疗程内序贯治疗新生血管性青光眼的疗效观察  

Observation on therapeutic effect of sequential treatment for neovascular glaucoma within course of treatment

作　　者：魏莉 钟海彬[2] Wei Li;Zhong Haibin(Datong Aier Eye Hospital,Guangxi University of Traditional Chinese Medicine,Nanning,Guangxi 530021,China;Department of Ophthalmology,People's Hospital of Guangxi Zhuang Autonomous Region,Nanning,Guangxi 530021,China)

机构地区：[1]广西中医药大学大同爱尔眼科医院,广西南宁530021 [2]广西壮族自治区人民医院眼科,广西南宁530021

出　　处：《齐齐哈尔医学院学报》2025年第5期454-459,共6页Journal of Qiqihar Medical University

摘　　要：目的探讨序贯使用玻璃体内注射抗VEGF药物、玻璃体切除(PPV)联合或不联合白内障超声乳化(PHACO)、全视网膜激光光凝(PRP)联合Ahemn青光眼引流阀植入治疗新生血管性青光眼(NVG)的长期疗效。方法回顾性分析2019年1-2022年7月本院收治的NVG 15例(15眼)患者的临床资料,所有患者均采用抗VEGF、PPV、PHACO、PRP及青光眼引流阀植入序贯治疗,观察注药后、玻切联合或不联合白内障联合全视网膜激光光凝术后及Ahemn青光眼引流阀植入术后视力、眼压、并发症,1年后视力、眼压、并发症。结果注药后和基线眼压比较,注射抗VEGF药物后眼压绝大数升高,差异有统计学意义(P<0.05)。玻切后和注药后眼压比较,玻切后眼压有所下降,差异无统计学意义(P>0.05)。植入青光眼引流阀后和基线眼压比较,植入青光眼引流阀后眼压降低,差异具有统计学意义(P<0.05)。最后复诊和基线眼压比较,植入青光眼引流阀后眼压降低,差异有统计学意义(P<0.05)。植入青光眼引流阀后和基线视力比较,视力的差异无统计学意义(P>0.05)。患者植入青光眼引流阀后视力与基线视力有相关性(P<0.05,R^(2)=0.343)。追踪到患者最后一次复诊(>12个月),2例发生前房积血、眼球萎缩,1例滤过泡纤维化后限局,4例再发生新生血管。结论采用序贯治疗,可使新生血管性青光眼患者眼压长期稳定,且并发症最少。Objective To explore the long-term efficacy of sequential use of intravitreal injection of anti-VEGF drugs,vitrectomy(PPV)combined with or without phacoemulsification(PHACO),panretinal laser photocoagulation(PRP),and Ahemn glaucoma drainage valve implantation in the treatment of neovascular glaucoma(NVG).Methods Retrospective analysis was conducted on the clinical data of 15 patients(15 eyes)with NVG admitted to our hospital from January 2019 to July 2022.All patients received sequential treatment with anti-VEGF,PPV,PHACO,PRP,and glaucoma drainage valve implantation.Visual acuity,intraocular pressure,and complications were observed after injection,vitrectomy with or without cataract combined with panretinal laser photocoagulation,and Ahemn glaucoma drainage valve implantation,as well as 1 year later.Results Most intraocular pressures increased after injection of anti-VEGF drugs compared to baseline,with a statistically significant difference(P<0.05).Intraocular pressure decreased after vitrectomy compared to post-injection levels,but the difference was not statistically significant(P>0.05).Intraocular pressure decreased after glaucoma drainage valve implantation compared to baseline,with a statistically significant difference(P<0.05).The intraocular pressure at the final visit was lower than baseline after glaucoma drainage valve implantation,with a statistically significant difference(P<0.05).There was no statistically significant difference in visual acuity between post-implantation and baseline(P>0.05).There was a correlation between visual acuity after glaucoma drainage valve implantation and baseline visual acuity,with a P value of<0.05 and an R-square value of 0.343.Following the patients'last follow-up visit(>12 months),2 cases developed hyphema and eyeball atrophy,1 case had localized filtration bleb fibrosis,and 4 cases developed new blood vessels.Conclusions Sequential treatment can achieve long-term stable intraocular pressure and minimize complications in patients with neovascular glaucoma.

关 键 词：抗VEGF治疗 玻璃体切除术 全视网膜激光光凝 Ahemd青光眼引流阀植入 

分 类 号：R779.6[医药卫生—眼科]