玻璃体腔与结膜下注射抗血管内皮生长因子联合小梁切除治疗新生血管性青光眼的效果比较  

Comparison of Efficacy of Intravitreal and Subconjunctival Anti-VEGF Injection Combined with Trabeculectomy in the Treatment of NVG

作　　者：江会丰 刘贤升 段明明 欧阳君[1] JIANG Huifeng;LIU Xiansheng;DUAN Mingming;OUYANG Jun(Department of Ophthalmology,Jiujiang First People's Hospital,Jiujiang 332000,China)

机构地区：[1]九江市第一人民医院眼科,九江332000

出　　处：《中国医药指南》2024年第17期11-14,共4页Guide of China Medicine

基　　金：江西省卫生健康委科技计划(SKJP420201231)。

摘　　要：目的探究在新生血管性青光眼(NVG)患者治疗中应用玻璃体腔和结膜下注射抗血管内皮生长因子(VEGF)并小梁切除联合治疗的疗效对比差异。方法随机选取我院2021年1月至2022年6月期间,明确诊断为NVG的住院患者为研究主体,总计纳入患者26例,患眼30只。基于随机数字表法均衡原则分组,命名为A组(患者13例,患眼15只)和B组(患者13例,患眼15只)。A组患者行玻璃体腔注射抗VEGF药,然后行小梁切除术,B组患者行结膜下注射抗VEGF药后行小梁切除术,对比组间视力恢复效果、术后不同时点眼压水平、患眼新生血管面积和并发症发生情况。结果组间患者视力恢复效果对比无差异(P>0.05);在术后第7天,第21天、半年以及术后1年两组患者眼压水平均呈下降变化趋势(均P<0.05),但比较术前及术后各时间点,两组患者眼压水平对比差异无统计学意义(P>0.05);两组治疗前及术后1~6 d内每日比较,两组新生血管面积无差异(P>0.05),术后两组患者的新生血管面积呈逐渐减小趋势,且与术前相比更小(均P<0.05);和A组比较,B组患者术后并发症发生率更低(P<0.05)。结论玻璃体腔与结膜下注射抗VEGF均可有效治疗NVG,均可以达到降低眼压、促进视力恢复,缩小新生血管面积的作用,但是以结膜下注射方式的安全性更高。Objective To explore the difference between vitreous and subconjunctival injection of anti-vascular endothelial growth factor(VEGF)coFmbined with trabeculectomy in neovascular glaucoma(NVG).Methods From January 2021 to June 2022,26 patients(30 eyes)with NVG were selected randomly as the main body of the study.Based on the equilibrium principle of random number table,the patients were divided into two groups:group A(153 patients,15 eyes)and group B(13 patients,15 eyes).Patients in group A received intravitreal injection of anti-VEGF drugs,followed by trabeculectomy,while patients in group B underwent trabeculectomy after subconjunctival injection of anti-VEGF drugs.Comparative indicators:visual acuity recovery effect,postoperative intraocular pressure at different time points,neovascularization area and complications of the affected eyes.Results There was no difference in the effect of visual acuity recovery between the groups(P>0.05);the IOP levels of the two groups showed a decreasing trend on the 7th d,21st d,half a year,and 1 year after surgery(all P<0.05),but the difference in IOP levels of the two groups was not statistically significant when comparing the preoperative and postoperative time points(P>0.05);There was no difference in the area of neovascularization between the two groups when comparing the two groups daily before treatment and 1-6 d after surgery(P>0.05),and the area of neovascularization in the two groups showed a trend of gradual reduction after surgery and was smaller compared with the preoperative period(both P<0.05);the incidence of postoperative complications in the patients of group B was lower when compared with that of group A(P<0.05).Conclusions Both vitreous cavity and subconjunctival injection of anti-VEGF can effectively treat NVG,which can reduce IOP,promote vision recovery and shrink neovascularization area.However,subconjunctival injection has higher safety.

关 键 词：新生血管性青光眼 玻璃体腔注射 结膜下注射 抗血管内皮生长因子 小梁切除术 

分 类 号：R775[医药卫生—眼科]