser parameters used during treatment, changes of intraocular pressure and visual acuity, the success rate of surgery, postoperative complications and the usage of anti-glaucoma drugs were compared. Results The laser energy and laser duration of group A were significantly lower and shorter than those of group B （t=35. 477,32. 965,P〈0. 05）, but there was no significant difference in the scope of photocoagulation between the two groups （t=0. 390,P〉0. 05）. 1 week, 1 month, 3 months and 6 months after surgery, the intraocular pressure was signif-icantly lower （t=13. 018,10. 932,11. 838,10. 786 and t=11. 426,8. 501,9. 525,8. 933,P〈0. 05）. 1 month, 3 months and 6 months after surgery, the intraocular pressure of group A was significantly lower than that of group B （t=4. 486, 3. 767,2. 325, P〈0. 05）. The improvement rate of visual acuity was significantly higher in group A than in group B （x2=8. 586,P〈0. 05）. The difference in the success rate of surgery was not statistically significant between the two groups （x2=0. 716,P〉0. 05）. The inci-dence of conjunctival burns was significantly lower in group A than in group B （x2=4. 893,P〈0. 05）. There was no significant difference in the usage of anti-glaucoma drugs between the two groups （x2=0. 003,0. 394,P〉0. 05）. Conclusion Both surgical approaches are effective in the treatment of NVG. Cyclophotocoagulation under direct vision combined with ranibizumab displays obvious advantages in improving visual acuity and reducing complications after surgery.