玻璃体内注射康柏西普联合手术治疗伴玻璃体积血的新生血管性青光眼

目的　观察玻璃体内注射康柏西普联合手术治疗伴玻璃体积血的新生血管性青光眼的临床疗效。方法　收集２０１４年６月至２０１６年２月在我院就诊、经药物无法控制眼压并伴有玻璃体积血的新生血管性青光眼患者１６例（１６眼），均玻璃体内注射康柏西普注射液０．５ｍｇ（０．０５ｍＬ），于玻璃体内注药后５～７ｄ行玻璃体切割联合小梁切除术，部分晶状体混浊者行晶状体切除术，术后行广泛视网膜激光光凝术。玻璃体内注射后１周、１个月、３个月、６个月随访复诊，观察最佳矫正视力、眼压及新生血管消退情况。结果　术前最佳矫正视力（标准对数视力）为３．１８±０．４０，术后１周、１个月、３个月、６个月最佳矫正视力分别为３．１７±０．３６、３．６２±０．２９、３．８８±０．３７、３．９１±０．３９，差异有统计学意义（Ｆ＝１４．１１４，Ｐ＝０．０００）；术后１周与治疗前比较，差异无统计学意义（Ｐ＞０．０５）；术后１个月、３个月、６个月与治疗前比较均明显提高，差异均有统计学意义（均为Ｐ＜０．０５）。术前眼压为（４７．３９±７．０５）ｍｍＨｇ（１ｋＰａ＝７．５ｍｍＨｇ），术后１周、１个月、３个月、６个月眼压分别为（２８．７９±４．３５）ｍｍＨｇ、（２１．７６±３．３６）ｍｍＨｇ、（１９．９７±３．３０）ｍｍＨｇ、（１８．６１±３．２１）ｍｍＨｇ，差异有统计学意义（Ｆ＝１２９．０００，Ｐ＝０．０００）；术后１周、１个月、３个月、６个月与治疗前比较均明显降低，差异均有统计学意义（均为Ｐ＜０．０５）。末次随访时，最佳矫正视力明显提高者１４眼，提高不明显者２眼；眼压完全控制者１４眼，眼压再次出现轻度升高者２眼。玻璃体内注药后５～７ｄ，１５眼虹膜及前房新生血管完全消失，１眼虹膜表面残留少许新生血管。随访期间所有患者未发生与玻璃体内注射康柏西普相关的眼部及全身并发症。结论　玻璃体内注射康柏西普联合玻璃体切割、小梁切除术及术后行广泛视网膜激光光凝术治疗伴玻璃体积血的新生血管性青光眼安全有效，能够有效控制眼压并能不同程度提高术后视力。

Intravitreal injection of conbercept and surgical treatment for neovascular glaucoma combined with vitreous hemorrhage

Objective To observe the clinical effects of intravitreal injection of conbercept and surgical treatment for neovascular glaucoma combined with vitreous hemorrhage. Methods Sixteen eyes of 16 patients with neovascular glaucoma combined with vitreous hemorrhage , whose intraocular pressure could not be controlled by anti-glaucoma medication.were collected in our hospital from June 2014 to February 2016 , and all cases underwent intravitreal injection of conbercept 0. 5 mg ( 0. 05 mL) . Vitrectomy combined with trabeculectomy were performed at 5 - 7 days after intravitreal injection , and lentectomy was performed in patients with lens opacity. Extensive laser photocoagulation was performed after the operation. Best corrected visual acuity ,intraocular pressure and regression of neovascularization were observed at I week. I month .3 months ,6 months after intravitreal injection. Results The best corrected visual acuity ( standard logarithmic visual acuity) before intravitreal injection was 3. 18 + 0. 40 , which at I week, I month. 3 months. 6 months after intravitreal injection were 3. 17 + 0. 36 , 3. 62 + 0. 29 , 3. 88 + 0. 37 , 3. 91 + 0. 39 , respectively , there was statistically sigruficant differences (F= 14. 114 .P = 0. 000 ) , there was no significant difference at I week after injection compared with before treatment (P > 0. 05 ) , there were sigruficantly improved at I month .3 months , 6 months compared with before treatment ( all P < 0. 05 ) . The intraocular pressure before intravitreal injection was ( 47. 39 + 7. 05 ) mmHg ( I kPa = 7. 5 mmHg) , which at I week,l months ,3 months.6 months after intravitreal injection were ( 28. 79 + 4. 35 ) mmHg , ( 21. 76 + 3. 36 ) mmHg , ( 19. 97 + 3. 30 ) mmHg, ( 18. 61 + 3. 21 ) mmHg , respectively , there were statistically significant differences ( F = 129. 000 .P = 0. 000) .there were significantly decreased at I week, I month.3 months ,6 months compared with before treatment ( all P < 0. 05 ) . At the last follow-up , the best corrected visual acuity improved in 14 eyes , and stabled in 2 eyes ; The intraocular pressure were controlled completely within the normal range in 14 eyes, and slightly increased in 2 eyes. At 5 - 7 days after intravitreal injection.the new blood vessels in the iris and anterior chamber completely disappeared in 15 eyes,a few new blood vessels in the iris surface was remained in I eye. A1l patients did not have severe ocular and systemic complications related to conbercept during the follow-up period. Conclusion Intravitreal injection of conbercept and vitrectomy , trabeculectomy , extensive laser photocoagulation is a safe and effective treatment of neovascular glaucoma combined with vitreous hemorrhage , can effectively control the intraocular pressure , and the postoperative visual acuity were improved in different degree.