玻璃体腔内和结膜下注射雷珠单抗联合小梁滤过术对晚期新生血管性青光眼的效果观察

目的探讨玻璃体腔内和结膜下注射雷珠单抗联合小梁滤过术对晚期新生血管性青光眼(NVG)的治疗效果。方法选择2013年1月-2015年1月收治的晚期NVG患者96例(96眼),按随机数字表法分为A、B组,每组48例。A组采用玻璃体腔内和结膜下注射雷珠单抗联合小梁滤过术治疗,B组予以单纯小梁切除术治疗。随访6个月,观察2组视力提高率、眼压改善情况、眼压控制成功率、虹膜和房角新生血管消退时间及治疗后并发症和不良反应发生情况。结果A组失访2例,纳入研究46例,B组失访1例,纳入研究47例。A组视力提高率和眼压控制成功率高于B组,虹膜及房角新生血管消退时间均短于B组(P0.05)。2组治疗后眼压均低于治疗前,且A组低于B组(P0.05)。2组治疗后并发症及不良反应发生率比较差异无统计学意义(P0.05)。结论采用经玻璃体腔内、结膜下注射雷珠单抗治疗晚期NVG效果好,可提高小梁滤过术成功率,减少术后并发症。

Effects of Intravitreal and Subconjunctival Injection of Ranibizumab Combined with Trabecular Filtering Surgery in Advanced Stage Neovascular Glaucoma

Objective To investigate the therapeutic effect of intravitreal and subconjunctival injection of ranibizumab combined with trabecular filtering surgery in advanced stage neovascular glaucoma (NVG).Methods A total of 96 cases (96 eyes) of patients with advanced NVG were selected and randomly divided into group A and group B,with 48 cases in each group.Group A was treated with intravitreal and subconjunctival injection of ranibizumab combined with trabecular filtering surgery while group B was treated by simple trabeculectomy.The success rate of surgery was analyzed.Changes of eyesight and intraocular pressure were compared between the two groups 6 months after surgery.The incidence of postoperative complications and adverse reactions was recorded and the changes of iris neovascularization after treatment were observed.Results In postoperative follow-up of 6 months,there were 2 cases in group A lost to follow-up and a total of 46 cases were enrolled in the study.One case in group B was lost to follow-up and a total of 47 cases were enrolled.The improvement rate of eyesight and success rate of intraocular pressure control in group A were higher than those in group B (P＜0.05).After treatment,the intraocular pressure of group A and B became lower.The intraocular pressure in group A during different periods after treatment was reduced more significantly than that in group B (P＜0.05).The regression time of the iris and chamber angle neovascularization in group A was shorter than that in group B (P＜0.05).The incidence of complications in the two groups was not significantly different (P＞0.05).Conclusion Intravitreal and subconjunctival injection of ranibizumab in patients with advanced NVG can improve the success rate of trabecular filtering surgery and reduce postoperative complications.