贝伐单抗联合小梁切除术或睫状体光凝术治疗晚期新生血管性青光眼疗效比较  

Comparison of clinical efficacy between intravitreal bevacizumab combined with trabeculectomy and intravitreal bevacizumab combined with cyclophotocoagulation for late stage neovascular glaucoma

作　　者：黄萍[1] 王雯倩[1] 石砚[2] 刘恩泽[1] 张纯[1] 

机构地区：[1]北京大学第三医院眼科,100191 [2]首都医科大学附属北京同仁医院,100730

出　　处：《中华实验眼科杂志》2015年第4期362-366,共5页Chinese Journal Of Experimental Ophthalmology

摘　　要：背景 新生血管性青光眼（NVG）是眼部缺血性病变的继发性改变,属于难治性青光眼.抗血管内皮生长因子（VEGF）药物在眼部的应用为NVG的治疗提供了新的手段,但应用方法和治疗效果仍在进一步研究.目的 观察和比较抗VEGF药物贝伐单抗球内注射后联合小梁切除术或睫状体光凝术治疗NVG的疗效和安全性,探讨NVG的治疗策略.方法 采用非随机分组病例对照研究方法,连续收集2012年1月至2013年3月于北京大学第三医院确诊的NVG患者23例23眼,根据采用手术方案的不同将患者分为小梁切除术组9例9眼和睫状体光凝组14例14眼.所有患者确诊后先行贝伐单抗眼内注射,用胰岛素注射针头在角膜缘后4 mm处垂直眼球中心刺入眼内,前房穿刺放液50 μl后注射贝伐单抗50 μl（1.25 mg）,然后各组患者分别接受相应的手术.分别于术后1周和3个月进行视力、眼压和治疗相关指标的检测,并观察各组术眼的并发症情况,对2个组的治疗结果进行比较,建立NVG的治疗流程.结果 2个组患眼的基线特征比较差异均无统计学意义（均P＞0.05）.小梁切除术组术前及术后1周、3个月的眼压分别为（43.4±6.2）、（15.6±3.0）和（19.7±3.2） mmHg（1 mmHg=0.133 kPa）,睫状体光凝组为（42.8±4.9）、（25.4±7.5）和（23.3±6.6） mmHg,2个组注射药物前与抗青光眼术后不同时间点眼压的比较,差异均有统计学意义（F分组=28.817,P＜0.001;F时间=158.418,P＜0.001;F交互作用=7.260,P=0.002）.各组内术后1周和3个月的眼压值均低于术前,差异均有统计学意义（均P＜0.01）;术后1周,睫状体光凝组术眼的眼压明显高于小梁切除术组,差异有统计学意义（P＜0.01）;而术后3个月,2个组间眼压的差异无统计学意义（P=0.095）.术后3个月,小梁切除术组视力下降者3眼,睫状体光凝组视力下降者9眼,差异有统计学意义（P=0.042）.睫状体光凝组患者贝伐单抗注射Background Neovascular glaucoma （NVG） often occurs secondary to ocular ischemic diseases and is refractory glaucoma.Intravitreal injection of bevacizumab offers a new approach to the rapid regression of anterior segment neovascularization and therefore is used as an adjunct therapy of NVG.However,the efficacy of intravitreal injection of bevacizumab combined with anti-glaucoma surgery NVG is still explorating.Objective This clinical study was to assess the efficacy and safety of intraocular injection of bevacizumab combined with trabeculectomy （Trab） or cyclophotocoagulation （CPC） for NVG and explore a optimal treating flowchart.Methods This study was approved by Ethic Committee of Peking University Third Hospital,and written informed consent was obtained prior to any medical procedure.This was a nonrandomized case control study.Twenty-three eyes of 23 patients with NVG were collected from January 2012 to March 2013 in Peking University Third Hospital.The patients were grouped to the Trab group （9 eyes） and the CPC group （14 eyes） with the matched demography between the two groups.Bevacizumab at the dose of 1.25 mg （50 μl） was initially injected via the anterior chamber to vitreous,and then the corresponding surgery was performed on the NVG eyes in different groups.The visual acuity,intraocular pressure （IOP） and treatment-related indexes were examined 1 week and 3 months after operation.The intraoperative and postoperative complications were evaluated.A flowchart of combination procedure for NVG was established.Results No significant difference was found in the demography between the two groups （all at P＞0.05）.The IOPs were （43.4±6.2）,（15.6±3.0） and （19.7±3.2） mmHg before operation and 1 week,3 months after operation in the Trab group,and those in the CPC group were （42.8±4.9）,（25.4±7.5） and （23.3±6.6） mmHg,with significant differences between different groups and time points （Fgroup =28.817,P＜O.001 ;Ftime =158.418,P＜0.001 ; Fintrtaction =7.2

关 键 词：血管生成抑制剂/治疗用途 人源化单克隆抗体/治疗用途 联合疗法 新生血管性青光眼/治疗 眼压 玻璃体腔注射 小梁切除术 睫状体光凝术 血管内皮生长因子/拮抗剂&抑制剂 

分 类 号：R779.6[医药卫生—眼科]