改良Ahmed青光眼引流阀植入术治疗闭角期新生血管性青光眼疗效的临床研究

The effect of modified Ahmed glaucoma valve implantation on neovascular glaucoma at the angle-closure stage

目的观察改良Ahmed青光眼引流阀植入术对闭角期新生血管性青光眼的疗效。方法选择2017年10月至2021年1月就诊于邯郸市眼科医院眼科的闭角期新生血管性青光眼患者45例(45只眼)。其中,男性30例(30只眼),女性15例(15只眼);年龄35~82岁,平均年龄(59.4±13.5)岁。所有患者予玻璃体腔注射雷珠单抗0.05mg,3~7d后行改良Ahmed青光眼引流阀植入术,术后2周分期行全视网膜光凝,术后1d、3d、7d、1个月、3个月及6个月随访,观察患者视力、眼压、虹膜新生血管及眼部并发症的情况。年龄、最小分辨角对数(logMAR)视力及眼压符合正态分布以x珋±s表示。全视网膜光凝治疗的初步有效率和性别以例数和百分比表示。患者不同时间点眼压的比较采用单因素重复测量方差分析,当差异有统计学意义时,进一步两两比较。结果45例(45只眼)闭角期新生血管性青光眼患者术前logMAR视力为1.28±0.45,终末logMAR视力1.07±0.48。与术前相比,术后6个月视力较治疗前提高者30例(30只眼),占66.7%;无明显变化者15例(15只眼),占33.3%。玻璃体腔注射雷珠单抗3~7d后,45例(45只眼)虹膜新生血管均明显消退。改良Ahmed青光眼引流阀植入术前、术后1d、3d、7d、1个月、3个月及6个月患者的眼压分别为(42.64±7.96)mmHg(1mmHg=0.133kPa)、(19.11±10.15)mmHg、(12.98±2.80)mmHg、(15.04±4.38)mmHg、(15.47±2.46)mmHg、(15.69±1.98)mmHg及(15.25±1.63)mmHg。所有患者不同时间点眼压比较的差异有统计学意义(F=162.012,P<0.05)。术后任意时间点与术前眼压比较的差异均有统计学意义(t=12.81,25.51,20.39,23.87,22.73,21.85;P<0.05)。患者术后7d、术后1个月、术后3个月及术后6个月时眼压比较的差异无统计学意义(F=1.130,P>0.05)。眼压控制稳定。术后6个月后,眼压≤21mmHg者38例(38只眼),占84.44%;使用1~2种抗青光眼药物治疗后≤21mmHg者7例(7只眼),占15.56%。术中前房出血者7例(7只眼),占15.56%;结膜对合不良者1例(1只眼),占2.22%。术后短暂性前房出血、短暂性脉络膜脱离、管周虹膜粘连及滤过泡包裹者分别为3例(3只眼)、1例(1只眼)、1例(1只眼)及3例(3只眼),分别占6.67%、2.22%、2.22%及6.67%。结论抗血管内皮生长因子、改良Ahmed青光眼引流阀植入及全视网膜光凝术序贯治疗闭角期新生血管性青光眼,可有效地降低患者眼压,提高患者残余视功能。

Objective The aim of this study is to observe the efficacy of modified Ahmed glaucoma drainage valve implantation in the treatment of angle-closure neovascular glaucoma.MethodsA total of 45 cases(45 eyes)of neovascular glaucoma with closed angle were collected from October 2017 to January 2021 at Department of Ophthalmology in Handan Eye Hospital.Among them,there were 30 males(30 eyes)and 15 females(15 eyes)with the average age of(59.4±13.5)years,ranged from 35 to 82 years.All patients were injected with 0.05 mg of Lucentis into the vitreous cavity,and were implanted with the modified Ahmed glaucoma drainage valve 3 to 7 d later.Panretinal photocoagulation was performed at 2 weeks after surgery,and the visual acuity,intraocular pressure(IOP),iris neovascularization and complications were observed after surgery for 1 d,3 d,7 d,1 month,3 months and 6 months.Age,logarithmic minimum angle of resolution(logMAR)visual acuity and IOP conformed to normal distribution and expressed as±s.The initial response rate of laser therapy and gender are expressed as number of cases and percentage.The IOP of patients at different time points was compared by ANOVA,and further pairwise comparison was performed when the difference was statistically significant.ResultsThe logMAR visual acuity before surgery and at the end of surgery was 1.28±0.45,1.07±0.48 in 45 eyes with angle-closure neovascular glaucoma,respectively.Compared with the preoperative results,30 cases(30 eyes)had higher visual acuity after operation for 6 months,accounting for 66.7%.There were 15 cases(15 eyes)with no obvious change,accounting for 33.3%.After intravitreal injection of Lucentis for 3 to 7 d,iris neovascularization subsided significantly in all eyes.The IOP of patients was(42.64±7.96)mmHg(1 mmHg=0.133 kPa),(19.11±10.15)mmHg,(12.98±2.80)mmHg,(15.04±4.38)mmHg,(15.47±2.46)mmHg,(15.69±1.98)mmHg and(15.25±1.63)mmHg at 1 day,3 days,7 days,1 month,3 months and 6 months before and after implantation of the modified Ahmed glaucoma drainage valve.After surgery for 6 months,there were 38 cases(38 eyes)with IOP≤21 mmHg,accounting for 84.44%.There were 7 cases(7 eyes)with IOP≤21 mmHg,accounting for 15.56%after using 1 to 2 antiglaucoma drugs.The difference of IOP at different time points was statistically significant(F=162.012,P<0.05).There was a significant difference in the IOP of patients between before and after surger at any time point(t=12.81,25.51,20.39,23.87,22.73,21.85;P<0.05).There was not a significant difference in the IOP of patients between after surgery for 7 days,1 month,3 months and 6 months(F=1.130,P>0.05),which indicating that the IOP of patients tended to be stable.There were 7 patients(7 eyes)with intraoperative anterior chamber hemorrhage,accounting for 15.56%.There was 1 case(1 eye)with conjunctival malocclusion,accounting for 2.22%.Transient anterior chamber bleeding,transient choroidal detachment,periductal iris adhesion and filtration bubble wrapping occurred in 3 cases(3 eyes),1 case(1 eye),1 case(1 eye)and 3 cases(3 eyes),respectively,accounting for 6.67%,2.22%,2.22%and 6.67%.ConclusionsAnti-vascular endothelial growth factor,modified Ahmed glaucoma drainage valve implantation and panretinal photo-coagulation in sequential treatment of angle-closure neovascular glaucoma could effectively reduce the IOP and improve the residual visual function of patients.