贝伐单抗玻璃体内注射联合引流阀植入治疗新生血管性青光眼  

Intravitreal injection of bevacizumab combined with Ahmed drainage valve implantation for the treatment of neovascular glaucoma

作　　者：胡宏阁 金学民[2] 

机构地区：[1]许昌市中心医院眼科,河南461000 [2]郑州大学第一附属医院眼科,450052

出　　处：《中华眼外伤职业眼病杂志》2016年第6期468-472,共5页Chinese Journal of Ocular Trauma and Occupational Eye Disease

摘　　要：目的观察玻璃体内注射贝伐单抗（bevacizumab）联合引流阀植入术治疗新生血管性青光眼（NVG）的效果。方法A组26例（26眼）NVG患者先行贝伐单抗（1．25mg／0．05ml）玻璃体内注射，1周后行Ahmed引流阀植入术；B组行引流阀植入术联合广泛视网膜光凝（panretinal photocoagulation）。结果A组26例（26眼）注射前眼压（44．04±1．58）mmHg（1mmHg=0．133kPa），注射后7d眼压（43．16±1．50）mmHg，引流阀植入术后6个月眼压（13．20±5．70）mmHg，玻璃体内注射贝伐单抗和引流阀植入术治疗前、治疗后6个月眼压差异有统计学意义（t=25．41，P=0．000）。治疗成功18例，成功率69．23％。B组32例（32眼）治疗前眼压（49．10±14．32）mmHg，广泛视网膜光凝和引流阀植入手术后6个月眼压（13．80±6．23）mmHg，治疗前、后眼压差异有统计学意义（t=12．79，P=0．001）。治疗成功20例，成功率62．50％。两组成功率比较（x2=0．288，P=0．62）差异无统计学意义。A组26眼玻璃体内注药后7d内有21眼新生咀管完全消退，5眼部分消退。观察6个月，新生血管未完全消退和复发病例共19例（73．08％）。B组32眼在治疗后有21眼的新生血管完全消退，10眼部分消退，1眼未消退。观察6个月，新生血管未完全消退和复发病例共15例（46．88％）。两组间比较差异有统计学意义（X2=4．06，P=0．045）。结论贝伐单抗玻璃体内注射能快速使虹膜新生血管消退，为Ahmed青光眼引流阀植入术创造好的手术条件，但远期效果不如广泛视网膜光凝和引流阀植入术。Objective To investigate the efficacy of intravitreal injection of bevacizumab combined with Ahmed drainage valve implantation for neovascular glaucoma（NVG）. Methods Twenty-six eyes of 26 cases diagnosed as NVG were treated with intravitreal injection of bevacizumab combined with Ahmed drainage valve implantation which was taken as group A. Injections of bevaeizumab （ 1.25 mg/0.05 ml） for twenty-six eyes were performed under topical anesthesia, and all cases were implanted with Ahmed drainage valve after 1 week. In group B, as the control group, 32 NVG eyes of 32 cases were treated with Ahmed drainage valve implantation and the preoperative or postoperative panretinal photocoagulation. The follow-up time was more than 6 months. Results In group A, the mean intraoeular pressure of 26 eyes of 26 cases before and one week after bevaeizumab injection was （44.04 ± 1.58） mmHg （ 1 mmHg = 0. 133 kPa） and （43.16 ± 1.50） mmHg, respectively. The mean intraocular pressure at 6 months after Ahmed drainage valve implantation was （ 13.20 ± 5.70） mmHg. The difference of the mean intraocular pressure before and 6 months after treatment was statistically significant （ t = 25. 41, P = 0. 000）. In group B, the mean intraocular pressure of 32 eyes of 32 cases before and 6 months after treatment was （49.10 ± 14.32） mmHg and （13.80±6.23） mmHg, respectively, and the difference was statistically significant（ t = 12.79, P = 0.001 ）. The success rates of two groups were 69.23% and 62.50%, respectively, and the difference was not statistically significant （ X2 = 0. 288,P = 0.62）. Seven days after intravitreal injection of Bevacizumab in group A, neovascularization in 21 eyes regressed completely, and partly regressed in 5 eyes. The change of neovascularization before and after operation was not obvious. There were 19 cases （73. 08% ） had neovascularization after the follow-up 6 months, including the neovascularization regression uncompletely in 5 eyes and the recurred neovascularization i

关 键 词：青光眼 新生血管性 玻璃体内注射 贝伐单抗 青光眼引流阀 广泛视网膜光凝 

分 类 号：R775[医药卫生—眼科]