雷珠单抗联合Ahmed青光眼阀植入和小梁切除术治疗新生血管性青光眼的效果及安全性对比分析

Effect and safety of rayzumab combined with Ahmed glaucoma valve implantation or trabec⁃ulectomy in the treatment of neovascular glaucoma

目的:对比分析雷珠单抗联合Ahmed青光眼阀植入和小梁切除术治疗新生血管性青光眼(NVG)的临床效果及安全性。方法:将2014年6月至2019年1月天津医科大学眼科收治的98例(98眼)NVG患者,根据手术方法不同分为Ahmed青光眼阀植入术组(A组)46例和小梁切除术组(B组)52例,两组均联合雷珠单抗进行治疗。术后均随访至少3个月,监测眼压变化,记录视力改善效果,统计手术成功率及并发症发生情况。结果:与术前比较,两组手术后7 d、14 d、1个月、3个月眼压均明显降低(P<0.05);A组手术后1个月、3个月眼压均明显低于B组(均P<0.05);与术前比较,两组手术后3个月视力均明显改善(均P<0.05),且A组、B组视力改善效果比较,差异无统计学意义(P>0.05)。手术后3个月,A组、B组手术累积成功率分别为91.30%、90.38%,两组比较,差异无统计学意义(P>0.05)。A组、B组术后并发症均给予对症处理后好转,各并发症发生率比较,差异无统计学意义(P>0.05)。结论:雷珠单抗联合Ahmed青光眼阀植入和小梁切除术治疗NVG的疗效确切,手术成功率高,并发症少,且Ahmed青光眼阀植入在控制和维持眼压方面有明显的优势。

Objective:To compare the clinical effect and safety of rayzumab combined with Ahmed glaucoma valve implantation or trabeculectomy on neovascular glaucoma(NVG).Methods:From June 2014 to January 2019,98 patients(98 eyes)with NVG treated inThe Ophthalmology Hospital of Tianjin Medical University were divided into group A(46 cases,received Ahmed glaucoma valve implantation)and group B(52 cases,received trabeculectomy)according to different surgical methods.All patients were treated with rayzumab and followed up for at least 3 months after operation.The intraocular pressure,visual improvement,success rate of operation and the incidence of complications werecompared.Results:The intraocular pressure of both groups decreased significantly after 7 d,14d,1 months and 3 months(P<0.05).The intraocular pressure of group A was significantly lower than that of group B(P<0.05).The visual acuity of both groups was significantly improved 3 months after operation,but there was no significant difference in visual improvement between the two groups(P>0.05).At 1 month and 3 months after surgery,intraocular pressure in group A was significantly lower than that in group B(P<0.05).Compared with that at admission,visual acuity in both groups was significantly improved at 3 months after surgery(P<0.05).There was no significant difference in improvement effect of visual acuity between group A and group B(P>0.05).Three months after operation,the cumulative success rate of operation in group A and group B were 91.30%and 90.38%,respectively(P>0.05).The postoperative complications in both groups were improved after symptomatic treatment,and there was no significant difference in the incidence of complications between the two groups(P>0.05).Conclusion:Ranibizumab combined with Ahmed glaucoma valve implantation or trabeculectomy is effective in the treatment of NVG,with high success rate and few complications,and Ahmed glaucoma valve implantation has obvious advantages in controlling and maintaining intraocular pressure.