注射不同剂量康柏西普联合PRP及EX-PRESS引流钉植入术治疗NVG的疗效对比

Comparison of efficacy of different doses of Conbercept combined with panretinal photocoagulation and EX-PRESS glaucoma shunt implantation in the treatment of neovascular glaucoma

目的:评估玻璃体腔注射三种剂量康柏西普联合全视网膜光凝(PRP)后行EX-PRESS引流钉植入术治疗新生血管性青光眼(NVG)的有效性及安全性。方法:前瞻性研究。收集我院2018-05/2020-09收治的NVG患者37例37眼,均接受玻璃体腔注射康柏西普3~5d后行PRP。术后1wk内接受EX-PRESS青光眼引流钉植入术。采用随机数字表法,将术前玻璃体腔注射三种剂量康柏西普分为低剂量组(13眼)、常规剂量组(12眼)、高剂量组(12眼),分别玻璃体腔注射10mg/mL康柏西普0.03、0.05、0.08mL(含康柏西普0.3、0.5、0.8mg)。观察三组患者玻璃体腔注药后虹膜及房角新生血管(NV)消退情况,比较三组患者术后眼压(IOP)、最佳矫正视力(BCVA)、并发症。结果:所有患者均完成随访。三组患者玻璃体腔注射后3~5d,虹膜及房角NV消退眼数高剂量组明显高于低剂量组(χ^(2)=0.132,P=0.003)、常规剂量组(χ^(2)=0.154,P=0.015)。三组术后1、3、6mo时,BCVA、IOP均较术前有所改善。术后12mo低剂量组、常规剂量组、高剂量组的IOP分别为14.12±2.63、13.37±2.18、12.15±1.43mmHg,高剂量组IOP均低于低剂量组及常规剂量组(均P<0.05)。术后12mo高剂量组BCVA均优于低剂量组及常规剂量组(均P<0.05)。术后12mo并发症发生率三组之间均无差异(P>0.05)。结论:玻璃体腔注射0.8mg高剂量康柏西普联合PRP及EX-PRESS引流钉植入术治疗NVG临床效果尤为显著。

AIM:To evaluate the efficacy and safety of three doses of Conbercept intravitreal injection with panretinal photocoagulation(PRP)followed by EX-PRESS glaucoma shunt implantation on patients with neovascular glaucoma(NVG).METHODS:Prospective study.A total of 37 patients(37 eyes)with NVG from May 2018 to September 2020 were collected.All accepted intravitreal injection of Conbercept and PRP 3-5d later,and accepted EX-PRESS glaucoma shunt implantation within 1wk after surgery.They were randomly divided into the low-dose group(13 eyes),the conventional dose group(12 eyes)and the high-dose group(12 eyes)according to three doses of preoperative Conbercept intravitreal injection,and they were injected with 10mg/mL Conbercept of 0.03,0.05 and 0.08 mL(0.3,0.5 and 0.8 mg Conbercept contained)respectively.The regression of iris and angle neovascularization(NV)after intravitreal injection was observed in the three groups,and postoperative intraocular pressure(IOP),best corrected visual acuity(BCVA)and complications were compared among the three groups.RESULTS:All patients completed follow-up.Cases with NV regression of iris and angle in the high-dose group were significantly more than the low-dose group(χ^(2)=0.132,P=0.003)and the conventional dose group(χ^(2)=0.154,P=0.015)3-5d after intravitreal injection.BCVA and IOP of the three groups at 1,3 and 6mo after surgery were improved compared with those before treatment.IOP of the low-dose group,the conventional dose group and the high-dose group at 12mo after surgery was 14.12±2.63,13.37±2.18 and 12.15±1.43mmHg,respectively.IOP of the high-dose group was lower than that of the low-dose group and the conventional dose group(all P<0.05).The BCVA of the high-dose group at 12mo after surgery was better than that of the low-dose group and the conventional dose group(all P<0.05).There was no significantly statistical difference in the incidence of postoperative complications at 12mo after surgery among the three groups(P>0.05).CONCLUSIONS:The intravitreal injection of high-dose(0.8mg)Conbercept combined with PRP and EX-PRESS glaucoma shunt implantation has particularly significant clinical effect on the treatment of NVG.