EX-PRESS引流钉植入术联合康柏西普及PRP治疗新生血管性青光眼

Analysis of the efficacy of EX-PRESS drainage nail implantation combined with anti-VEGF and PRP in the treatment of neovascular glaucoma

目的:评价EX-PRESS房水引流钉植入术联合玻璃体内注射康柏西普及全视网膜光凝(PRP)治疗新生血管性青光眼的临床疗效。方法:回顾性分析2015-01/2018-05在我院符合纳入标准的新生血管性青光眼患者21例21眼,术前均先行康柏西普玻璃体内注射,5~10d虹膜新生血管消退后接受EX-PRESS房水引流钉植入术,2~3wk后行全视网膜光凝术,术后随访12mo观察眼压、视力、虹膜新生血管复发率、术后并发症情况。结果:患者引流钉植入术前术后不同时间眼压比较,差异有统计学意义(F=18.513,P<0.05)。引流钉植入术前和术后视力比较,差异有统计学意义(P=0.008)。至末次随访时,手术完全成功18眼(86%),条件成功2眼(9%),总手术成功率95%。虹膜新生血管复发1眼(5%),术后浅前房1眼(5%)、高眼压5眼(24%)。结论:康柏西普注射玻璃体后行EX-PRESS房水引流钉植入术再联合PRP可有效降低新生血管性青光眼的眼压。

AIM:To evaluate the clinical efficacy of EX-PRESS aqueous humor drainage nail implantation combined with intravitreous injection of conbercept universal panretinal photocoagulation(PRP)in the treatment of neovascular glaucoma.METHODS:Totally 21 patients(21 eyes)with neovascular glaucoma who met the inclusion criteria in our hospital from January 2015 to May 2018 were analyzed retrospectively.They were treated with intravitreal injection of conbercept before operation,EX-PRESS aqueous humor drainage nail was implanted after iris neovascularization disappeared 5-10d,and panretinal photocoagulation 2-3wk later.Intraocular pressure(IOP),visual acuity,recurrence rate of iris neovascularization and postoperative complications were observed after 12mo follow-up.RESULTS:There were significant differences in intraocular pressure at different time before and after EX-PRESS aqueous drainage nail implantation(F=18.513,P<0.05).There was significant difference between preoperative and postoperative visual acuity of EX-PRESS(P=0.008).At the last follow-up,the operation was completely successful in 18 eyes(86%),the condition was successful in 2 eyes(9%),and the total success rate of operation was 95%.Recurrence of iris neovascularization occurred in 1 eye(5%),shallow anterior chamber in 1 eye(5%)and high IOP in 5 eyes(24%).CONCLUSION:Implantation of EX-PRESS aqueous humor drainage nail combined with PRP can effectively reduce the intraocular pressure of neovascular glaucoma and can be widely used in clinical treatment.