雷珠单抗联合小梁切除术及全视网膜光凝治疗新生血管性青光眼的临床观察

目的　观察玻璃体内注射雷珠单抗联合小梁切除术及全视网膜光凝（ｐａｎｒｅｔｉｎａｌｐｈｏｔｏｃｏａｇｕｌａｔｉｏｎ，ＰＲＰ）治疗新生血管性青光眼（ｎｅｏｖａｓｃｕｌａｒｇｌａｕｃｏｍａ，ＮＶＧ）的临床疗效。方法　选取２０１３年１月至２０１４年１２月我院收治的ＮＶＧ患者６０例（８０眼），均采用玻璃体内注射雷珠单抗联合小梁切除术及ＰＲＰ治疗，术后随访１～６个月，观察患者术后一般疗效、视力、眼压及并发症等情况。结果　８０眼中手术完全成功７０眼，条件成功６眼，失败４眼，手术成功率为９５．０％。与术前比较，术后１周、１个月、６个月视力均有不同程度提高（Ｐ＜０．０５）。术前、术后１周、１个月、６个月眼压分别为（３５．２±２．８）ｍｍＨｇ（１ｋＰａ＝７．５ｍｍ-Ｈｇ）、（１７．４±１．３）ｍｍＨｇ、（１８．２±１．６）ｍｍＨｇ、（１８．４±１．５）ｍｍＨｇ，与术前比较，术后１周、１个月、６个月眼压均下降，差异均有显著统计学意义（均为Ｐ＜０．０１）。术后１周形成功能性滤过泡５８眼（８２．９％），非功能性滤过泡１２眼（１７．１％）；术后６个月形成功能性滤过泡６２眼（７７．５％），非功能性滤过泡１８眼（２２．５％）。术后并发症主要包括前房积血、浅前房、前部葡萄膜炎、玻璃体积血等。结论　玻璃体内注射雷珠单抗联合小梁切除术及ＰＲＰ治疗ＮＶＧ能显著控制眼压，并发症较少。

Clinical study of intravitreal injection of ranibizumab and trabeculectomy with panretinal photocoagulation for neovascular glaucoma

Objective To evaluate the clinical effects of intravitreal injection of ranibizumab and trabeculectomy with panretinal photocoagulation ( PRP) for neovascular glaucoma( NVG) . Methods Sixty cases ( 80 eyes) with NVG were chosen in our hospital from January 2013 to December 2014 , all cases received the intravitreal injection of ranibizumab and trabeculectomy with PRP. The follow-up time was from I month to 6 months after operation. The therapeutic effect , visual acuity , intraocular pressure and postoperative complications was observed after operation. Results After operation, the operation was totally successful in 70 eyes, partly successful in 6 eyes, failed in 4 eyes ,the successful rate was 95. 0% . Compared with before operation , the visual acuity at I week.l month and 6 months after operation were improved ( all P < 0. 05 ) . The intraocular pressure before operation and I week.l month and 6 months after operation were ( 35. 2 +2. 8 ) mmHg ( 1 kPa = 7. 5 mmHg) , ( 17. 4 + 1. 3 ) mmHg, ( 18. 2 + 1. 6) mmHg , ( 18. 4 + 1. 5 ) mmHg, respectively, the differences were significant compared with before operation ( all P < 0. 01 ) . The functional filter bleb was formed in 58 eyes ( 82. g% ) and 62 eyes (77. 5% ) at I week and 6 months ,the non-functional filter bleb was formed in 12 eyes( 17. 1% ) and 18 eyes (22. 5% ) at I week and 6 months,respectively. The postoperative complications included hyphema, shallow anterior chamber , anterior uveitis , and vitreous hemorrhage. Conclusion Intravitreal injection of ranibizumab and trabeculectomy with PRP for NVG can obviously control the intraocular pressure with less complications.