雷珠单抗联合小梁切除术及视网膜光凝术治疗新生血管性青光眼临床疗效分析  

Therapeutic effects of ranibizumab combined with trabeculectomy and panretinal photocoagulation for neovascular glaucoma

作　　者：冯希敏[1] 赵庆新[1] 张凤妍[2] 

机构地区：[1]新乡市中心医院眼科,河南省新乡市453000 [2]郑州大学第一附属医院眼科,河南省郑州市450052

出　　处：《眼科新进展》2018年第1期80-83,共4页Recent Advances in Ophthalmology

摘　　要：目的对比分析玻璃体内注射雷珠单抗+小梁切除术+视网膜光凝术和睫状体光凝术+视网膜光凝术治疗新生血管性青光眼的临床疗效和安全性。方法选取2016年1月至10月我院收治的新生血管性青光眼患者38例(40眼),将患者分为两组,小梁切除术组(18眼)采用玻璃体内注射雷珠单抗+小梁切除术+视网膜光凝术的手术方案;睫状体光凝术组(22眼)采用睫状体光凝术+视网膜光凝术的手术方案,两组患者一般资料比较差异均无统计学意义(均为P>0.05)。术后对两组患者分别随访6个月。观察记录两组患者虹膜及前房角新生血管消退情况,术前及术后6个月最佳矫正视力(best corrected visual acuity,BCVA),术前及术后1个月、3个月、6个月眼压变化,手术成功率,术中及术后并发症情况。结果小梁切除术组玻璃体内注射雷珠单抗1周,所有患者新生血管均消退,随访6个月仅1眼可见少量新生血管复发;睫状体光凝术组睫状体光凝术后2周,新生血管消退18眼,新生血管明显减少3眼,新生血管未见减少1眼,随访6个月6眼可见少量新生血管再次复发。小梁切除术组术后BCVA与术前比较明显提高,差异有统计学意义(P=0.026);睫状体光凝术组术后BCVA与术前比较未见明显提高,差异无统计学意义(P=0.438),小梁切除术组术后BCVA较睫状体光凝术组明显提高,差异有统计学意义(P=0.039)。两组术后1个月、3个月、6个月小梁切除术组眼压较睫状体光凝术组均降低,差异均有统计学意义(均为P<0.05)。两组手术成功率差异有统计学意义(P=0.047),小梁切除术组疗效优于睫状体光凝术组。小梁切除术组并发症发生率较睫状体光凝术组低,差异有统计学意义(P=0.024)。结论玻璃体内注射雷珠单抗+小梁切除术+视网膜光凝术治疗新生血管性青光眼是安全有效的,临床效果优于睫状体光凝术+视网膜光凝术。Objective To evaluate the clinical efficacy of intravitreal ranibizumab injection and panretinal photocoagulation for neovascular glaucoma. Methods T otally 8 patients( 40 eyes) with neovascular glaucoma in the First Affiliated Hospital of Zhengzhou university from January 2016 to O ctober 2016 were collected in this study,and the patients w ere randomly divided into two groups according to the different treatments: trabeculectomy group( 18 eyes), in w hich the patients were treated w ith intravitreal injection of ranibizumab + trabeculectomy + panretinal photocoagulation,and cyclophotocoagulation group( 22 eyes),subjects undergoing cyclophotocoagulation + panretinal photocoagulation. All patients w ere follow ed up for 6 months. And there w as no significant difference in the general data of the tw o groups( all P > 0. 05). Finally,variables including iris neovascularization,the best corrected visual acuity( BC VA),the preoperative and postoperative 1 month,3 months and 6 months intraocular pressure,the operation successful rate and complications in both groups w ere evaluated and compared. Results In the trabeculectomy group,1 w eek after treatment,neovascularization in all patients w as disappeared,and 6 months of follow-up,a small amount of neovascular recurrence occurred;in the cyclophotocoagulation group,2 w eeks after treatment,neovascularization disappeared in 18 eyes,decreased in 3 eyes,and did not change in 1 eye; additionally,6 months of follow-up,some eyes presented neovascularization recurrence. T he postoperative BC VA in the trabeculectomy group w as significantly higher than that before operation,and the difference was statistically significant( P = 0. 026),But there w as no significant difference betw een preoperative and postoperative BC VA in the cyclophotocoagulation group( P = 0. 438). Preoperative BC VA in the trabeculectomy group w as significantly higher than that in the cyclophotocoagulation group,and the difference was statistically significant( P = 0. 039). T he intraocular pressures of

关 键 词：雷珠单抗 小梁切除术 睫状体光凝术 视网膜光凝术 新生血管性青光眼 

分 类 号：R775[医药卫生—眼科]