综合治疗新生血管性青光眼疗效观察  

Management of neovascular glaucoma with intravitreal Ranibizumab, and subsequent trabeculectomy with mitomycin C combined with panretinal photocoagulation

作　　者：王华[1] 王涛[1] 张风[1] 左华欣 

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、北京市眼科学与视觉科学重点实验室,北京100730

出　　处：《中国实用眼科杂志》2015年第4期370-373,共4页Chinese Journal of Practical Ophthalmology

摘　　要：目的观察玻璃体腔内注射雷珠单抗（Lueentis）后联合小梁切除术和全视网膜光凝治疗新生血管性青光眼的效果。方法前瞻性非随机系列病例研究。对2012年5月至2013年3月在北京同仁医院眼科行玻璃体腔内注射0．5mg（0．05ml）雷珠单抗后行小梁切除术联合丝裂霉索，观察术中术后并发症的情况，及术后眼压随访结果。结果连续接诊的12例（13只眼）接受玻璃体腔内注射雷珠单抗后择期行小梁切除术，随访3～9个月（平均6个月），术后末次随访视力提高者5只眼（38．5％），视力未变者8只眼（61．5％），无视力下降者。术前眼压平均（44．65±15．09）mmHg（范围22～65mmHg），术后末次随访的眼压为（17±6．50）mmHg（范围9～33mmHg）。手术成功的定义为不用药物眼压控制低于21mmHg。局部用药眼压控制〈21mmHg定义为部分成功。组中病例完全成功9只眼，2只眼部分成功，2只眼失败眼压失控再次行睫状体光凝术。2只眼术中出现前房少量出血，术后第3天积血全部吸收。病例中无浅前房或脉络膜脱离等发生。结论雷珠单抗对于减少虹膜和房角的新生血管有效，小梁切除术中术后前房出血，术后滤过区瘢痕化等并发症少，术后半年随访成功率较高。Objective To observe the efficacy of trabeculectomy after intravitreal injection of ra- nibizumab in the treatment of neovascular glaucoma. Methods The trabeculectomy was performed 4-24 days after intravitreous injection of ranibizumab （Luncentis） 0.5mg （0.05ml）. The intraocular pressure and the visual acuity before and after the surgery and complications were recorded. Re- suits Thirteen eyes of 12 patients were received intravitreous injection of ranibizumab followed by Trabeculectomy. The follow-up time was 3-9 months （averaged 6 months）. The mean pre-surgery IOP was 44.65±15.09mmHg while the last follow-up IOP was 17±6.50 mmHg （P 〈0.001）. Success- ful rate of the surgery （IOP 〈 21mmHg with no medication after the surgery）： 9/13=69.2 %, Success- ful rate of the surgery combined with medication （IOP〈 21mmHg after the surgery）： 2/13 （15.4%）, 2 eyes （15.4%） received cyclophotocoagulation after the trabeculectomy. Rate of improved VA after the surgery： 5 eyes （38.5%）, Rate of sustained VA after the surgery： 8 eyes （61.5%）. Complications： Incidence rate of anterior chamber hyphema： 2/13 （15.4%）, the hyphema disappeared 3 days after op- eration. Incidence rate of choroidal detachment： 0%. Conclusions The surgery of trabeculectomy af- ter intravitreal injection of Ranibizumab controls the IOP effectively. And there are little hemorrage and other complications during and after the surgery.

关 键 词：小梁切除术 RANIBIZUMAB 新生血管性青光眼 

分 类 号：R775[医药卫生—眼科]