康柏西普联合Ahmed引流阀植入及白内障超声乳化贯序治疗新生血管性青光眼

Sequential treatment of neovascular glaucoma with cataract by Conbercept intraocular injection combined with Ahmed valve implantation and phacoemulsification

目的:评估玻璃体腔注射康柏西普联合Ahmed引流阀植入及白内障超声乳化吸除贯序治疗新生血管性青光眼(NVG)的疗效。方法:回顾性分析。纳入2018-06/2020-01我院眼科收治合并白内障的NVG患者18例18眼。所有患者均术前3~7d行玻璃体腔注射康柏西普,符合手术指征后进行白内障超声乳化吸除术联合Ahmed引流阀植入术,术后随访12mo,记录最佳矫正视力(BCVA)、眼压、虹膜新生血管消退情况、手术效果及并发症情况。结果:术后1、7d,1、3、6mo,1a眼压分别为25.94±11.82、15.39±4.97、15.94±2.69、15.33±4.54、18.89±7.95和16.27±5.22mmHg,均低于术前平均眼压51.44±8.18mmHg(P<0.05)。末次随访时67%(12/18)患者BCVA提高,28%(5/18)BCVA不变,1眼BCVA降低;术后1a手术完全成功15眼(83%),部分成功2眼(11%),失败1眼(6%)。结论:玻璃体腔注射康柏西普联合Ahmed引流阀植入及白内障超声乳化吸除贯序治疗合并白内障的NVG可以有效控制术后眼压,同时尽可能地提高患者BCVA,便于随诊和治疗视网膜原发疾病,可作为合并白内障的NVG治疗的有效方法。

AIM:To investigate the therapeutic effect of conbercept injection combined with Ahmed valve implantation and phacoemulsification in the treatment of neovascular glaucoma(NVG).METHODS:Retrospective analysis.Totally 18 patients(18 eyes)with NVG complicated combined with cataract in our hospital from June 2018 to January 2020.All patients received intraocular injection of conbercept at 3-7d before surgery,Ahmed valve implantation and phacoemulsification were performed after meeting the surgical indications.Best corrected visual acuity(BCVA),intraocular pressure(IOP),resolution of iris neovascularization and postoperative complications were followed up after the surgery,and all the cases were followed up 12mo.RESULTS:Compared with preoperation(51.44±8.18 mmHg),IOP was significant decreased at 1,7d,1,3,6mo,1a after surgery(25.94±11.82,15.39±4.97,15.94±2.69,15.33±4.54,18.89±7.95,16.27±5.22 mmHg)(P<0.05).Last follow up after surgery,BCVA was improved in 12 eyes(67%),unchanged in 5 eyes(28%)and decreased in one eye.At 1a after operation,the complete success rate was 83%(15 eyes),conditional success rate was 11%(2 eyes),one eye of losing control of IOP was failed.CONCLUSION:Conbercept intraocular injection combined with Ahmed valve implantation and phacoemulsification can not only effectively control postoperative IOP,but also improve the visual acuity of the patients as much as possible.It is an effective method for the treatment of NVG with cataract.