玻璃体腔注射雷珠单抗联合小梁切除术及PRP治疗新生血管性青光眼

Intravitreal Ranibizumab injection combined with trabeculectomy and PRP for neovascular glaucoma

摘要:

目的：观察玻璃体腔注射雷珠单抗联合小梁切除术及全视网膜光凝(panretinal photocoagulation， PRP)治疗新生血管性青光眼(NVG)的中期临床疗效。

方法：回顾分析我院2015-01/2017-03间收治的21例21眼新生血管性青光眼病例的临床资料，治疗上均先行玻璃体腔雷珠单抗注射，后行5-氟尿嘧啶联合下的小梁切除术及术后行全视网膜光凝。随访6mo观察治疗前后患者眼内压(intraocular pressure，IOP)、视力、虹膜及房角新生血管、抗青光眼药物的应用、术后的并发症等。

结果：患者随访至少6mo。21例患者术后眼压均得到了有效控制，患者术前平均眼压为53.17±10.52mmHg，术后6mo复查平均眼压为18.50±3.51mmHg，与术前眼压比较，差异有统计学意义(P=0.001)。术后视力均有一定程度提高。3眼出现前房出血及玻璃体出血情况，予保守治疗后消退。患者虹膜及房角新生血管明显消退。

结论：玻璃体腔注射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中期疗效稳定。

Abstract:

AIM: To determine the medium term efficacy of intravitreal ranibizumab injection combined with subsequent trabeculectomy and panretinal photocoagulation(PRP)for the treatment of neovascular glaucoma(NVG).

METHODS: In this retrospective study, 21 neovascular glaucoma patients(21 eyes)were enrolled between January 2015 and March 2017 in the department. All cases received combination therapy with intravitreal injection(IVR)of ranibizumab, subsequent 5-fluorouracil(5-FU)padding trabeculectomy and then pan-retinal photocoagulation(PRP). Intraocular pressure(IOP), visual function, the status of neovascularization of the iris and the anterior chamber angle, the use of anti-glaucoma medications and the surgical complication were recorded during the complete follow-up period of 6mo before and after treatment.

RESULTS: Of the 21 patients, all completed the 6-month follow-up, and 3 completed the 2a follow-up(mean 7.8mo). The IOP of all 21 eyes were well controlled after the combination therapy. The post-operative IOP in the 6mo after treatment was 18.50±3.51mmHg, which was significantly lower compared with the pre-operative IOP(53.17±10.52mmHg, P=0.001). Visual acuity improved after treatment, to some extent. Anterior chamber hemorrhage and vitreous hemorrhage occurred in three surgical eyes, which were absorbed after conservative treatment. Neovascularization of the iris and angle had clearly regressed in all of the patients after completion of the treatment process.

CONCLUSION: The medium outcomes reveals that intravitreal ranibizumab injection combined with subsequent 5-fluorouracil padding trabeculectomy and PRP is a possible new method for NVG.