抗VEGF联合Ahmed引流阀植入治疗新生血管性青光眼的临床疗效

Clinical efficacy of anti-VEGF combined with Ahmed glaucoma drainagevalve implantation in the treatment of neovascular glaucoma

目的:观察玻璃体腔抗血管内皮生长因子(VEGF)注射联合Ahmed青光眼引流阀(AGV)植入对新生血管性青光眼(NVG)的疗效与安全性。方法:回顾性分析NVG病人47例(47眼)临床资料,其中25例(25眼)实施AGV植入术(AGV组),22例(22眼)行小梁切除术(小梁组)。2组病人术前均予以玻璃体腔内抗VEGF药物注射,术后完成全视网膜光凝,1年内定期随访。比较2组术后最佳矫正视力改善情况和手术前后眼内压(IOP)、抗青光眼药物使用情况及术后并发症、手术成功率。结果:抗VEGF治疗后,2组病人均获得不同程度的虹膜面新生血管消退,且IOP均较术前降低(P<0.05);术后各时点,2组IOP均较术前和抗VEGF治疗后降低(P<0.05)。2组病人间比较,各时间点IOP差异均无统计学意义(P>0.05)。2组术后最佳矫正视力改变情况差异无统计学意义(P>0.05)。2组术后应用抗青光眼药物种类均较术前明显减少(P<0.01)。2组术后并发症发生率差异无统计学意义(P>0.05)。AGV组手术成功率高于小梁组(P<0.05)。结论:抗VEGF药物玻璃体腔内注射联合AGV植入术治疗NVG安全有效。

Objective:To investigate the clinical efficacy and safety of anti-vascular endothelial growth factor(VEGF)combined with Ahmed glaucoma drainage valve(AGV)implantation in the treatment of neovascular glaucoma(NVG).Methods:The clinical data of 47 patients with NVG were retrospectively analyzed.The patients were treated with Ahmed glaucoma drainage valve(AGV)implantation[AGV group,25 cases(25 eyes)]and trabeculectomy[trabecular group,22 cases(22 eyes)].Two groups were injected with intravitreal anti-VEGF drugs before surgery,the panretinal photocoagulation was completed after surgery,and all cases were regularly followed up within 1 year.The best corrected visual acuity improvement,intraocular pressure(IOP)before and after surgery,use of anti-glaucoma drugs,postoperative complications and operation success rate were compared between two groups.Results:After anti-VEGF treatment,the neovascularization of iris surface in two groups showed regression to different degrees,and the IOP in two groups was lower than that before surgery(P<0.05).At each time-point of operation,the IOP in two groups was lower than that before surgery and after anti-VEGF treatment(P<0.05).There was no statistical significance in the IOP between two groups at each time-point(P>0.05).There was no statistical significance in the best corrected visual acuity between two groups after operation(P>0.05).Compared with before operation,the types of anti-glaucoma drugs use after operation reduced significantly in two groups(P<0.01).There was no statistical significance in the incidence of postoperative complications between two groups(P>0.05).The operative success rate in the AGV group was higher than that in trabecular group(P<0.05).Conclusions:Intravitreal injection of anti-VEGF agents combined with AGV implantation is effective and safe in the treatment of neovascular glaucoma.