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[摘要]
目的:比较Ahmed青光眼房水引流阀植入术联合玻璃体腔内注射不同抗血管内皮生长因子药物治疗新生血管性青光眼(neovascular glaucoma,NVG)有效性和安全性。
方法:采用回顾病例对照研究,收集2009-09/2013-11在我院行Ahmed 阀植入术治疗NVG的患者资料。根据患者Ahmed阀植入术前玻璃内注射的抗VEGF药物不同分为贝伐单抗组和雷珠单抗组。观察并比较两组患者术后手术成功率、眼压、术后抗青光眼用药的数目、术后最佳矫正视力、并发症、新生血管的消退和复发的情况。
结果:两组患者随访1a时,术后眼压、术后抗青光眼药物数目在所有随访时间点均较术前明显降低,差异有统计学意义(P<0.01)。相对贝伐单抗组,雷珠单抗组在术后眼压、抗青光眼用药数目、最佳矫正视力方面,无明显优势,差异无统计学意义。Kaplan-Meier生存曲线显示:在随访1a时,贝伐单抗组和雷珠单抗组手术总成功率分别为80.6%、79.3%,差异无统计学意义(P=0.896)。手术完全成功率方面,差异亦无统计学意义(P=0.753)。
结论:Ahmed青光眼房水引流阀植入联合玻璃体腔内注射贝伐单抗或雷珠单抗是治疗NVG安全有效的方法。然而,两种抗血管内皮生长因子药物联合Ahmed 青光眼房水引流阀植入术治疗NVG在有效性和安全性方面没有明显差异。
[Key word]
[Abstract]
AIM:To evaluate the efficacy and safety of Ahmed glaucoma valve implantation(AGVI)combined with different anti-vascular endothelial growth factor(VEGF)agent injected before surgeries for neovascular glaucoma(NVG).
METHODS:This was a retrospective case controlled study on patients with NVG in whom AGVI was performed between September 2009 and November 2013. The sample was divided into two groups according to the pretreatment:the intravitreal injection of bevacizumab or lucentis. The success rate of surgeries, intraocular pressure(IOP), the number of antiglaucoma medications used after surgeries, best correct visual acuity(BCVA), postoperative complications, regression and recurrence of iris neovascularization were analyzed between the groups.
RESULTS:Compared with preoperative, IOP, the number of antiglaucoma medications used of the two groups decreased significantly at every follow-up(P<0.05). There were no significant difference on postoperative IOP, the number of postoperative antiglaucoma medications, and BCVA between bevacizumab and lucentis groups. Kaplan-Meier survival curves showed that the success rate was 80.6% for the bevacizumab group and 79.3% for the lucentis group at endpoint of follow-up, the difference between the two groups was not significant(P=0.896). There was no significant difference on the complete success rates between the two groups(P=0.753).
CONCLUSION:Preoperative intravitreal injection of bevacizumab/ lucentis may be an effective and safe combined with AGVI on managing NVG. However, the two drugs have the similar efficacy and safety.
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