两种方案治疗不同时期新生血管性青光眼的临床过程分析

Clinical analysis of two schemes for treatment of neovascular glaucoma at different stages

目的分析两种不同的方案治疗不同时期新生血管性青光眼的临床疗效。方法根据术前眼压、房角情况将新生血管性青光眼患者分为两组,采用不同方法治疗。A组27例(27只眼)患者,术前眼压38. 7～53. 2mm Hg之间,平均(45. 43±5. 37) mm Hg,2/3周以上或全周房角关闭。先行玻璃体腔注射雷珠单克隆抗体,观察虹膜表面新生血管消退情况。注射后4～7 d行Ahmed青光眼引流阀植入。术后3周,陆续完成全视网膜光凝。B组18例(18只眼)患者,术前眼压26. 3～30 mm Hg之间,平均(27. 54±2. 37) mm Hg,1/2周以上至2/3周房角关闭。3周左右完成全视网膜光凝。光凝后1周行Ahmed青光眼引流阀植入术。两组患者治疗后均随访6～12个月,观察眼压、视力及相关并发症情况。结果 A组引流阀植入术后1周、2周、1、3、6个月平均眼压依次为:(10. 31±1. 23) mm Hg、(14. 23±3. 12) mm Hg、(16. 34±3. 08) mm Hg、(16. 78±2. 13) mm Hg和(19. 67±4. 21) mm Hg,术后各时间点眼压均较术前明显下降,差异具有统计学意义(t=14. 57、t=16. 42、t=16. 38、t=15. 56、t=16. 74,P<0. 05)。B组引流阀植入术后1周、2周、1、3、6个月平均眼压依次为:(9. 25±1. 07) mm Hg、(12. 53±2. 14) mmHg、(17. 67±2. 13) mm Hg、(17. 78±1. 54) mm Hg和(18. 12±3. 31) mm Hg,术后各时间点眼压均较术前明显下降,差异具有统计学意义(t=12. 36、t=11. 42、t=14. 54、t=14. 38、t=15. 36,P <0. 05)。术后各时间点平均眼压相比,两组间无统计学意义。A组引流阀植入术后6个月时,7只眼(25. 9%)最佳矫正视力提高,18只眼(66. 7%)视力无明显变化,2只眼(7. 4%)视力降低。B组引流阀植入术后6个月时,3只眼(16. 7%)最佳矫正视力提高,15只眼(83. 3%)视力无明显变化。A组引流阀植入后1周内,13只眼出现1～2度浅前房,有4只眼出现不超过瞳孔区的前房出血。B组引流阀植入后1周内,7只眼出现1～2度浅前房。结论遵循治疗原发病、降压、抗新生血管的原则,对不同病程时期的新生血管性青光眼患者,灵活制定不同的治疗方案,均可获得良好的疗效,同时可在一定程度上减轻患者经济负担。

Objective To analyze the clinical efficacy of two different regimens in the treatment of neovascular glaucoma at different stages. Methods Patients with neovascular glaucoma were divided into two groups according to preoperative intraocular pressure and angle of the eye. The two groups were used different treatment options. In group A, there were 27 cases （27 eyes）, intraocular pressure 38.7~53.2 mmHg, average （45.43± 5.37） mmHg, and above 2/3 or all angle closure. After the intravitreal injection of Ranibizumab, the neovascularization on the iris surface was observed. Ahmed glaucoma drainage valve was implanted on the 4~7 day after injection. The whole retinal photocoagulation was completed 3 weeks after the operation. In group B, there were 18 cases （18 eyes）. Preoperative intraocular pressure was 26.3~30 mmHg, averaging （27.54 ± 2.37） mmHg, range from 1/2 to 2/3, and angle closure. Complete retinal photocoagulation was completed around 3 weeks. Ahmed glaucoma drainage valve implantation was performed 1 weeks after photocoagulation. The two groups were followed up for 6~12 months after treatment, and the intraocular pressure, visual acuity and related complications were observed. Results The average intraocular pressure at the 1 week, 2 weeks, 1 month, 3 months and 6 months after drainage valve implantation in group A was： （10.31±1.23） mmHg, （14.23±3.12） mmHg, （16.34±3.08） mmHg, （16.78±2.13） mmHg and （19.67±4.21） mmHg, and the intraocular pressure at all time points after the operation were significantly lower than that before operation（ t =14.57, t =16.42, t =16.38, t =15.56, t =16.74, P 〈0.05）. The average intraocular pressure at the 1 week, 2 weeks, 1 month, 3 months and 6 months after drainage valve implantation in group B was： （9.25±1.07） mmHg, （12.53±2.14） mmHg, （17.67±2.13） mmHg, （17.78±1.54） mmHg and （18.12±3.31） mmHg, and the intraocular pressure at all time points after the operation were significantly lower than those before the operation （ t =12.36, t =11.42, t =14.54, t =14.38, t =15.36, P 〈0.05）. There was no significant difference in mean intraocular pressure at each time point after operation between the two groups. In group A, 6 months after implantation, 7 eyes （25.9%） had better corrected visual acuity, 18 eyes （66.7%） had no obvious visual acuity, 2 eyes （7.4%） had lower vision. In group B, at 6 months after implantation, 3 eyes （16.7%） had better corrected visual acuity, and 15 eyes （83.3%） had no significant change in visual acuity. In group A, 13 eyes appeared shallow anterior chamber 1~2 degree, 4 eyes developed hyphema within 1 weeks after valve implantation. In group B, there were 1~2 shallow anterior chamber in 7 eyes within 1 weeks after valve implantation. Conclusions Follow the principle of treating primary diseases, lowering intraocular pressure and anti neovascularization. For different conditions of neovascular glaucoma patients, flexible treatment of different treatment options, can achieve good results. At the same time, it can reduce the economic burden of patients.