2002-2016年北京同仁医院新生血管性青光眼原发病因及治疗方式的变化趋势  

Etiological and clinical therapeutic changes trend of neovascular glaucoma in Beijing Tongren Hospital from 2002 to 2016

作　　者：乔春艳 邵蕾 许欣悦 杜秀娟[2] 杨晓晗 曹凯 刘涛 QIAO Chun-yan;SHAO Lei;XU Xin-yue;DU Xiu-juan;YANG Xiao-han;CAO Kai;LIU Tao(Beijing Tongren Eye Center,Beijing Key Laboratory of Ophthalmology and Visual Sciences,Beijing Institute of Ophthalmology,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China)

机构地区：[1]首都医科大学附属北京同仁医院北京同仁眼科中心眼科学与视觉科学北京市重点实验室北京市眼科研究所,100730 [2]山东中医药大学附属眼科医院,250002

出　　处：《眼科》2019年第1期11-16,共6页Ophthalmology in China

基　　金：国家自然科学基金(81570837)

摘　　要：目的分析新生血管性青光眼(neovascular glaucoma,NVG)2002-2016年病因及治疗方式的变化趋势。设计回顾性病例系列。研究对象2002-2016年北京同仁医院住院治疗的NVG患者。方法回顾2002年1月1日-2016年12月31日住院治疗的NVG患者1094例(1152眼)的病历资料。分析2002-2006年及2012-2016年两组患者的年龄、性别、病因构成比;并且分析2013年前后NVG手术治疗方式构成比。主要指标病因构成比、手术方式构成比。结果 2002-2006年组(121例)及2012-2016年组(486例)糖尿病视网膜病变均为首要原发病(54.5%和52.1%);视网膜静脉阻塞其次(33.1%和26.7%)。2012-2016年组中视网膜中央动脉阻塞、眼内肿瘤病例明显增多。儿童NVG最常见原发病是Coats病(36.4%)。2013年前睫状体破坏性手术最多(37.2%),2013年后下降到18.1%(χ~2=53.997,P=0.000);玻璃体注射抗VEGF药物从2.9%上升到45.1%(χ~2=246.599,P=0.000)。外滤过手术治疗者从32.6%下降到16.6%(χ~2=39.714,P=0.000),视网膜光凝或冷凝联合睫状体破坏类手术者从11.1%下降到2.2%(χ~2=38.495,P=0.000)。去除单纯行玻璃体注射抗VEGF药物者,2013年前、2013年后,睫状体破坏性手术均居于首位,其次为外滤过手术,变化均无显著差异。结论 2002-2016年15年间北京同仁医院NVG住院患者人口学特征和原发病因未发生明显变化。首要病因均为糖尿病视网膜病变,其次为视网膜静脉阻塞。随着抗VEGF药物临床应用,NVG治疗策略发生巨大变化,抗VEGF治疗取代睫状体破坏类手术成为首位初始治疗方式;睫状体破坏和外引流手术有下降趋势但仍是目前治疗NVG的重要手术方式。Objective To investigate clinical etiological and therapeutic changes trend of ncovascular glaucoma(NVG)from 2002 to 2016. Design Retrospective case series. Participants the NVG inpatients in Beijing Tongren Hospital from 2002 to 2016. Methods Totally 1094 cases(1152 eyes) of consecutive NVG inpatients were enrolled and reviewed. The gender, age, etiology were compared between two periods(in 2002-2006 and in 2012-2016). For therapeutic analysis, taking 2013 as a key point when anti-VEGF drugs were widely used, operation method of NVG was analyzed. Main Outcome Measures the constituent ratio of etiological and operative methods. Results The first clinical etiology of NVG both in 2002-2006 group(121 cases) and in 2012-2016 group(486 cases) were diabetic retinopathy(54.5%, 52.1%), followed by retinal vein occlusion(33.1%, 26.7%). Cases of central retinal artery occlusion and intraocular tumor increased significantly in 2012-2016. Coats disease(36.4%) was the most common original disease in children. Cyclodestructive procedures were the most popular(37.2%) before 2013, then significantly decreased to 18.1%(χ^2=53.997, P=0.000), while vitreous injection of anti-VEGF drugs were the first therapy after 2013, of which composition ratio increased from 2.9% to 45.1%(χ^2=246.599, P=0.000). External filtration was decreased from 32.6% to 16.6%(χ^2=38.495, P=0.000), and retinal photocoagulation or condensation combined ciliary body damage was decreased from 11.1% to 2.2%(χ^2=38.495, P=0.000). If the cases of simple vitreous anti-VEGF drugs were removed, the first therapy was ciliary body destructive surgery in both periods, and the second was external filtration(all P>0.05).Conclusion The clinical demographic characteristics and etiological change trend of NVG in 2002-2016 don’t change too much. The first etiology of NVG is diabetic retinopathy, followed by retinal vein occlusion. As the clinical application of anti-VEGF drugs, the cases accepted anti-VEGF treatment are significantly increased, and becomes the first the

关 键 词：新生血管性青光眼 病因 构成比 抗VEGF治疗 

分 类 号：R779.6[医药卫生—眼科]