不同抗VEGF药物联合小梁切除术治疗新生血管性青光眼患者的效果及其对眼压、视力及眼动脉血流动力学指标的影响

Effects of different anti-VEGF drugs combined with trabeculectomy in the treatment of neovascular glaucoma and their effects on IOP level,visual acuity level and hemodynamics of ocular artery

目的 对比新生血管性青光眼(NVG)患者应用小梁切除术联合不同抗血管生长因子(VEGF)药物治疗的效果。方法 随机数字表法将2020年12月至2022年12月间我科65例NVG患者(98眼)分为2组,入院第3d开始,康柏西普组32例(48眼)予康柏西普玻璃体内点注注射0.04~0.06mL,雷珠单抗组33例(50眼)8点位角膜缘4mm处注入0.05mL雷珠单抗,均治疗1w后行小梁切除术,对比两组术前、术后3个月视力、新生血管消退情况、眼动脉血流动力和并发症。结果 康柏西普组平均消退时间(3.17±0.59) d较雷珠单抗组的(3.81±0.71) d短(t=4.8427,P<0.05),康柏西普组3个月末眼压(19.30±2.21) mmHg及动脉血流阻力系数(0.66±0.07)较雷珠单抗组的(32.19±3.18) mmHg、(0.73±0.06)低(t=23.3785,5.3222,P<0.05),视力(0.73±0.14)、眼舒张末期流速(10.89±0.44) cm/s和收缩期峰值流速(34.49±3.90) cm/s较雷珠单抗组的(0.61±0.16)、(8.21±0.59) cm/s和(31.11±3.44) cm/s高(t=3.9448,25.5582,4.5547,P<0.05),康柏西普组并发症总发生率25.00%(12/48)与雷珠单抗组的28.00%(14/50)无显著差异(χ^(2)=0.1131,P>0.05)。结论 NVG患者接受小梁切除术前联合玻璃体内注射康柏西普可较雷珠单抗更有效、迅速的促进新生血管消退,且术后眼压控制效果、眼动脉血流动力和视力改善效果优于雷珠单抗。

Objective To compare the effects of trabeculectomy combined with different anti-vascular growth factor(VEGF)drugs in patients with neovascular glaucoma(NVG).Methods A total of 65 patients with NVG treated in our department from December 2020 to December 2022 were divided into 2 groups by random number table method,32 patients(48 eyes)in the Conbercept group were injected 0.04-0.06mL intravitreal with CompaplCept starting from the third day of admission.while 33patients(50 eyes)in the Ranibizumab group were injected 0.05mL at 4mm of the corneal limbus at 8 o'clock on the 3rd day after admission.Trabeculectomy was performed 1w after treatment.Visual acuity,neovascularization,ocular artery flow dynamics and complications were compared between the two groups before and 3 months after surgery.Results The mean resolution time of(3.17±0.59)d was shorter in the Conbercept group than that of(3.81±0.71)d in the Ranibizumab group(t=4.8427,P<0.05).At the end of 3 months,the IHP(19.30±2.21)mmHg and the coefficient of arterial blood flow resistance(0.66±0.07)in the Conbercept group were lower than those in the Ranibizumab group(32.19±3.18)mmHg and the coefficient of arterial blood flow resistance(0.73±0.06),(t=23.3785,5.3222,P<0.05),The visual acuity of(0.73±0.14)degree,end-diastolic flow velocity of(10.89±0.44)cm/s and peak systolic flow velocity of(34.49±3.90)cm/s were higher than those of(0.61±0.16)degree,enddiastolic flow velocity of(8.21±0.59)cm/s and peak systolic flow velocity of(31.11±3.44)cm/s height in ranibizumab group(t=3.9448,25.5582,4.5547,P<0.05),there was no significant difference in the total incidence of complications between the Conbercept group(25.00%)(12/48)and the Ranibizumab group(28.00%)(14/50)(χ^(2)=0.1131,P>0.05).Conclusion In patients with NVG who received trabeculectomy combined with intravitreal injection of conbercept can promote neovascularization more effectively and rapidly than ranibizumab,and the postoperative IOP control effect,ocular arterial blood flow dynamics and visual acuity improvement effect are better than ranibizumab.