改良Ahmed青光眼引流阀植入术治疗闭角期新生血管性青光眼疗效的临床研究  

The effect of modified Ahmed glaucoma valve implantation on neovascular glaucoma at the angle-closure stage

作　　者：崔宏宇[1] 杨一佺 郭黎霞 吕爱国[1] 张志宏[1] 张新[1] 杨艳萍 申然[1] 连丽英[1] 曹志刚[1] 王立芳 胡建华 范肃洁[1] Cui Hongyu;Yang Yiquan;Guo Lixia;Lyn Aiguo;Zhang Zhihong;Zhang Xin;Yang Yanping;Shen Ran;Lian Liying;Cao Zhigang;Wang Lifang;Hu Jianhua;Fan Sujie(Glaucoma Department,Handan City Eye Hospital(The Third Hospital of Handan),Handan 056001,China;Beijing Tongren Eye Center,Beijing Tongren Hospital,Capital Medical University,Beijing Institute of Ophthalmology,Beijing Key Laboratory of Ophthalmology and Visual Sciences,Beijing 100730,China;Department of Ophthalmology,Third Affiliated Hospital of Beijing University of Chinese Medicine,Beijing 100029,China)

机构地区：[1]邯郸市眼科医院(邯郸市第三医院)青光眼科,056001 [2]首都医科大学附属北京同仁医院、北京同仁眼科中心、北京市眼科研究所、北京市眼科学与视觉科学重点实验室,100730 [3]北京中医药大学第三附属医院眼科,100029

出　　处：《中华眼科医学杂志（电子版）》2023年第2期76-81,共6页Chinese Journal of Ophthalmologic Medicine(Electronic Edition)

基　　金：河北省卫生健康委员会医学适用技术跟踪项目(GZ2021081)。

摘　　要：目的观察改良Ahmed青光眼引流阀植入术对闭角期新生血管性青光眼的疗效。方法选择2017年10月至2021年1月就诊于邯郸市眼科医院眼科的闭角期新生血管性青光眼患者45例(45只眼)。其中,男性30例(30只眼),女性15例(15只眼);年龄35~82岁,平均年龄(59.4±13.5)岁。所有患者予玻璃体腔注射雷珠单抗0.05mg,3~7d后行改良Ahmed青光眼引流阀植入术,术后2周分期行全视网膜光凝,术后1d、3d、7d、1个月、3个月及6个月随访,观察患者视力、眼压、虹膜新生血管及眼部并发症的情况。年龄、最小分辨角对数(logMAR)视力及眼压符合正态分布以x珋±s表示。全视网膜光凝治疗的初步有效率和性别以例数和百分比表示。患者不同时间点眼压的比较采用单因素重复测量方差分析,当差异有统计学意义时,进一步两两比较。结果45例(45只眼)闭角期新生血管性青光眼患者术前logMAR视力为1.28±0.45,终末logMAR视力1.07±0.48。与术前相比,术后6个月视力较治疗前提高者30例(30只眼),占66.7%;无明显变化者15例(15只眼),占33.3%。玻璃体腔注射雷珠单抗3~7d后,45例(45只眼)虹膜新生血管均明显消退。改良Ahmed青光眼引流阀植入术前、术后1d、3d、7d、1个月、3个月及6个月患者的眼压分别为(42.64±7.96)mmHg(1mmHg=0.133kPa)、(19.11±10.15)mmHg、(12.98±2.80)mmHg、(15.04±4.38)mmHg、(15.47±2.46)mmHg、(15.69±1.98)mmHg及(15.25±1.63)mmHg。所有患者不同时间点眼压比较的差异有统计学意义(F=162.012,P<0.05)。术后任意时间点与术前眼压比较的差异均有统计学意义(t=12.81,25.51,20.39,23.87,22.73,21.85;P<0.05)。患者术后7d、术后1个月、术后3个月及术后6个月时眼压比较的差异无统计学意义(F=1.130,P>0.05)。眼压控制稳定。术后6个月后,眼压≤21mmHg者38例(38只眼),占84.44%;使用1~2种抗青光眼药物治疗后≤21mmHg者7例(7只眼),占15.56%。术中前房出血者7例(7只眼),占15.56%;Objective The aim of this study is to observe the efficacy of modified Ahmed glaucoma drainage valve implantation in the treatment of angle-closure neovascular glaucoma.MethodsA total of 45 cases(45 eyes)of neovascular glaucoma with closed angle were collected from October 2017 to January 2021 at Department of Ophthalmology in Handan Eye Hospital.Among them,there were 30 males(30 eyes)and 15 females(15 eyes)with the average age of(59.4±13.5)years,ranged from 35 to 82 years.All patients were injected with 0.05 mg of Lucentis into the vitreous cavity,and were implanted with the modified Ahmed glaucoma drainage valve 3 to 7 d later.Panretinal photocoagulation was performed at 2 weeks after surgery,and the visual acuity,intraocular pressure(IOP),iris neovascularization and complications were observed after surgery for 1 d,3 d,7 d,1 month,3 months and 6 months.Age,logarithmic minimum angle of resolution(logMAR)visual acuity and IOP conformed to normal distribution and expressed as±s.The initial response rate of laser therapy and gender are expressed as number of cases and percentage.The IOP of patients at different time points was compared by ANOVA,and further pairwise comparison was performed when the difference was statistically significant.ResultsThe logMAR visual acuity before surgery and at the end of surgery was 1.28±0.45,1.07±0.48 in 45 eyes with angle-closure neovascular glaucoma,respectively.Compared with the preoperative results,30 cases(30 eyes)had higher visual acuity after operation for 6 months,accounting for 66.7%.There were 15 cases(15 eyes)with no obvious change,accounting for 33.3%.After intravitreal injection of Lucentis for 3 to 7 d,iris neovascularization subsided significantly in all eyes.The IOP of patients was(42.64±7.96)mmHg(1 mmHg=0.133 kPa),(19.11±10.15)mmHg,(12.98±2.80)mmHg,(15.04±4.38)mmHg,(15.47±2.46)mmHg,(15.69±1.98)mmHg and(15.25±1.63)mmHg at 1 day,3 days,7 days,1 month,3 months and 6 months before and after implantation of the modified Ahmed glaucoma drainage valve.After sur

关 键 词：新生血管性青光眼 抗血管内皮生长因子治疗 改良Ahmed青光眼阀植入术 全视网膜光凝术 

分 类 号：R779.6[医药卫生—眼科]