新生血管性青光眼患者药物联合小梁切除术的安全性分析

目的：观察抗血管内皮生长因子( vascular endothelial growth factor,VEGF)药物联合小梁切除术治疗新生血管性青光眼患者后其视力及眼压变化,以探究此联合治疗方法的有效性和安全性。
　　方法：将2012-08/2014-08在我院眼科定期复查且随访时间>6 lo的60例60眼青光眼患者采用随机数字法均分为A组(观察组)和B组(对照组),观察组给予玻璃体腔注射雷珠单抗联合小梁切除术治疗；对照组予以睫状体冷凝术治疗。术后观察患者视力变化、眼压、虹膜及房角新生血管等。
　　结果：视力：术后A组视力提高9眼显著高于B组,视力下降5眼显著低于B组,差异有统计学意义(P<0.05)。眼压：A组术眼玻璃体腔注射雷珠单抗后眼压无明显下降,行小梁切除术后眼压明显下降并能基本保持平稳,术后1wk A组14.6±3.7llHg显著低于B组；B组患者治疗后眼压逐渐下降,手术1 lo以后基本稳定。 A组术后1、3、6 lo眼压水平分别显著低于B组,差异有统计学意义(P<0.05),末次随访12lo 末,A 组治疗成功26眼(87%),有4眼眼压>30llHg,但患者症状减轻,显著高于B组治疗成功14眼(47%),13眼眼压>30llHg,症状减轻,3眼眼压<7llHg,眼球未萎缩,两组治疗成功率比较差异有统计学意义(P=0.026)。 A 组并发症发生率(13%)显著低于B组(67%),差异有统计学意义(P<0.05)。
　　结论：抗VEGF药物联合小梁切除术治疗新生血管性青光眼可提高患者视力、降低眼压、缓解症状,安全性较好。

Safety of anti-VEGF drugs with trabeculectomy for neovascular glaucoma

AIM:To observe the changes of vision and intraocular press in patients with neovascular glaucoma after the treatment of anti-vascular endothelial growth factor(VEGF)drugs with trabeculectomy and to explore the effectiveness and safety of this combination therapy.

METHODS:Sixty patients(60 eyes)with glaucoma went to our hospital from August 2012 to August 2014 and whose follow-up periods were >6mo were divided into two groups, group A(observation group)and group B(control group), by random number method. Observation group was treated with intravitreal injection of Ranibizumab and trabeculectomy. Control group was treated with cyclocryotherapy. The changes on visual acuity, intraocular pressure(IOP), neovascularization at iris and anterior chamber angle were observed.

RESULTS:Postoperative visual acuity improved in 9 eyes in group A which was significantly more than that of group B(P<0.05)and decreased in 5 eyes in group A which was significantly less than that of group B(P<0.05). In group A, IOP after injection of ranibizumab did not decrease much, but IOP decreased significantly after trabeculectomy and kept stable. IOP of group A after treatment was 14.6±3.7mmHg which was lower than that of group B(P<0.05). IOP of group B decreased gradually after treatment, and kept stable after 1mo. IOP of group A at 1, 3 and 6mo was lower than those of group B at the same time point(P<0.05). At the final follow up of 12mo, 26 eyes(87%)were treated successfully with IOP>30mmHg in 4 eyes. But there were more patients with relieved symptoms in group A than in group B. Fourteen eyes(47%)were treated successfully in group B with IOP> 30mmHg in 13 eyes, symptoms were relieved and IOP<7mmHg in 3 cases(P=0.026). No ocular atrophied. The rate of complication in group A was 13%, which was significantly lower than that of group B(67%, P<0.05).

CONCLUSION:The anti-VEGF drugs with trabeculectomy for neovascular glaucoma can improve visual acuity, reduce IOP, and relieve symptoms with high safety.