雷珠单抗联合玻璃体切割术治疗糖尿病视网膜病变合并新生血管性青光眼

Clinical outcomes of ranibizumab combined with vitrectomy in treatment of patients with diabetic retinopathy accompanied by neovascular glaucoma

目的观察雷珠单抗联合玻璃体切割术治疗糖尿病视网膜病变合并新生血管性青光眼的临床效果。方法回顾性分析糖尿病视网膜病变合并新生血管性青光眼并行雷珠单抗联合玻璃体切割术的16例(16眼)患者的临床资料。术后随访6个月,对比观察手术前后眼压、最佳矫正视力、虹膜新生血管、房角开闭情况等,并记录并发症情况。结果术前患眼眼压为(42.54±16.52)mmH g(1 kP a=7.5 mmH g)。玻璃体内注射雷珠单抗后1 d眼压为(38.78±11.38)mmH g,与术前相比差异无统计学意义(P>0.05);玻璃体切割术后1周眼压(45.30±12.20)mmH g,与术前相比差异无统计学意义(P>0.05);术后1个月、3个月、6个月眼压分别为(27.56±19.38)mmH g、(20.49±18.66)mmH g、(19.79±16.53)mmH g,与术前相比差异均有统计学意义(均为P<0.05)。随访结束时,10眼(62.5%)虹膜新生血管完全消退,6眼(37.5%)虹膜新生血管明显减少。结论雷珠单抗联合玻璃体切割术治疗糖尿病视网膜病变合并新生血管性青光眼,可有效降低眼压,轻度提高视力,术后并发症少。

ObjectiveTo investigate the efficacy of ranibizumab combined with pars plana vitrectomy(PPV)in treatment of patients with diabetic retinopathy together with neovascular glaucoma.MethodsA retrospective analysis of16patients(16eyes)with diabetic retinopathy accompanied by neovascular glaucoma underwent vitrectomy combined with ranibizumab between June2013and June2017was conducted.Data were collected on patients’intraocular pressure(IOP),best corrected visual acuity(BCVA),iris neovascularization,chamber angle changes before and after surgery,and the postoperative complications were recorded.ResultsNo significant difference was approached in IOP before surgery and1day after ranibizumab injection[(42.54±1652)mmHg vs.(38.78±11.38)mmHg,1kPa=7.5mmHg](P>0.05).And there was also no significant difference in the IOP before surgery and1week after vitrectomy[(45.30±12.20)mmHg vs.(42.54±16.52)mmHg](P>0.05);The IOP at1month,3months and6months after surgery was(27.56±19.38)mmHg,(20.49±18.66)mmHg and(19.79±16.53)mmHg,respectively,which were significantly different from preoperative IOP(all P<0.05).At the end of the follow up,iris neovascularization completely disappeared in10eyes(62.5%)and iris neovascularization was significantly lessened in6eyes(37.5%).ConclusionRanibizumab with PPV for diabetic retinopathy and neovascular glaucoma can effectively reduce intraocular pressure and postoperative complications as well as improve visual acuity slightly.