康柏西普联合23G玻璃体切割及全视网膜光凝治疗糖尿病性视网膜病变继发新生血管性青光眼

Intravitreal Injection of Conbercept Combined with 23G Vitrectomy and Panretinal Photocoagulation for Secondary Neovascular Glaucoma Caused by Diabetic Retinopathy

目的观察康柏西普联合23-Gauge(23 G)玻璃体切割及全视网膜光凝治疗糖尿病性视网膜病变继发开角期或早期闭角期(房角开放或虹膜前粘连<180°)新生血管性青光眼的临床疗效。方法收集2016年1-6月在西安市第四医院就诊的糖尿病视网膜病变继发开角期或早期闭角期新生血管性青光眼患者17例20只眼,所有患眼行玻璃体内注射康柏西普眼用注射液0.05 m L(10 g/L),第3天行23 G玻璃体切割及全视网膜光凝治疗,术中联合玻璃体腔消毒空气或硅油填充术,术后随访12个月。结果术后12个月裸眼视力与术前比较差异无统计学意义(P>0.05)。术后12个月最佳矫正视力与术前比较差异有统计学意义(P<0.05),术前与术后1天、1周、1个月、3个月、6个月、12个月的眼压分别为(51.5±5.5)mm Hg(1 mm Hg=0.133 k Pa)、(34.5±5.8)mm Hg、(27.6±4.6)mm Hg、(20.5±3.0)mm Hg、(19.4±4.1)mm Hg、(17.1±2.9)mm Hg、(17.7±3.0)mm Hg,总体比较差异有统计学意义(P<0.001)。术后12个月随访应用降眼压药物数量与术前比较差异有统计学意义(P<0.001)。随访中未见虹膜新生血管反复病变。结论康柏西普联合23 G玻璃体切割及全视网膜光凝治疗糖尿病视网膜病变继发开角期或早期闭角期新生血管性青光眼是安全有效的。

Objective To observe the clinical effects of intravitreal injection of conbercept combined with 23 G vitrectomy and panretinal photocoagulation for secondary open-angle or early angle-closure（ angle opening or the degree of iris anterior adhesion 180°） neovascular glaucoma caused by diabetic retinopathy. Methods From Jan. 2016 to Jun. 2016,17 patients（ 20 eyes） with secondary open-angle or early angle-closure neovascular glaucoma caused by diabetic retinopathy were collected in Xi＇an No. 4 Hospital. Intravitreal injection of conbercept 0. 05 m L（ 10 g/L） in the 20 eyes was made. 23 G vitrectomy and panretinal photocoagulation were implemented on the third day,and sterilized air or silicone oil was filled during operation. The follow-up time was 12 months. Results The difference between the preoperative natural visual acuity and the postoperative natural visual acuity in the 12 th month of the follow-up was not significant（ P〈0. 05）. The difference between the preoperative best corrected vision acuity and the postoperative best corrected vision acuity in the 12 th month of the follow-up was significant（ P〈0. 05）. There was a significant difference in intraocular pressure at all time points of postoperative 1 day,1 week,1 month,3 months,6 months and 12 months[（ 51. 5 ± 5. 5） mm Hg,（ 34. 5 ± 5. 8） mm Hg,（ 27. 6 ±4. 6） mm Hg,（ 20. 5 ± 3. 0） mm Hg,（ 19. 4 ± 4. 1） mm Hg,（ 17. 1 ± 2. 9） mm Hg,（ 17. 7 ± 3. 0） mm Hg]（ P〈0. 001）.The difference between the quantity of preoperative antiglaucomatous drugs and postoperative antiglaucomatous drugs in the follow-up 12 month was significant（ P〈0. 001）. There was no recurrence of neovascularization of iris during the follow-up.Conclusion Intravitreal injection of conbercept combined with 23 G vitrectomy and panretinal photocoagulation for secondary open-angle or early angle-closure neovascular glaucoma caused by diabetic retinopathy is safe and effective.