玻璃体腔内注射雷珠单抗联合Ahmed青光眼阀植入术治疗新生血管性青光眼

Intravitreal injection of Ranibizumab combined with Ahmed glaucoma valve implantation for neovascular glaucoma

目的观察玻璃体腔内注射雷珠单抗联合Ahmed青光眼阀植入术对新生血管性青光眼(NVG)的临床效果及安全性。方法选取2015年3月至2017年3月收治的NVG患者62例(62眼),依照治疗方案不同分为观察组31例(31眼)和对照组31例(31眼)。对照组采取Ahmed青光眼阀植入术治疗,观察组采取玻璃体腔内注射雷珠单抗联合Ahmed青光眼阀植入术治疗。对比两组治疗前、治疗后1周血清白细胞介素-6(IL-6)、血管内皮生长因子(VEGF)水平;治疗前、治疗后6个月眼压情况;治疗后随访6个月比较两组虹膜与前房角新生血管消退、视力提高及并发症发生情况。结果治疗后1周,两组血清IL-6、VEGF水平均较治疗前降低,且观察组低于对照组(P<0.01)。治疗后6个月观察组视力提高率高于对照组(77.42%vs51.61%,χ^2=4.509,P=0.034)。治疗后6个月两组眼压水平均较治疗前降低,且观察组低于对照组(P<0.01)。治疗后6个月观察组虹膜与前房角新生血管消退率显著高于对照组(83.87%vs0,χ^2=44.778,P=0.000)。观察组并发症发生率低于对照组(9.68%vs32.26%,χ^2=4.769,P=0.029)。结论NVG患者给予玻璃体腔内注射雷珠单抗联合Ahmed青光眼阀植入术治疗可有效控制眼压,降低血清IL-6、VEGF水平,提高患者视力,促进虹膜及前房角新生血管消退,减少并发症发生。

Objective To explore the clinical efficacy and safety of intravitreal injection of ranibizumab combined with Ahmed glaucoma valve implantation in treating patients with neovascular glaucoma(NVG).Methods Sixty-two NVG patients (62 eyes) from March 2015 to March 2017 were divided into observation group (31 eyes) and control group (31 eyes) according to different treatment schemes.The ahmed glaucoma valve implantation was performed in control group,and the intravitreal injection of ranibizumab was added based on ahmed glaucoma valve implantation in observation group.The serum levels of interleukin -6 (IL-6 ),vascular endothelial growth factor (VEGF) before and 1 week after treatment, intraocular pressure before and 6 months after treatment and neovascularization of iris and anterior chamber angle,visual acuity improvement and complications during 6-month postoperative follow-up were observed and compared between two groups.Results One week after treatment,the serum levels of IL-6 and VEGF were significantly lower than those before treatment in both groups and were lower in observation group than those in control group (P < 0.01).After 6 months of treatment,the visual acuity improvement rate in observation group was higher than that in control group (77.42% vs 51.61%,χ^2 = 4.509,P = 0.034);the intraocular pressure level was lower than that before treatment in both groups and was lower in observation group than that in control group (P < 0.01);the regression rate of neovascularization of iris and anterior chamber angle in observation group was significantly higher than that in control group (83.87% vs 0,χ^2 = 44.778, P = 0.000).The incidence of complications in observation group was significantly lower than that in control group (9.68% vs 32.26%,χ^2 = 4.769,P = 0.029).Conclusion For NVG patients,intravitreal injection of ranibizumab combined with Ahmed glaucoma valve implantation can effectively control intraocular pressure,reduce serum IL-6 and VEGF levels, improve visual acuity,promote neovascularization of iris and anterior chamber angle and reduce complications.