不同方法联合治疗新生血管性青光眼的临床观察  

Clinical observation of combined treatment for neovascular glaucoma

作　　者：周林[1] 李芳芳[1] 冯军[1] 

机构地区：[1]中国江苏省淮安市第二人民医院徐州医学院附属淮安医院眼科,223002

出　　处：《国际眼科杂志》2017年第5期954-957,共4页International Eye Science

摘　　要：目的:观察不同方法[降眼压药物+玻璃体腔注射雷珠单抗+复合式小梁切除+全视网膜光凝(PRP)]联合治疗新生血管性青光眼(neovascular glaucoma,NVG)的疗效。方法:回顾性非随机临床对照研究。新生血管性青光眼患者24例24眼纳入研究,经降眼压药物治疗后,7眼正常眼压,17眼高眼压。所有患者均行玻璃体腔注射雷珠单抗0.50mg/0.05mL,7d后行复合式小梁切除术。复合式小梁切除术后予以全视网膜光凝。术后随访6~18mo,观察联合治疗后虹膜新生血管消退时间、眼压、视力变化,术中术后并发症以及滤过泡情况。结果:所有患者玻璃体腔注射雷珠单抗后,虹膜新生血管1wk内完全消退。治疗前平均眼压41.38±3.16mmH g,治疗后6mo平均眼压12.69±1.52mmH g,两者比较有统计学差异(F=25.592,P<0.05)。治疗前最佳矫正视力>0.1者3眼,视力0.01~0.1者10眼,无光感~指数者11眼,治疗后最佳矫正视力>0.1者5眼,视力0.01~0.1者16眼,无光感~指数者3眼,差异有统计学意义(Z=-2.201,P<0.05)。结论:不同方法联合治疗NVG患者能有效地控制眼压,保护视功能。AIM： To observe the effect of combined treatment （using intraocular pressure-lowering drugs ＋ intravitreal injection of Lucentis ＋ complex trabeculectomy ＋ panretinal photocoagulation）for neovascular glaucoma （NVG）. METHODS： This was a prospective non-randomized clinical study. A total of 24 patients （24 eyes） with NVG were enrolled. After using intraocular pressure （IOP）- lowering drugs, the elevated lOP in 7 eyes was controlled within normal limits and 17 eyes within high levels. All patients were treated with intravitreal injection of Lucentis 0.50mg/0.05mL. Complex trabeculectomy were performed within 7d after injection. All patients were treated with panretinal photocoagulation after complex trabeculectomy. The regression of iris neovascularization, changes in lOP, best corrected visual acuity, intraoperative and postoperative complications and filtering bleb were analyzed after combined treatment. Patients were followed-up for 6-18mo. RESULTS. Iris neovascularization completely regressed within lwk in 24 eyes after intravitreal injection of Lucentis. The average lOP was 41.38±3.16mmHg before combined treatment, and 12.69±1.52mmHg in 6mo after combined treatment. The differences had statistically significant before and after combined treatment（ F= 25. 592, P〈0.05）. Before combined treatment, the best-corrected visual acuity was 〉0.1 in 3 eyes, 0.01-0.1 in 10 eyes, non light perception （NLP）- finger counting （FC） in 11 eyes.After combined treatment, the best-corrected visual acuity was 〉0.1 in 5 eyes, 0.01-0.1 in 16 eyes, NLP - FC in 3 eyes, which showed statistically significant difference with the visual acuity before combined treatment （ Z= -2. 201, P〈0.05）. CONCLUSION. Combined treatment could effectively control the lOP and preserve the visual function in patients with neovascular glaucoma.

关 键 词：雷珠单抗 复合式小梁切除术 全视网膜光凝 新生血管性青光眼 

分 类 号：R779.6[医药卫生—眼科]